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Napolitano: expect "a big influx" of swine flu cases this fall

Pathfinder

Editor, Senior Moderator
Written by Associated Press Wednesday, 02 September 2009 01:31AM

National Politics AP

WASHINGTON (AP) ?

Homeland Security Secretary Janet Napolitano said Wednesday that people should expect "a big influx" of swine flu cases this fall and prepare as best they can.

"The best thing we all can do are the very simple things, the washing of the hands, the coughing into the sleeve," Napolitano said in a nationally broadcast interview. " ... We're in all likelihood going to have them (new infections) before the vaccine is available."

Napolitano was among a host of Cabinet officers who briefed President Barack Obama Tuesday on the federal government's preparations and planning for the fall. Another of those Cabinet members, Education Secretary Arne Duncan, said in a separate interview that it's critically important to keep schools open and education uninterrupted.

"We got a little bit lucky" in the last school year, he said, because the H1N1 didn't surface until very near the end of the academic year.

"We're not going to be so lucky this year," Duncan added, "so the more we're prepared, the more we're talking ... the better we're going to be able to handle this as a country, the more we're going to be able to keep our schools open."

There have been over 550 deaths in the United States from H1N1 and a scientific advisory panel recently sent the White House a report saying it was possible that anywhere from 30 percent to half the population could catch what doctors call "2009 H1N1" and that it was also possible there could be between 30,000 and 90,000 deaths.

"Everything we've seen in the U.S. and everything we've seen around the world suggests we won't see that kind of number if the virus doesn't change," Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention, said in a C-SPAN interview last week.

In her interview Wednesday on NBC's "Today" show, Napolitano was asked why the government isn't requiring all Americans to get the swine flu vaccine, once it's available. "Because health programs generally aren't mandatory, and you get pushback to that," she replied.

She also reiterated statements that administration officials had made earlier, saying the initial supplies of vaccine should go to people most susceptible to the virus like young children, pregnant women and people with certain health problems such as asthma.

Napolitano noted that Congress has appropriated billions of dollars to buy vaccine supplies and said she believed more money could be approved if necessary. "This is a changing environment," she said. "We'll have to deal with it day by day."

Asked if her Homeland Security Department was moving toward prohibiting sick people from boarding commercial aircraft, she said that decision would be left to the individual airlines.

Duncan, appearing on ABC's "Good Morning America," said federal officials want to make sure that every young person between 5-24 get the vaccine, free of charge.

He praised efforts by states and localities to get ready for new infections, saying planning is going forward. "What you're seeing around the country is an outbreak of common sense," Duncan said.

Obama on Tuesday urged Americans to take steps to prevent infection. "I don't want anybody to be alarmed, but I do want everyone to be prepared," the president said after getting a briefing on swine flu preparedness.

Vaccine development is ongoing and is likely to be available by October. Certain groups are more vulnerable to swine flu, including children under 2, pregnant women and people with health problems like asthma, diabetes and heart disease.

Like the seasonal flu, swine flu spreads through coughs and sneezes of people who are sick.


http://www.neworleans.com/index.php?option=com_content&view=article&id=203147&Itemid=2590
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

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Re: Napolitano: expect "a big influx" of swine flu cases this fall

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GS, the 30% and 90K deaths is not HHS. That came from the PCAST report. Further, those numbers reflect a planning scenario, not a prediction.
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

I hadn't read the whole article - deleted my comment - but you were faster
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

I think the "planning scenario" and "prediction" wording is curious. Why would they make a plan based on something other than a prediction? If that's actually what they've done, then maybe they should have started with a worse case scenario.

Who was it that said: *Plan for the worse and hope for the best.*?

If I understand things correctly, the PCAST is just a review (and agreement) of the report issued by the Working Group, which appeared to me to be the who's who of the US flu experts.

I thought this was interesting from the Working Group (June 18); I wonder what probability values Korch referrs to?:

Dr. Rose: Are we contemplating mass vaccination with a mild outbreak? I don’t think we have enough information to deploy. We need to figure out what problem to solve first.

Dr. Korch: The decision tree that I showed you includes probability values. It’s an expensive decision, so you need to evaluate all the aspects.
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

No changes.


#1: "Napolitano was among a host of Cabinet officers who briefed President Barack Obama Tuesday on the federal government's preparations and planning for the fall. Another of those Cabinet members, Education Secretary Arne Duncan, said in a separate interview that it's critically important to keep schools open and education uninterrupted.

"We got a little bit lucky" in the last school year, he said, because the H1N1 didn't surface until very near the end of the academic year.

"We're not going to be so lucky this year," Duncan added, "so the more we're prepared, the more we're talking ... the better we're going to be able to handle this as a country, the more we're going to be able to keep our schools open.""
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

I think the "planning scenario" and "prediction" wording is curious. Why would they make a plan based on something other than a prediction? If that's actually what they've done, then maybe they should have started with a worse case scenario.

Who was it that said: *Plan for the worse and hope for the best.*?

If I understand things correctly, the PCAST is just a review (and agreement) of the report issued by the Working Group, which appeared to me to be the who's who of the US flu experts.

I thought this was interesting from the Working Group (June 18); I wonder what probability values Korch referrs to?:

Dr. Rose: Are we contemplating mass vaccination with a mild outbreak? I don?t think we have enough information to deploy. We need to figure out what problem to solve first.

Dr. Korch: The decision tree that I showed you includes probability values. It?s an expensive decision, so you need to evaluate all the aspects.

PCAST is a group of science and technology experts. I do not believe any of the members are influenza experts, although one has a background in oncology.

For plans to be robust, they should consider possible alternative scenarios, which is one of the big values in the PCAST work. Their's was not a prediction, nor was it the worst case scenario. It was a plausible scenario based on the information available at the time it was researched and authored. With our Southern Hemisphere experience behind us, it is less likely that the Northern Hemisphere will see the levels of serious illness reflected in the PCAST report, unless of course the virus mutates into a more virulent form.

It is probably wise to get the Swine Flu vaccine when it is available. Although the current virus circulating is relatively mild for most people, it could turn nasty in a hurry with only a few mutations.
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

PCAST is a group of science and technology experts. I do not believe any of the members are influenza experts, although one has a background in oncology.

The PCAST standing group is composed of science and technology experts. But, the working group included very experienced medical, scientific and public health figures, including Webster and Palese, who in my perception are pretty conservative with their statements.

The planning scenario envisioned possibly 30-90,000 deaths. This is, in fact, a mild pandemic planning scenario because 90,000 is the lowest estimate for a Level 2 pandemic (according to Flu.gov). Thus, 30,000-89,999 is a level 1 pandemic. The number of deaths is based upon an attack rate of 30-50%.

We can't really say we haven't seen that level of infection in the Southern Hemisphere, because nobody is testing. With an apparent significant number of asymptomatic infections, the number of actual infections is much higher than any reporting.

We certainly haven't seen anywhere near 30,000 deaths in the Southern Hemisphere, no matter how liberally we may count. But, it helps to remember this particular virus seems to be an 'all weather interceptor', and the notion of a flu 'season' may be quite inappropriate.

What is both realisitic and alarming about the PCAST report is that the primary planning assumption is for an unmitigated pandemic, i.e. no vaccine in time to be of any help because of the explosive nature of infections in the scenario. The report says a peak by the middle of October, and it'll all be over by the end of November.

So, I guess it's obvious I think the message is being 'laundered' a bit for general consumption.
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

The PCAST standing group is composed of science and technology experts. But, the working group included very experienced medical, scientific and public health figures, including Webster and Palese, who in my perception are pretty conservative with their statements.


So, I guess it's obvious I think the message is being 'laundered' a bit for general consumption.

WSJ

MAY 2, 2009

Why Swine Flu Isn't So Scary

By PETER PALESE

[snip]

Although the swine virus currently circulating in humans is different from the 1976 virus, it is most likely not more virulent than the other seasonal strains we have experienced over the last several years. It lacks an important molecular signature (the protein PB1-F2) which was present in the 1918 virus and in the highly lethal H5N1 chicken viruses. If this virulence marker is necessary for an influenza virus to become highly pathogenic in humans or in chickens -- and some research suggests this is the case -- then the current swine virus, like the 1976 virus, doesn't have what it takes to become a major killer.

Since people have been exposed to H1N1 viruses over many decades, we likely have some cross-reactive immunity against the swine virus. While it may not be sufficient to prevent illness, it may very well dampen the impact of the virus on mortality. I would postulate that by virtue of this "herd immunity," even a 1918-like H1N1 virus could never have the horrific effect it had in the past. The most likely outcome is that the current swine virus will become another (fourth) strain of regular seasonal influenza.

[snip]

http://online.wsj.com/article/SB124122223484879119.html

So, do we think that Peter might agree with the final PCAST report and how it was presented? Or was his input "laundered a bit" by the standing committee?

I actually think that he would support the report in its current form as long as it was put into the proper context for the media. Otherwise, people look for the biggest numbers, something that will be exciting to read and talk about, and the boring facts as to how this pandemic is playing out can be left to the historians, or perhaps to flu experts like Dr. Palese.
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

#9: "If this virulence marker is necessary for an influenza virus to become highly pathogenic in humans or in chickens -- and some research suggests this is the case -- then ..."


If ...
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

If I understand things correctly, the PCAST is just a review (and agreement) of the report issued by the Working Group, which appeared to me to be the who's who of the US flu experts.
Mamabird, I was referring to the Pandemic Influenza Working Group (not PCAST) as being the who's who of the US flu experts.

It appears that just about every division of HHS was represented by at least one person. Just to name a few randomly from the list:
National Biodefense Science Board
HHS: Aubrey K. Miller, M.D., M.P.H., CAPT USPHS, Bruce Gellin, M.D., M.P.H.,
DHS: Terry Adirim, M.D., M.P.H., Victoria J. Davey, R.N., M.P.H.,
Industry reps for: GlaxoSmithKline, Macrogenics, CSL Limited, BioCryst Pharmaceuticals, Hoffmann La Roche, Inc., MedImmune, LLC, Sanofi Pasteur, Novartis Vaccines & Diagnostics Inc,
Represented: National Institutes of Health, U.S. Food and Drug Administration ~ Office of Antimicrobial Products, Division of Antiviral Products, Armed Forces Institute of Pathology, CDC's Anthony Fiore, M.D., M.P.H., CAPT USPHS, James Lawler, MD MPH FACP Director for Medical Preparedness Policy.
Invited Experts: Robert Belshe, M.D. Edward Doisy Research Center, Damien Bishop London's Department of Health, Daniel Camus Global Health Security Action Group Paris, Brooke Courtney, J.D., M.P.H University of Pittsburgh Medical Center, Walter R. Dowdle, Ph.D.Task Force for Global Health, Neil Ferguson, Fmed Sci Imperial College London, St Mary’s Campus, Alina Baciu, MPH Institute of Medicine (IOM) and Padma Natarajan, M.P.H., M.S. Infectious Diseases Society of America.
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

Mamabird, I was referring to the Pandemic Influenza Working Group (not PCAST) as being the who's who of the US flu experts.

Yes, I understand.

I fully agree that all the people that worked on this project are highly qualified, and the Working Group itself utilized an additional boatload of influenza experts (listed in acknowledgments at the end of the report). I'm just curious as to how many of those involved are comfortable with the way the report was delivered without much in the way of context. I know that Dr. Varmus was a bit upset with this (but he stated it was above his pay grade).

So, maybe I should not blame PCAST for the media's treatment of an otherwise well prepared piece of research, and the substantial misunderstanding by the public that has resulted. If anyone was attempting to scare everyone into knee jerk preparation efforts, then they succeeded.

I would suggest that we need to realize that there may be subsequent waves of pandemic infection until herd immunity is achieved. This could easily turn out to be a long-term event. If this wave turns out to be mild, there may ensue public distrust of later communications that encourage vaccination and preparation for a virus that has in fact turned lethal. Throwing money at this problem for short-term solutions out of fear is not wise in my opinion and could be counter-productive, unless of course they know something that we don't.:(
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

Mamabird,

The 'message' I am refering to is the message in the PCAST report. The 'laundering' was done by the White House yesterday, and by CDC's response to the report the day after it became public.

My point is that even though the PCAST report was a 'plausible', conservative scenario (level 1), and was produced with contributors like Palese (your post of Palese agrees with my characterization of his position) and Webster, it was still shocking to the masses. And, the administration, in the name of CDC immediately threw water on it, because it was causing alarm. That's what I mean by 'laundering'.

An opportunity to deal with the justified alarm caused by the report, by educating the the public was lost.
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

The Working Group report unnerved me because of how unprepared we were as late as June 18; the PCAST didn't bother me much.

Here's Osterholm's latest; he's certainly laying it right out there:

US health-care systems have been stretched and have no surge capacity. The system cannot handle this pandemic, even it if remains moderate in severity. The same applies to many of the supplies we get. Ask anybody who has tried to order an N95 respirator recently; there aren't any. We recently surveyed a group of world-class pharmacists to identify the essential drugs needed daily to keep patients from dying. They came up with a list of more than 30 — all generics, and most made offshore, mainly in Asia, and China and India in particular. Nobody is thinking what might happen to US or global supply chains when pandemic flu hits these countries, where the primary workforce are the young, who are most affected by the virus.

The United States has a federal programme for vaccine procurement but it is administered at the state level, and the two do not always mesh up. It is still not clear how this vaccine is going to be rolled out, or whether it will be here in time.

I worry most that, given current existing public concerns about vaccines, in the autumn we might see mounting public responses and concerns about pandemic-vaccine safety, and people refusing to be vaccinated. Expect the unexpected over the next six months.

http://www.nature.com/news/2009/090902/full/461020a.html?s=news_rss#comments
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

Mamabird,

The 'message' I am refering to is the message in the PCAST report. The 'laundering' was done by the White House yesterday, and by CDC's response to the report the day after it became public.

My point is that even though the PCAST report was a 'plausible', conservative scenario (level 1), and was produced with contributors like Palese (your post of Palese agrees with my characterization of his position) and Webster, it was still shocking to the masses. And, the administration, in the name of CDC immediately threw water on it, because it was causing alarm. That's what I mean by 'laundering'.

An opportunity to deal with the justified alarm caused by the report, by educating the the public was lost.

Sure, I see your point.

Instead of using the term "laundering", I feel more comfortable with the phrase "putting the message into context". There is absolutely nothing wrong with the PCAST report work, and I would be the last to "throw water on it" per se. The folks that authored it were well intentioned I'm certain.

However, the report itself describes four scenarios in addition to the plausible one highlighted in the letter and by the media. All of the scenarios are necessary for robust planning. However, if everyone picks up on only one, even though it is clearly stated that it is not a prediction, then a lot of the value of the other scenarios is likely diluted.

If a balanced approach to pandemic preparation is not taken, then the result could be that we box in HHS and CDC as to what they can do (vaccination campaign for example). I just don't think it is wise to set up a situation whereby the public could dictate policy on matters that are highly technical and specialized. Like you, I think there was some opportunities lost.
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

Perhaps, 'laundered' carries a criminal connotation that I hadn't intended. I like your term better.

However, if everyone picks on only one... Wouldn't it be wonderful if everybody did pick one...and prepare for it. Alas, where is their motivation to do so?

Thanks for all you many contributions to this forum, especially where they add a sense of balance to the discussion :applause:

Snick
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

However, if everyone picks on only one... Wouldn't it be wonderful if everybody did pick one...and prepare for it. A

For sure.

Let me offer a suggested preparation activity that is long term in nature and may be our best defense against the Swine Flu - vaccinate the public. The steps might be:

1. Test the new vaccines thoroughly to ensure their safety and gain public confidence.

2. Encourage vaccination through sustained public education, but do not promote (and for certain do not require).

3. Use as much of our existing infrastructure as we can to distribute and administer the jabs (similar to the annual flu shots).

4. Plan for limited supplies in mid-October to be given to those that are most at risk for serious illness.

5. Plan on vaccinating the remainder of the population in a systematic manner as sufficient vaccine supplies become available even though that may take to the end of the year.

6. Continue to offer the Swine Flu vaccines from time to time over the early part of 2010 based on continued need as dictated by public participation.

7. Monitor the Swine Flu virus carefully for antigenic changes that might affect the efficacy of the vaccines.

8. Monitor the virulence of the Swine Flu bug to determine if an accelerated vaccination program is needed.

9. Monitor the public's reaction to the vaccine to ensure continued safety.

Do we think that PCAST would endorse such a plan? Do we think that the public would accept such a plan? If not, then Houston, we have a problem.
 
Re: Napolitano: expect "a big influx" of swine flu cases this fall

Hi,

I prefer no laundering, no context, simply the facts and data.

The phrase "putting the message into context" is very worrying to a thinking person. We have far too many politicians and bureaucrats putting things into context far too long.

People with facts do not need spin or context.

Tom

Yes, facts are friendly (and you can quote me on that).

And, as I know you agree, it is unfortunate that some media struggle with the facts, especially when they are not exciting enough to stimulate readership.
 
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