Swine flu - Prepping for Tough Times

Nurses COVID


The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.

We've been talking about the possibility of a flu pandemic here for four and a half years. The cliché during much of that time was that the right way to think of a flu pandemic was not "if," but "when." As long as no pandemic materialized, however, there was great scope for what it would look like and hence what to plan for. The hoary adage, "Hope for the best, plan for the worst" made sense but left a great deal of scope for different approaches to planning. What, after all, was the worst we could expect? We had two models, one historical, one hypothetical but plausible. The historical one was the 1918 pandemic, a truly catastrophic public health event brought to vivid life by John Barry's book, The Great Influenza, a surprise best seller just at the time we were contemplating the hypothetical, but plausible, prospect the next pandemic could come from H5N1 avian influenza. The relatively rare cases of human bird flu showed a virus even more virulent than the 1918 virus and there was (and is) a prodigious amount of it "out there" in the form of a panzootic in poultry and wild birds. So far, though, H5N1 has not learned to transmit easily in humans. Yet the pandemic arrived anyway, in the form of swine flu H1N1. For the moment, then, we need to be ready to manage the consequences of the pandemic that's here, not the one that is not yet and may never be. This means the calculus of "hope for the best and prepare for the worst" has become more concrete and narrowed in scope. That means adjusting on both what hoping for the best means and what planning for the worst means. In some respects, we believe there is a danger of getting it wrong on both scores by simultaneously planning for the best and if not hoping for the worst, imagining worse than is plausible.

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Sorting Out the Vacccine Puzzle

With flu season in the northern hemisphere looming and H1N1 cutting a nasty swath through good portions of the southern hemisphere's current flu season, attention is being turned to the non-existent but hoped-for vaccine against swine flu. Yesterday we discussed the problem of pinning pandemic planning on a vaccine. That's planning for the best, not hoping for the best. There are a lot of uncertainties regarding whether an unadorned egg-based vaccine -- the bulk of the vaccine now in development -- will be sufficient, available in time or even effective. But those problems just scratch the surface of vaccine unknowns, as a typically excellent piece by Helen Branswell of Canadian Press lays out:

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