Analysis of H1N1 flu response shows progress, problems

first_imgJun 4, 2009 (CIDRAP News) – A coalition of health policy groups today offered a “good news, bad news” evaluation of the US response to the novel H1N1 influenza epidemic so far.The good news: The experience has shown that years of pandemic preparation have paid dividends, particularly with regard to coordination, communication, antiviral drugs, and vaccine development.The bad news: The outbreak has pointed up the serious limitations of the financially strapped public health sector, suggesting that it would be overwhelmed in a more severe and widespread epidemic.The report was produced by Trust for America’s Health (TFAH), a nonprofit, nonpartisan advocacy group in Washington, DC, in collaboration with the Center for Biosecurity at the University of Pittsburgh Medical Center and the Robert Wood Johnson Foundation.”It was clear in our report that all the pandemic planning and preparedness efforts over the past several years have improved our ability to respond to an outbreak, but it was also clear that the situation didn’t test the limits of our response,” said Jeff Levi, PhD, executive director of TFAH, at a press briefing this morning.Positives and negatives are sprinkled through the 10 lessons presented in the report, titled “Pandemic Flu Preparedness: Lessons from the Frontlines.” Many of them repeat familiar TFAH messages about the need to restore and strengthen the nation’s public health infrastructure.Investments prove wiseThe first finding was that federal, state, and local planning efforts of recent years “enabled public health officials to react to the outbreak effectively and keep the public informed. Investments in antiviral stockpiles and enhanced vaccine manufacturing capacity also proved to be prudent.”At the press briefing, David Fleming, MD, director of Seattle and King County Public Health, strongly endorsed that conclusion. He said Seattle officials had thought through many of the issues and stockpiled medications.In particular, “Telling citizens we had sufficient supplies of Tamiflu [oseltamivir] went a long way” to help the situation, said Fleming, a peer reviewer for the report.He said that by the time the outbreak began, private antiviral supplies were “essentially zero,” because it was the end of the regular flu season. “We dipped into our local reserve [of antivirals] and made those available to people through our public health clinics,” which resulted in moderate but not overwhelming use, he added.Nationally, only modest amounts of stockpiled antivirals have been used, since relatively few people have been infected, said Thomas V. Inglesby, MD, deputy director of the Center for Biosecurity and a co-author of the report. But he said the stockpiles gave people confidence in their ability to help the sickest patients, adding, “I think the investment is widely seen to have been wise.”Lack of resources exposedThe second lesson cited in the report is that public health departments didn’t have enough resources to carry out their carefully made plans.”Capacity to track, investigate and contain cases of H1N1 has been hampered due to lack of resources,” the document states. “For instance, CDC [Centers for Disease Control and Prevention] and state laboratory testing was days to more than a week behind the on-the-ground reality.”Fleming said the national surveillance picture was 1 to 2 weeks behind what was happening on the ground. In Seattle, some schools that had possible cases were closed and then reopened before the CDC confirmed and reported a single local case of the novel flu, he said.Largely because of the economic recession, Fleming said, “It’s getting really tough on the front lines of public health in this country now.” For example, he said Seattle has had to reduce its public sector immunization efforts by 80%.He also said a key part of Seattle’s response to the novel flu was using public health nurses to educate school and daycare authorities about the outbreak. Ironically, many of the nurses were due to receive layoff notices 2 weeks after the start of the flu outbreak.A third finding was that, though the outbreak was mild, healthcare systems in some areas were “overwhelmed.” In many hospitals, emergency departments were flooded by the “worried well,” and some outpatient clinics had inadequate personal protective equipment and “a limited understanding of infection control measures.”The report, however, doesn’t offer an estimate of how widespread these problems were.Need for flexibility, good communicationAnother lesson was that the outbreak underlined that pandemic plans must be adaptable, according to the report. It notes that pandemic planning has focused on the threat of the virulent H5N1 avian influenza and often has assumed that the United States would have 6 weeks of lead time before an emerging pandemic strain overseas reached US shores. Instead, the novel H1N1 outbreak featured a generally mild virus emerging in North America.On the public communication front, the report gives US leaders good grades, saying the president and other authorities conveyed consistent, accurate information about hand hygiene, respiratory etiquette, and the need to stay home when sick. Leaders also helped dispel rumors, such as concerns about the safety of imported Mexican foodstuffs.Other lessonsOther early lessons from the epidemic, the report says, include the following:Where schools were closed because of the outbreak, parents had to scramble to find alternative child care arrangements.The lack of sick leave caused problems. There were reports of people with flu-like symptoms going to work because they had no sick leave, which is true for 48% of American workers, said Levi. Also, some parents sent sick children to school because they couldn’t stay home to care for them.Communication between the public health system and medical providers fell short, as many private practitioners complained that they did not receive CDC guidance documents in a timely fashion.The World Health Organization’s (WHO’s) pandemic alert system was not well-matched with the realities of the H1N1 outbreak. (The WHO’s alert phases are based strictly on the geographic spread of the virus, not the severity of disease. The agency said this week it would come up with a severity scale in an effort to reduce confusion.)International coordination posed some problems: Against WHO advice, some countries closed their borders to Mexican citizens or banned pork from the United States and Mexico.’Biggest single vaccination program’Several questions at the press briefing had to do with how the novel virus might behave when the next flu season hits in the fall and the prospect of a nationwide vaccination campaign.Inglesby predicted that the vaccination drive will be “the biggest single vaccination program for influenza and probably for any virus in a short period of time that’s been performed in the United States.” Five or six years ago, there would have been no possibility of starting mass vaccinations in the fall, because the necessary infrastructure investments had not been made, he added.He and the other officials asserted that vaccination planning should forge ahead despite the unpredictability of public demand for the vaccine.”If it turns out that for whatever reason there’s not an interest in taking the vaccine, there’d be the ability to slow down or turn off production,” he said. “But my sense is there’ll be an unusual level of interest in the vaccine.”Fleming said school children will be a critical target group for vaccination against the new virus. Asserting that the virus is capable of causing “explosive” school outbreaks, he said, “We absolutely need to prioritize our kids and especially kids who are susceptible to complications from influenza.”It’s not possible to predict whether the new virus will elbow out seasonal viruses and become the predominant strain next fall and winter, said Inglesby. That’s why the government is proceeding with plans to offer vaccination against seasonal flu and the new virus.”I’m agnostic, and health authorities seem to be agnostic in general about which one will out-compete the other,” he said.See also: TFAH press releasehttp://healthyamericans.org/newsroom/releases/?releaseid=178Full text of reporthttp://healthyamericans.org/assets/files/pandemic-flu-lesson.pdflast_img read more

The Latest: Baseball Hall of Fame museum reopens

first_img___Tennis great Goran Ivanisevic says he has tested positive for the coronavirus.The former Wimbledon champion coaches top-ranked Novak Djokovic and was at the recent Adria Tour exhibition series in Serbia and Croatia.Djokovic and three other players have also tested positive for the virus after playing in the events. Grigor Dimitrov, Borna Coric and Viktor Troicki are the others.Ivanisevic won the Wimbledon title in 2001. He says he twice tested negative for the virus over the past 10 days but has now tested positive. June 26, 2020 Ivanisevic says “I would like to inform everyone who has been in contact with me that I tested positive and ask them to take extra good care of themselves and their loved ones.”The Croat says he has no symptoms but will self-isolate.___More AP sports: https://apnews.com/apf-sports and https://twitter.com/AP_Sports That was a 5.3% rate of positive tests leaguewide. The league did not announce results of testing on staffers and other members of team travel parties, all of whom are also part of the mandatory testing program.The league and the union say that “any player who tested positive will remain in self-isolation until he satisfies public health protocols for discontinuing isolation and has been cleared by a physician.”___The Carolina Hurricanes will begin “voluntary small-group training” at PNC Arena on Tuesday.The team said Friday those sessions will be closed to the public and media. Sixteen players, divided into two groups, are expected to participate. World Triathlon has resurrected a second race in its world series, in Montreal in October.The pandemic shelved the seven-race series, and the finals in Edmonton in August were canceled.But the Hamburg stop in July was postponed to September, and the Montreal leg in June will race on Oct. 4.A new date for the World Cup leg in Arzachena, Italy that was postponed in May was also found — Oct. 10. ___ Diamond League track meets in France and the United States have been canceled because of the coronavirus pandemic.Organizers say the Sept. 6 event in Paris and the Prefontaine meet on Oct. 4 in Eugene, Oregon, cannot be held because of the current restrictions on mass gatherings and international travel.A meet in Gateshead, England, has been postponed from Aug. 16 to a possible date in mid-September.The next possible Diamond League meet is scheduled for Aug. 14 in Monaco.___ Now the World Group I and World Group II preliminary matches will be played in various sites in either March or September 2021. The finals will be in Madrid during the week of Nov. 22, 2021.The International Tennis Federation says the 18 nations that already qualified for the 2020 finals will get a spot in 2021.The ITF has also scrapped the women’s Fed Cup finals for this year and says they will be played April 13-18 in Budapest, Hungary.The Fed Cup originally was supposed to be played this April but was initially postponed because of the pandemic.___ Players and staff permitted inside the arena will be tested for COVID-19. Team personnel will follow safety guidelines outlined in the second phase of the NHL’s return plan, as well as those from the Centers for Disease Control and Prevention, and North Carolina’s Department of Health and Human Services.The team says the arena has received “extensive cleaning” during the suspended NHL season and there will be “enhanced cleaning and sanitation efforts” going forward.___The Davis Cup men’s tennis competition has been canceled this year because of the coronavirus pandemic and will pick up again in 2021.Matches were scheduled for this September and the Davis Cup finals were set for November in Madrid. Share This StoryFacebookTwitteremailPrintLinkedinRedditThe Latest on the effects of the coronavirus outbreak on sports around the world:___The baseball Hall of Fame museum has reopened after being shut for more than three months. Virginia says its football players can begin returning to campus on July 5 if they participate in a voluntary workout period under protocols set by the school’s health system.The school says all student-athletes and staff will receive COVID-19 specific education through a variety of print and video media, utilizing CDC and NCAA resources. The UVA Health System will administer and coordinate testing of student-athletes and staff.The voluntary workouts will go from July 5-14, followed by required activity for up to eight hours a week including weight training, conditioning and film study from July 15-25. The program will then transition into a two-week period of required activities for 20 hours a week including walk-through sessions before fall training camp opens on Aug. 9.The UVA Health System also will be required to report positive tests or cases to the local health district and to the athletics program’s team physicians.The Cavaliers are scheduled to open the season against Georgia on Sept. 7 in Atlanta. The Latest: Baseball Hall of Fame museum reopens ___Brewers general manager David Stearns says no Milwaukee players have opted out of playing this season for personal reasons. He says “a small number of individuals in our organization” have tested positive for COVID-19 but were asymptomatic. He didn’t specify the number or say whether these individuals were players, other team employees or both.___The NBA and the National Basketball Players Association say 16 players tested positive for coronavirus in the first wave of mandatory tests done in preparation for the restart of the season.Those 16 players were part of a pool of 302 tested on Tuesday. Tests are continuing for all 22 teams that will be participating in the restart at the Disney campus near Orlando, Florida, next month. The player names were not disclosed; some, such as Malcolm Brogdon of Indiana and Sacramento teammates Jabari Parker and Alex Len have publicly acknowledged they have recently positive. Associated Press University of Tennessee President Randy Boyd says reducing the number of fans further because of the coronavirus pandemic would have a “significant impact” on the budget. But Boyd said Friday that Tennessee is financially prepared to handle any problems.Tennessee projects a drop of 19.4% with $29.8 million in revenue from athletic ticket sales. That would be down $7.1 million from the $37 million taken in over 2019-20. John Compton, chairman of the UT Board of Trustees, says that estimate is appropriate for now. He also says Tennessee will be able to handle if ticket revenue winds up even 50% lower.The Volunteers won their final six games last season under coach Jeremy Pruitt. They are scheduled to host Florida and Alabama, which are traditionally big draws for fans.Athletic director Phillip Fulmer has said Tennessee is expecting to fill Neyland Stadium this season and will adjust as needed.___ Denny McCarthy told Golfchannel.com that he withdrew after feeling sick Thursday night and testing positive for the coronavirus on Friday. Bud Cauley, who played with McCarthy on Thursday, also withdrew before Friday’s second round. McCarthy became the third PGA Tour player to test positive for the virus since its restart and the second this week, joining Cameron Champ who withdrew on Tuesday. Nick Watney withdrew just before the second round of last week’s RBC Heritage Championship. Webb Simpson, Graeme McDowell, Brooks Koepka and his brother Chase also withdrew from the Travelers after coming into contact with people who had the virus. The caddies for McDowell and Brooks Koepka both tested positive. Simpson cited the positive test of a family member.___Tennessee’s athletic budget for 2020-21 assumes the Volunteers will have fans in the stands for football season but still includes a $10.1 million cut in overall revenues. Closed on March 15 because of the coronavirus pandemic, the Hall welcomed visitors on Friday in Cooperstown, New York. Face masks are required from all staff and guests.The shrine is selling tickets that permit visitors to reserve a specific date and time to enter, reducing congestion in the front lobby and throughout the museum. Some of the Hall’s bigger gathering spots will remain closed. The popular plaque gallery is open.The Hall announced earlier that this year’s Hall of Fame induction ceremonies had been canceled because of the virus outbreak. Derek Jeter, Marvin Miller, Ted Simmons and Larry Walker will be enshrined next year, on July 25, 2021.___Two more players on the PGA Tour have withdrawn from the Travelers Championship because of COVID-19. This year’s Fed Cup finals have been rescheduled for 2021 because of “challenges” related to the coronavirus pandemic.The International Tennis Federation says the women’s team competition will take place April 13-18 in Budapest, Hungary.The 2020 event was originally scheduled for April but was postponed because of the pandemic. Officials had hoped to squeeze the competition in this year.The ITF says there are “significant logistical and regulatory challenges” to holding “an indoor mass gathering” at the Laszlo Arena. The tennis body says “guaranteeing the health and safety of all involved will not be feasible.”The Fed Cup finals feature 12 national teams competing in a new format.last_img read more