Wednesday, May 27, 2009
Monday, May 25, 2009
Sunday, May 24, 2009
Saturday, May 23, 2009
Dr. Keiji Fukuda, the deputy director general making the W.H.O. announcement, said that he could not predict exactly what the new rules would be but that criteria would include a “substantial risk of harm to people,” not just the geographic spread of a relatively benign virus.
The main drawback, besides the added cost, is feasibility. There are two systems (vapor and “dry mist”), and the vapor apparently requires that the room be sealed (doors, windows, ventilation ducts, etc.) during application. The Rhode Island group reports that H2O2 vapor decontamination required a mean of 2 hours and 20 minutes—not an appealing prospect for hospitals that run at or near capacity and for which short room turnaround times are critical.
Thursday, May 21, 2009
As I walked from the ASM General Meeting to my hotel room a couple days ago, I noticed that our novel H1N1 was having a brief media resurgence—CNN and MSNBC were on in the hotel bar, broadcasting alarming new stories about what might happen if the WHO moved to “level 6” on the pandemic scale, and discussing more school closures in New York.
Meanwhile, the CDC is confirming something I blogged about earlier—those over 50 years of age appear to have some protection against this virus, presumably due to exposure to H1N1 strains circulating until the late 1950s.
Finally, the weekly report on influenza and pneumonia mortality reveals…….nada. The influenza and pneumonia mortality in 122 U.S. cities has still not reached epidemic threshold. What does this mean? For starters, it means that if this novel H1N1 introduction had happened 10-15 years ago, we probably wouldn’t have even detected it.
Monday, May 18, 2009
That quote, by our friend and colleague Andreas Voss, is from an interesting news piece looking ahead to the Hajj and the potential impact it could have on the spread of the novel H1N1 virus. Ideally, a vaccine will be available by then.
It’s no coincidence that Andreas chose Pink Floyd, a band that foresaw the ominous role swine would play in the future in their song “Pigs on the Wing” from the Animals LP.
That said, I certainly wouldn’t cancel a Pink Floyd concert for this virus.
I’m at the ASM meeting in Philadelphia, and I should note that I haven’t seen a single person yet with a mask on (Neil Fishman, who gave a great talk on antimicrobial stewardship this afternoon, said he saw one person wearing a surgical mask). Our division (nosocomial infections) has another symposium tomorrow afternoon on MRSA—Mike Edmond will be talking about MRSA in the ICU, Mary Claire Roghmann will cover long term care, Jeff Bender the veterinary angle, and Loren Miller will talk about community MRSA. Should be a great session.
Friday, May 15, 2009
However, we have a university-affiliated VA as well. As our VA hospital epidemiologist, I’ve recommended we take a consistent approach to this at both hospitals (since many of our clinicians see patients in both facilities). Today I’ve been told we can’t do that—as a federal facility, we are bound to follow the CDC guidance. So now we have two very different approaches to prevention of H1N1 transmission in our two hospitals, a less-than-ideal situation.
I understand that CDC may be having a push-and-pull with OSHA on this, and feels obligated to fully investigate instances of healthcare worker infection with novel H1N1 before they change their guidance. But what will they possibly learn from healthcare worker H1N1 cases that will provide the evidence they seek, when we know that the use of N95 versus standard surgical masks to prevent pathogen transmission is not evidence-based to begin with? Sigh.
I believe that the CDC response to the novel H1N1 has been excellent overall—rapid, transparent, and calibrated over time to reflect new information as it is available. On this point, however, the CDC risks losing some credibility—once state departments of public health lose patience and begin to change to the WHO guidance, as is currently happening, the CDC looks increasingly out of touch with what is happening on the ground
Thursday, May 14, 2009
Wednesday, May 13, 2009
Tuesday, May 12, 2009
In other news, I expect that Iowa will soon join Minnesota and adopt infection control recommendations that reflect the WHO guidance, rather than that of CDC. As Mike pointed out previously, CDC really needs to update their interim guidance on this—too many hospitals are running short of N95 masks, and now that basically anyone in the U.S. with fever (or no fever) and cough has suspected H1N1, requiring N95s for patient contacts is not sustainable.
Monday, May 11, 2009
Sunday, May 10, 2009
Getting ready to return to Richmond. Schools in Mexico City open on Monday but in other cities where cases are increasing, they are waiting another week. The "no wearing a tie" rule anywhere in Mexico City is still in effect. Not sure of its origin or basis. To get to the ticket counter I had to fill out a form re: respiratory symptoms and then had to stand on a special area for remote temperature that registers on a huge screen on the side. Traffic is still only half of its usual and the restaurant this morning was mostly empty.
Saturday, May 9, 2009
"Many predicted that [WHO] would find some way to reflect the severity, and not just the geographic reach, of a new threat."
Friday, May 8, 2009
I made rounds on wards for H1N1 and in the ICU today. I saw some very sick patients- on respirators-and the very ill have a brief course to ARDS. I still don't know why the clinical difference here and home. But this virus can be virulent. The cases nationally are declining and less so at the referral centers. The worries here include what happens as it enters rural Mexico. Cases are up in some cities. More to come.
Only 15 percent of seats filled on the flight from Atlanta to Mexico City, and the airport is almost empty. All waiters wear masks, and at dinner I had to have a skin probe to measure temperature and hands out for alcohol. But shops are beginning to open up.
Thursday, May 7, 2009
Take a look at this recent article by Dr. Kent Sepkowitz in the online magazine Slate. In a piece that's both funny and factual, he describes how the New York Yankees have decided to coat their locker rooms, training rooms, showers, and coaches offices with an antimicrobial substance, and points out the folly of this endeavor. Although you will see his writing frequently in Slate and the New York Times, in his day job Kent's a card-carrying hospital epidemiologist who works at Memorial Sloan-Kettering Cancer Center in Manhattan.
Wednesday, May 6, 2009
Tuesday, May 5, 2009
Monday, May 4, 2009
Next we’ll need stronger guidance about testing and treatment—both of which should be reserved for those with severe illness and for those at highest risk for the complications of influenza.
Also of interest: two lines of evidence (early in vitro data from CDC labs, and the age distribution of current H1N1 cases) suggest that those over 50-60 years of age may have partial protection against this H1N1. Not enough data yet to make definitive statements, but if these observations are borne out it will help explain some of the features we’ve seen so far (especially the low case fatality rate, given that “age over 65” represents the biggest category of those at risk for complications of influenza).
Sunday, May 3, 2009
Saturday, May 2, 2009
And I'm happy to announce that non-H1N1 blogposts will begin again soon!
Friday, May 1, 2009
So said Texas pig-aficionado Kyle Stephens, regarding our new epidemic influenza strain. Now, it appears, there is finally agreement upon what that name will be: Influenza H1N1! Both CDC and WHO have adopted this language. A longer descriptive version for use in polite conversation is, “this new H1N1 of swine origin”.
So where are we now, with this new H1N1? More states and countries report confirmed cases each day, and over 90% of new cases are no longer linked to other confirmed cases. This means the virus is widespread in the community, there are many folks shedding virus with mild symptoms, and the time is approaching when we need to manage this like any late-season influenza epidemic. Freaking out about each new case, asking people with mild-moderate symptoms to come in for testing, trying to trace contacts, all these exercises are increasingly futile. We should focus instead upon community mitigation strategies that emphasize common sense infection control to limit spread (hand hygiene, “respiratory etiquette”, staying home when sick), and prophylaxis of those at high risk for complications of influenza who have been (or are likely to be) exposed.
I’m sticking with my earlier prediction that this will amount to a notable late-season epidemic that will burn itself out over the next few weeks, causing a lot of cases and some deaths, but that will not become the great global pandemic of 2009. Others concur (but “quietly”, so as not to be seen taking this too lightly!).