Global & Disaster Medicine

Archive for the ‘Pandemic’ Category

New Zealand, Australia and Iceland could act as island refuges to save humanity from extinction in the event of a catastrophic global pandemic and researchers have ranked 20 island nations which could act as refuges from which large-scale technological society could be rebuilt.

UOtago

“……The researchers say that for such a strategy to succeed, preparations must be made ahead of time. They suggest that New Zealand consider investing in resiliency measures and rehearse the rapid introduction of border controls...…”

In the journal:

Risk Analysis DOI: 10.1111/risa.13398

The Prioritization of Island Nations as Refuges from Extreme Pandemics

Matt Boyd and Nick Wilson

Abstract:  “In this conceptual article with illustrative data, we suggest that it is useful to rank island na-

tions as potential refuges for ensuring long-term human survival in the face of catastrophic

pandemics (or other relevant existential threats). Prioritization could identify the several is-

land nations that are most suitable for targeting social and political preparations and further

investment in resiliency. We outline a prioritization methodology and as an initial demon-

stration, we then provide example rankings by considering 20 sovereign island states (all with

populations greater than 250,000 and no land borders). Results describe each nation in nine

resilience-relevant domains covering location, population, resources, and society according

to published data. The results indicate that the most suitable island nations for refuge status

are Australia, followed closely by New Zealand, and then Iceland, with other nations all well

behind (including the relatively high-income ones of Malta and Japan). Nevertheless, some

key contextual factors remain relatively unexplored. These include the capacity of the juris-

diction to rapidly close its borders when the emerging threat was first detected elsewhere,

and whether or not large subnational islands should be the preferred focus for refuge design

(e.g., the Australian state of Tasmania, the island of Hokkaido in Japan, or the South Island

of New Zealand). Overall, this work provides conceptual thinking with some initial exam-

ple analysis. Further research could refine the selection of metrics, how best to weight the

relevant domains, and how the populations of prioritized island nations view their nation’s

selection as a potential refuge for human survival.”

AUSTRALIA

NEW ZEALAND

ICELAND

MALTA

JAPAN

CAPE VERDE

BAHAMAS

TRINIDAD/TOBAGO

BARBADOS

MADAGASCAR

CUBA

MAURITIUS

FIJI

MALDIVES

SRI LANKA

COMOROS

SOLOMON ISLANDS

JAMAICA

PHILIPPINES

VANUATU


Quack pharmacists around the world are fueling future superbug pandemics

Bureau of Investigative Journalism

“……Despite recent attempts by the Cambodian government to crack down on illegal pharmacies, these sellers fly under the radar. Most do not have any qualifications that would allow them to prescribe the cocktail of drugs they give patients, the researchers from the London School of Hygiene and Tropical Medicine and the University of Health Sciences found.

The invisible sellers had many misconceptions about antibiotics and dispensed them incorrectly, researchers said. Most openly admitted they sold them in response to patients’ demands, rather than medical need, leading to overprescription. They believed that antibiotics were necessary for colds and diarrhoea, and sold short courses of the drugs. They also sold antibiotics designed for humans to people wanting to give them to their cattle, chickens and dogs.

One seller said she learned about medicines during the Khmer Rouge regime and incorrectly believed antibiotics should be smeared into wounds. She said: “We break them into small pieces and pour them on wounds on our legs.”

This kind of misuse speeds up the creation of drug resistant bacteria, or superbugs, which are predicted to kill 10 million people by 2050 if no action is taken…..”


Rubbing hands with ethanol-based sanitizers may not be effective hand hygiene after all.

ASM

“……the researchers from the Kyoto Profectural University of Medicine found that ethanol-based disinfectants, or hand sanitizers, would have be in contact for at least 4 minutes with the influenza A virus before killing it, a much longer duration than typical use. After 2 minutes of use, the virus was still active...….”

Ryohei Hirose, Takaaki Nakaya, Yuji Naito, Tomo Daidoji, Risa Bandou, Ken Inoue, Osamu Dohi, Naohisa Yoshida, Hideyuki Konishi, Yoshito Itoh
“…….If there is insufficient time before treating the next patient (i.e., if the infectious mucus is not completely dry), medical staff should be aware that effectiveness of AHR (rubbing) is reduced. Since AHW is effective against both dry and nondry infectious mucus, AHW (washing) should be adopted to compensate for these weaknesses of AHR…….”

Project BioShield over 15 years of progress

ASPR

Project BioShield Evolution: Fifteen Years of Bridging the ‘Valley of Death’ in the Medical Countermeasures Pipeline

Author: By Dr. Robert Kadlec, Assistant Secretary for Preparedness and Response
Published Date: 7/17/2019 12:15:00 PM
Category: Innovations; Medical Countermeasures; National Health Security;

Saving lives in a public health emergency requires cutting-edge medical countermeasures: medications, vaccines, diagnostics, and more. In some types of emergencies, like an act of bioterrorism, some of those medical products have no commercial market. People don’t use an anthrax antitoxin every day – thank goodness. Yet that lack of commercial market also means pharmaceutical or biotech companies had only one possible buyer for their products: the federal government for stockpiling.

In 2004, Congress passed the Project BioShield Act to create a market for products necessary for disaster response but with limited or no commercial market. The Act provides HHS with a multi-year special reserve fund to support late-stage development and manufacturing, and the financial resources to buy these life-saving medical products for the American people to use in public health emergencies. In this way, Project BioShield is a critical part of the U.S. strategy for biodefense and our commitment to the American people.

Last month, Congress took action to further strengthen Project BioShield as part of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 (PAHPAIA). PAHPAIA increases the budget authorization and provides ten-year funding for product development. We know next-generation medical countermeasures aren’t developed overnight – in fact, getting a product across the finish line takes many years. Multi-year funding helps BARDA continue building the strong public-private partnerships needed to spur innovation and provide the private sector with the stability needed to produce potentially lifesaving medical countermeasures.

For example, smallpox is one of the most consequential infectious diseases in human history, responsible for nearly 300 million deaths in the 20th century alone. It is also a high-priority threat requiring federal agencies to develop strategies and countermeasures against this threat. Thanks to our partners at NIAID and DoD and the support of Project BioShield, last year our industry partner was issued an FDA approval for a treatment for smallpox via the animal rule. At present, there are now over 2 million treatment courses in ASPR’s Strategic National Stockpile to protect Americans in the event of a smallpox national security emergency.

However, we have found over the past 15 years the most practical and cost-effective approach is, whenever possible, to look at products that not only can be used for emergencies, but also have uses in daily medical care, such as burn care, the radiation effects cancer patients encounter, or seizures.

In some cases, we’ve worked with companies to expand indications for existing products. For example, three medical countermeasures are now FDA-approved to treat patients suffering bone marrow and blood cell damage from acute radiation syndrome. All three of these products were already licensed drugs used to treat patients undergoing radiation therapy for cancer. Project BioShield funding was used to conduct the critical studies needed to expand the indications for these products so they could also be used to treat the damage caused by acute radiation syndrome in a radiation emergency. Using such drugs is helpful in emergencies because healthcare facilities already stock the drugs, and clinicians are already familiar with using them.

We are using Project BioShield to support other new products with commercial market potential. For example, we supported a large study of a seizure treatment because seizures are one of the potentially deadly effects of nerve agents. The product is used commonly in preparing patients for surgery and for epileptic seizures; thanks to Project BioShield, the product is now approved as an antiseizure medication for status epilepticus and has been added to the Strategic National Stockpile for use in a chemical emergency response.

For 15 years, BARDA has been proud to partner with industry to develop cutting-edge medical countermeasures. Our country is better prepared to respond to health security threats because of Project BioShield. We look forward continued collaboration as we work to develop and produce medical countermeasures that can be used to save lives in the event of an emergency.


Baloxavir showed broad-spectrum in vitro replication inhibition of 4 types of influenza viruses

Mishin VP, Patel MC, Chesnokov A, De La Cruz J, Nguyen HT, Lollis L, et al. Susceptibility of influenza A, B, C, and D viruses to baloxavir. Emerg Infect Dis. 2019 Oct [date cited]. https://doi.org/10.3201/eid2510.190607

“…….Baloxavir displayed broad antiviral activity against diverse influenza viruses, including all 4 types and animal-origin influenza A viruses with pandemic potential. Our findings suggest that baloxavir might offer the first therapeutic option against influenza C virus infections. Further studies are needed to provide comprehensive assessment of baloxavir susceptibility by using a large panel of representative influenza C viruses. Ongoing monitoring of baloxavir susceptibility of emerging avian and swine influenza A viruses with pandemic potential is needed to inform clinical management and public health preparedness efforts...…”


Canadian pandemic influenza preparedness

Canada Pandemic Prep Document

Abstract

Henry B on behalf of the Canadian Pandemic Influenza Preparedness Task Group. Canadian pandemic influenza preparedness: Public health measures strategy. Can Commun Dis Rep 2019;45(6):159–63. https://doi.org/10.14745/ccdr.v45i06a03

“Public health measures, also known as non-pharmaceutical interventions, are basic actions aimed at slowing the community spread of a communicable disease outbreak. In the event of an influenza pandemic, public health measures and antiviral drugs are the only tools available to mitigate the effects of the pandemic during the months before a vaccine becomes available. The Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector (CPIP) outlines how federal, provincial and territorial governments will work together to ensure a coordinated and consistent health sector approach to pandemic influenza preparedness and response.
This article summarizes Canada’s pandemic public health measures strategy, as described in the recently updated CPIP Public Health Measures Annex. The strategy builds on lessons learned during the 2009 H1N1 pandemic.

Key elements of the public health measures strategy include individual measures (e.g. hand hygiene, self-isolation when ill), community-based measures (e.g. school closures, cancellation of mass gatherings), management of cases and close contacts, travel and border-related actions and public education. Factors that influence the effectiveness of public health measures in a pandemic include the pandemic epidemiology, timing of implementation, how the measures are used (i.e. alone or in combination), their scalability and flexibility and public compliance. The CPIP is an evergreen guidance document and the Annex will be updated as new information warrants.”


CDC: The pandemic mass grave in Brevig Mission, Alaska (1918)

Site of the mass grave in Brevig Mission, Alaska, where 72 of the small village’s 80 adult inhabitants were buried after succumbing to the deadly 1918 pandemic virus. Photo credit: Angie Busch Alston.


Global catastrophic biological risks (GCBRs)

Questioning Estimates of Natural Pandemic Risk
Published Online:
Abstract

The US House of Representatives yesterday passed bipartisan legislation reauthorizing the Pandemic and All-Hazards Preparedness and Advancing Innovations Act (PAHPA)

Pandemic legislation

Today, the House of Representatives passed bipartisan legislation, the Pandemic and All Hazards Preparedness and Advancing Innovation Act (PAHPA), authored by Reps. Susan W. Brooks (R-IN05) and Anna G. Eshoo (D-CA18) to strengthen the country’s existing preparedness and response programs. The bill now heads to the President’s desk to be signed into law.

The Pandemic and All-Hazards Preparedness and Advancing Innovation Act is critically important legislation that works to make our nation better prepared for and able to keep Americans safer in response to natural disasters or biological, chemical, radiological or nuclear threats to our public health and national security,” Brooks said. “I am proud this bipartisan legislation is now on its way to the President’s desk to be signed into law because it will ensure our health care professionals are trained to respond to possible pandemic outbreaks, prioritize the further development of our national stockpile of vaccines, medical equipment and diagnostics, and establish new advisory groups focused on protecting vulnerable populations such as senior citizens and people with disabilities during public health threats and emergencies.”

The Pandemic and All-Hazards Preparedness and Advancing Innovation Act better equips our federal agencies to respond to new and emerging threats that jeopardize our national security and public health,” Eshoo said. “I applaud the House and Senate’s bipartisan commitment to strengthening our nation’s existing preparedness and response programs, and I look forward to the President signing this important bill into law.”

BACKGROUND

The Pandemic and All Hazards Preparedness and Advancing Innovation Act (PAHPA) ensures our nation is prepared to respond to a wide range of public health emergencies, whether man-made or occurring through a natural disaster or infectious disease. PAHPA strengthens and improves our national preparedness and response for public health emergencies through our hospitals, state and local health providers, and by accelerating medical countermeasure research and development. Specifically, the legislation focuses on the needs of special populations including children, people with disabilities and seniors before and during a public health emergency. It codifies the Public Health Emergency Medical Countermeasure Enterprise and the duties of the Assistant Secretary for Preparedness and Response (ASPR), while maintaining the important role of the Centers for Disease Control in emergency and response activities. The legislation also provides the authorization and federal resources to invest in programs related to Pandemic Influenza and Emerging Infectious Diseases.

In addition, PAHPA reauthorizes funding to improve bioterrorism and other public health emergency preparedness and response activities such as the Hospital Preparedness Program, the Public Health Emergency Preparedness Cooperative Agreement, Project BioShield, and BARDA for the advanced research and development of medical countermeasures (MCMs). PAHPA previously expired on September 30, 2018.

Brooks and Eshoo are co-founders of the Congressional Biodefense Caucus. The Caucus serves as a platform to educate Members of Congress and their staff on the very real threats our nation faces from a chemical, biological, radiological or nuclear attack or pandemic outbreak. It also aims to identify the existing gaps in our preparedness and response capabilities.


Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, 2019

Trust For America’s Health

One lesson from recent events is that emergencies happen. And happen often. From disease outbreaks to natural disasters to man-made crises, the stakes are high: Americans face serious health risks and even death with increasing regularity. Therefore, as a nation, it’s critical to ask, “Are we prepared?”

Executive Summary

The public health emergencies of the past year—an unusually severe flu season, confounding cases of acute flaccid myelitis, two major hurricanes, and the deadliest fire season in California’s history reinforce the need for every jurisdiction to be vigilant about preparing for emergencies in order to safeguard the public’s health.

A fundamental role of the public health community is to protect communities from disasters and disease outbreaks. To this end, the nation’s health security infrastructure has made tremendous strides since 2001 by building modern laboratories, maintaining a pipeline of medical countermeasures, and recruiting and retaining a workforce trained in emergency operations. Yet, unstable and insufficient funding puts this progress at risk, and a familiar pattern takes shape: underfunding, followed by a disaster or outbreak, then an infusion of onetime supplemental funds, and finally a retrenchment of money once attention wanes. What’s more, states are uneven in their levels of preparedness. Some—often those that most frequently face emergencies—have the personnel, systems, and resources needed to protect the public. But others are less prepared and less experienced, elevating the likelihood of preventable harms. This unstable funding and uneven preparation undermines America’s health security.

The Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism series, produced by Trust for America’s Health (TFAH), has tracked public health emergency preparedness in the United States since 2003. The series has documented significant progress in the nation’s level of preparedness as well as those areas still in need of improvement.

Ready or Not examines the country’s level of public health emergency preparedness on a state-by-state basis using 10 priority indicators. (See Table 1.) Taken together, the indicators are a checklist of priority aspects of states’ readiness for public health emergencies. However, these indicators do not necessarily reflect the effectiveness of states’ public health departments. Improvement in these priority areas often requires action from other agencies, elected officials or the private sector.

The 2019 report finds that states have made progress in key areas, including public health funding and participation in provider compacts and coalitions. However, performance in other areas—such as flu vaccination, hospital patient safety, and paid time off for workers—has stalled or lost ground.

Table 1: Top-Priority Indicators of State Public Health Preparedness

Indicators
1 Incident Management: Adoption of the Nurse Licensure Compact. 6 Water Security: Percentage of the population who used a community water system that failed to meet all applicable health-based standards.
2 Cross-Sector Community Collaboration: Percentage of hospitals participating in healthcare coalitions. 7 Workforce Resiliency and Infection Control: Percentage of employed population with paid time off.
3 Institutional Quality: Accreditation by the Public Health Accreditation Board. 8 Countermeasure Utilization: Percentage of people ages 6 months or older who received a seasonal flu vaccination.
4 Institutional Quality: Accreditation by the Emergency Management Accreditation Program. 9 Patient Safety: Percentage of hospitals with a top-quality ranking (Grade A) on the Leapfrog Hospital Safety Grade.
5 Institutional Quality: Size of the state public health budget, compared with the past year. 10 Health Security Surveillance: The public health laboratory has a plan for a six- to eight-week surge in testing capacity.

Notes: The National Council of State Boards of Nursing organizes the Nurse Licensure Compact. The federal Hospital Preparedness Program of the U.S. Office of the Assistant Secretary for Preparedness and Response supports healthcare coalitions. The U.S. Environmental Protection Agency assesses community water systems. Paid time off includes sick leave, vacation time, or holidays, among other types of leave. The Leapfrog Group is an independent nonprofit organization. Every indicator, and some categorical descriptions, were drawn from the NHSPI, with one exception: public health funding. See “Appendix A: Methodology” for a description of TFAH’s funding data-collection process, including its definition.

Source: National Health Security Preparedness Index.

For the first time, Ready or Not groups states and the District of Columbia into one of three tiers based on their performance across the 10 indicators. This year, 17 states scored in the top tier, 20 and the District of Columbia placed in the middle tier, and 13 were in the bottom tier. (See Table 2).

By gathering together timely data on all 50 states and the District of Columbia, the report assists states in benchmarking their performance against comparable jurisdictions. To help states track their own progress, TFAH will strive to maintain continuity among the indicators tracked in this edition of the report for the next several years.

Table 2: State Public Health Emergency Preparedness

State performance, by scoring tier, 2018

 Performance Tier States Number of States
Top Tier AL, CO, CT, FL, ID, KS, MA, MD, MO, MS, NC, NE, NJ, RI, VA, WA, WI 17 states
Middle Tier CA, DC, GA, HI, IA, IL, LA, ME, MI, MN, MT, ND, NH, NM, NV, OK, OR, SC, TX, VT, WV 20 states and DC
Bottom Tier AK, AR, AZ, DE, IN, KY, NY, OH, PA, SD, TN, UT, WY 13 states

Report Findings

A majority of states have made preparations to expand capabilities in an emergency, often through collaboration. In 2018, 31 states participated in the Nurse Licensure Compact, which allows registered nurses and licensed practical or vocational nurses to practice in multiple jurisdictions with a single license. In an emergency, this enables health officials to quickly increase their staffing levels. For example, nurses may cross state lines to lend their support at evacuation sites or other healthcare facilities. The number of states participating in the compact is up by five from 26 in 2017.

In addition, hospitals in most states have a high degree of participation in healthcare coalitions. On average, 89 percent of hospitals were in a coalition and 18 states had universal coalition participation, meaning every hospital in the state was part of a coalition. Such coalitions bring hospitals and other healthcare facilities together with emergency management and public health officials to plan for, and respond to, events requiring extraordinary action. This increases the likelihood that patients are served in a coordinated and efficient manner during an emergency.

Finally, 44 states and the District of Columbia had a plan to surge public health laboratory capacity for six to eight weeks as necessary during overlapping emergencies or large outbreaks.

Most residents who got their household water through a community water system had access to safe water.  On average, just 6 percent of state residents used a community water system in 2017 that did not meet all applicable health-based standards. Water systems with such violations increase the chances of water-based emergencies in which contaminated water supplies place the public at risk.

Most states are accredited in the areas of public health, emergency management, or both. In 2018, the Public Health Accreditation Board or the Emergency Management Accreditation Program accredited 42 states and the District of Columbia; 26 states were accredited by both groups. Eight states (Alaska, Hawaii, Indiana, New Hampshire, South Dakota, Texas, West Virginia, and Wyoming) were accredited by neither. Both programs help ensure that necessary emergency prevention and response systems are in place and staffed by qualified personnel.

Seasonal flu vaccination rate, already too low, fell further. The seasonal flu vaccination rate among Americans ages 6 months or older dropped from 47 percent in the 2016–2017 season to 42 percent in the 2017–2018 season. This drop-in coverage may have exacerbated the severity of the 2017-2018 influenza season and the high number of illnesses, hospitalizations and deaths due to flu. Healthy People 2020, a set of federal 10-year objectives and benchmarks for improving the health of all Americans by 2020, set a seasonal influenza vaccination-rate target of 70 percent annually.

In 2018, only 55 percent of employed state residents, on average, had access to paid time off. Those without such leave are more likely to work when they are sick and risk spreading infection. In the past, some infectious disease outbreaks have been linked to or exacerbated by the absence of paid sick leave.

Only 28 percent of hospitals, on average, earned a top-quality patient safety grade. Hospital safety scores measure performance on such issues as healthcare-associated infection rates, intensive-care capacity, nursing staff volume, and an overall culture of error prevention. In the absence of diligent actions to protect patient safety, deadly infectious diseases can take hold or strengthen.

Climate Change Increases Likelihood of Extreme Weather

According to the Center for Climate and Energy Solutions, a nonprofit advocacy group, climate change is expected to increase the frequency, intensity, and consequences of some types of extreme weather events, including:

  • Drought, which can contribute to food insecurity and exacerbate wildfires.
  • Extreme heat, which in a typical year already kills more people in the United States than hurricanes, lightning, tornadoes, earthquakes, and floods combined. Extreme heat is especially dangerous for medically vulnerable people. It also worsens droughts and increases the risk of wildfires.
  • Heavy rains, which cause catastrophic flooding, landslides, and contaminated waterways.
  • Hurricanes, which sometimes have more destructive wind speeds, precipitation, and storm surges.
  • Wildfires, which can now burn more land and are more difficult to extinguish.

In 2017 alone, at least 15 extreme weather events across the globe were made more likely by climate change, according to studies published by the American Meteorological Society.

On top of possible federal action, states and localities can act to mitigate these threats, particularly the dangers they pose to people with health ailments or in poor living conditions. For example, land-use planning can reduce loss of life and property from wildfires. Zoning rules that limit building in flood-prone areas reduces the dangers from floods, and replacing nonpermeable surfaces with “green infrastructure,” such as rain gardens and bioswales, reduces stormwater runoff and subsequent flooding. In drought-prone areas, green infrastructure can retain stormwater for later use. Cooling centers can keep vulnerable populations safe during heat waves, and green roofs can reduce the urban heat island effect. Finally, preserving coastal wetlands, dunes, and reefs can help absorb storm surges from hurricanes.

Report Recommendations

There are a host of concrete actions to further protect the public’s health that TFAH recommends be taken by federal, state, and local officials; the healthcare system; academia; and the private or nongovernmental sectors.

Those that are of highest priority include:

  • Providing stable, dedicated, and sufficient funding for preparedness activities and a significant funding increase for core public health capabilities.
  • Establishing a complementary emergency response fund to accelerate crisis responses.
  • Maintaining a long-term investment in the Global Health Security Agenda framework and global preparedness and response programs to help prevent infectious disease threats from becoming global crises.
  • Fully implementing the National Biodefense Strategy including with transparent goals, implementation plans, and budgets for all relevant agencies.
  • Monitoring and addressing any potential challenges caused by the transition of the Strategic National Stockpile and significantly strengthening the “last mile” of distribution and dispensing.
  • Developing a multiyear strategic vision, and fully funding surveillance infrastructure, for fast, accurate outbreak detection at all levels of government.
  • Bolstering the Hospital Preparedness Program and multisector healthcare collaboration as well as adopting state policies to improve healthcare delivery during disasters.
  • Adopting comprehensive climate change adaptation plans, including a public health assessment and response.
  • Increasing public and private investments in efforts to combat antimicrobial resistance, including through diagnostic, stewardship, detection, and treatment methods.
  • Supporting vaccine infrastructure and first-dollar coverage of recommended vaccines.
  • Promoting health equity in emergency preparedness planning, response, and recovery, including through the appointment of a chief equity or resilience officer.

Taken together, action on TFAH’s recommendations would make the United States safer for all its residents.


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