Tuesday, June 30, 2009

Novel H1N1 Kills the Economy

I don't know how things are where you live, but in my neck of the woods, the economic crisis has not been kind. The neighbors across the street are moving out today -- another foreclosure. The local news is filled with reports of more lay-offs, including scores of government and school district employees.

Economically -- bad timing for a global flu pandemic.

On a basic local level, we have already spent tens of thousands of dollars on supplies, transportation of specimens, and employee overtime. But researchers at Oxford Economics estimate dire consequences for the global economy. That's right. Dire. Not that I am over-reacting... What does that look like? Increased unemployment, decreased consumer spending, possible deflation, long-term consequences -- ultimately increasing the length of the recession (depression?).

Irradiated Cat Food

This was just too interesting not to comment on. In a Promed report, there was discussion about how investigators in Australia determined that irradiation of dry cat food was leading to fatal neurological damage in some cats. For some reason, only female cats who became pregnant while on a diet of the irradiated food were affected -- male cats and the kittens did not develop symptoms. Dogs were not affected. Irradiation is apparently performed on imported foods. They also irradiate some human foods (although this is qualified with a note that it is at much lower levels than the pet food).

A couple of weeks ago, I spoke with a USDA inspector who was involved with the E coli outbreaks in produce from California. He said he believes all produce should be irradiated. Anyone else concerned about this? I'm not a cat, but I'm not terribly excited about eating irradiated foods.

Wednesday, June 24, 2009

Not My Cookie Dough

Frozen chocolate chip cookie dough has been recalled due to possible contamination with E coli O157:H7. This is a really nasty bug that can lead to kidney failure and, in some cases, death. Investigators performed a case control study. Basically, what you do is interview all the sick people, find out every food they ate in the last two weeks. Then you interview a well person, usually someone else in the home, and find out everything they ate in the last two weeks. This is tough -- a lot of people don't remember everything they ate. Sometimes you have to ask about foods normally eaten. For example, I don't ever eat fried liver, so I know I haven't eaten it in the last two weeks. So that would be a 'no' on the questionnaire. I do eat raw spinach, and while I can't remember for sure if I ate it in the last two weeks, there is a good possibility, so it should be marked 'yes.' In the case control study, frozen cookie dough emerged as the most likely culprit. Statistically, people who were sick were significantly more likely to have consumed it than people who were not sick.

The big question in my mind is how the heck did the E coli end up in raw cookie dough? E coli primarily comes from contaminated cattle, although other animals can be infected. When you hear about produce outbreaks, in all likelihood the field was contaminated somehow, like through water runoff or wild animal activity. How did it end up in the dough? I heard a news report which suggested that meat products are also processed at the cookie dough plant, but it still seams odd to me.

In one of the salmonella in commercial food outbreaks investigators found that birds roosting in the rafters of the processing facility were defecating down into the works of the machinery. How disgusting is that?

If you still have any of the recalled dough, throw it away. While cooking it would kill the bacteria, there is a very high likelihood for cross-contamination of your hands and kitchen. Which means you would get sick any way. You might be able to see if you can get your money back from the store where you purchased it.

Friday, June 19, 2009

Pandemic Severity Index

Since the "stages" of pandemic do not appear to be terribly useful in describing novel H1N1, CDC has created a Pandemic Severity Index. It mirrors the hurricane severity index, with a Category 1 being mild, like seasonal flu, versus Category 5 as the most severe. Disease control activities are then based on the severity of the illness, although I would think you would still be concerned with the stage -- ie the levels of transmission within the area -- in conjunction.

I just returned from a table top exercise on what I suppose would be a Category 4 or 5 pandemic. Bad case scenario, where lots of people die, the grocery stores run out of food, people have heart attacks on the street because the hospitals are too full to accept them, etc. One of the big worries the responders expressed was about how the public will react next time -- "See there they go again, the government over-reacting!" and then ignoring prudent advice.

One of the big problems is that for the last few years (decades?) we have lived in a culture of fear. Fear is the primary motivation for people. Scare the crap out of people to get them to do things. Check your breasts monthly so you don't die of breast cancer. Put your kids in car seats so they don't die in car wrecks. Everything is dangerous. Nothing is safe. Parents won't let their kids play outside because of a fear that they might be abducted.

Not long ago I had a conversation with a friend about the use of fear as a tool to control people in religion, and how there has been a shift away from that. As a kid, I was scared to death that I would burn in a lake of fire. Terrified, terrorized really, of going to hell (why yes, I was a Catholic. What do you ask?). A lot of churches (Western, Christian) have gotten away from that message, and now promote spirituality and having a relationship with God for the sake of the relationship, rather than blindly following church doctrine out of fear of hell. It seems to me that this is something we should consider moving towards as a society -- acting because something is the right thing to do, rationally, rather than being driven by fear and anxiety. I am not sure how to accomplish that, but it makes sense to me.

Monday, June 15, 2009

Influenza Pandemic

I've been meaning to post for a few days now, but vacation activities and yet another viral illness (GI through the family) interfered. So here you go:

The World Health Organization has declared that we are now in an influenza pandemic. Pandemic alert phase 6.

It is sort of anti-climactic, isn't it?

Pandemic is a scary sounding word. The truth is, all it means is that person-to-person transmission is happening in several regions of the world. We've been in an HIV pandemic for quite a few years now and the majority of Americans are not too worked up about that.

Interestingly, there is some evidence that this bug has been around longer than we first thought.

There are still lots of reported problems with testing for novel H1N1. The rapid flu tests seem to be hit or miss, and the PCR testing seems to be running at about 90% accuracy, according to Promed. On the plus side, some of the commercial labs are now offering the test, which should take some of the pressure off of the LRNs.

Last week, Egypt reported cases of novel H1N1. This is concerning because they have cocirculating influenza H5N1 -- otherwise known as the avian flu we've all been worried about. Of course they are not the only country to have both, but they have had a lot of H5N1 human cases of late.

An epidemiologist friend of mine told me that she investigated a household in which one family member tested positive for novel H1N1 and another family member tested positive for seasonal influenza. That's a family to watch -- it is situations like that which allow for gene swapping and breeding of new bugs.