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Paul drew my attention to whoissick.org, a site in which individuals are supposed to report their own symptoms and it provides analytical tools to break down their incidence, spatial concentration, and so on. Browsing through different areas, it does not yet seem very densely populated. (My own Lower East Side, one of the more densely settled areas in the United States, only shows a smattering of "reports.") The best thing: you can receive outbreak alerts by email. Also, check out the symptom tag cloud on the lower right. This is our web 2.0 world.

An article in today's Times reports on substantial housing development in the flood plain of the the Mississippi River following the floods of 1993.

Building is happening on flood plains across Missouri, but most of the development is in the St. Louis area, and it is estimated to be worth more than $2.2 billion. Though scientists warn about the danger of such building, the Missouri government has subsidized some of it through tax financing for builders.

“No one has really looked at the cumulative effect,” said Timothy M. Kusky, a professor of natural sciences at St. Louis University, who calculates that there has been more development on the Missouri River flood plain in the years since 1993 than at any other time in the history of the region.

These developments raise again a series of problems relating catastrophe, risk, and insurance that first emerged after the United States passed its first disaster relief act in 1950, formalizing federal aid to flood victims. Immediately, it was recognized that these policies created a problem of moral hazard: individual homeowners would not purchase insurance against what they perceived to be unlikely events, particularly since they counted on the federal dollars to bail them out (often, or so libertarian and economist critics argues, leaving them in better shape than when they started). In 1968 a program of federal flood insurance was created, which relied on the government to construct hazard models that would serve as the basis for determining premiums, and counted on private insurers to provide policies. But this program -- which has been revised many times since -- did not entirely solve the problem. On the one hand, individuals purchased policies at much lower rates than was expected, leaving much of the damage from floods still to be covered by federal relief (and the government often stepped in to offer even more relief after major events). On the other hand, these policies did not always do enough to prevent development in flood-prone areas. Of note in the article is the line drawn around the "100 year flood." This threshold was key to the original program of federal flood insurance, which mandated insurance policies for homeowners living in the damage area of a 100 year event. The question, of course, is how accurate the models are, and whether that threshold is the right one. One resident who had purchased a house outside the 100 year flood plain (and was thus not required to purchase insurance), said that “It’s not going to flood here for another 100 years, and I won’t be around by then.” A touch unclear on the concept, one might say. In the long run the dynamic is familiar. Bigger levies mean more housing in the flood plain. Which may contain small events, but open the gates for ever bigger, if rarer, events. “If history tells us anything, it’s that levees once built eventually fail,” Professor Pinter said. “But instead of being farmland there, now it’s a strip mall or residential area, or a whole city.” As Aaron Wildavsky might say, "safety" is being purchased at the price of resilience.

Do you want a quick result or a correct result? - Here is an interesting piece on problems with molecular tests. Faith in Quick Test Leads to Epidemic That Wasn’t By GINA KOLATA Dr. Brooke Herndon, an internist at Dartmouth-Hitchcock Medical Center, could not stop coughing. For two weeks starting in mid-April last year, she coughed, seemingly nonstop, followed by another week when she coughed sporadically, annoying, she said, everyone who worked with her. Before long, Dr. Kathryn Kirkland, an infectious disease specialist at Dartmouth, had a chilling thought: Could she be seeing the start of a whooping cough epidemic? By late April, other health care workers at the hospital were coughing, and severe, intractable coughing is a whooping cough hallmark. And if it was whooping cough, the epidemic had to be contained immediately because the disease could be deadly to babies in the hospital and could lead to pneumonia in the frail and vulnerable adult patients there. It was the start of a bizarre episode at the medical center: the story of the epidemic that wasn’t. For months, nearly everyone involved thought the medical center had had a huge whooping cough outbreak, with extensive ramifications. Nearly 1,000 health care workers at the hospital in Lebanon, N.H., were given a preliminary test and furloughed from work until their results were in; 142 people, including Dr. Herndon, were told they appeared to have the disease; and thousands were given antibiotics and a vaccine for protection. Hospital beds were taken out of commission, including some in intensive care. Then, about eight months later, health care workers were dumbfounded to receive an e-mail message from the hospital administration informing them that the whole thing was a false alarm. Not a single case of whooping cough was confirmed with the definitive test, growing the bacterium, Bordetella pertussis, in the laboratory. Instead, it appears the health care workers probably were afflicted with ordinary respiratory diseases like the common cold. Now, as they look back on the episode, epidemiologists and infectious disease specialists say the problem was that they placed too much faith in a quick and highly sensitive molecular test that led them astray. Infectious disease experts say such tests are coming into increasing use and may be the only way to get a quick answer in diagnosing diseases like whooping cough, Legionnaire’s, bird flu, tuberculosis and SARS, and deciding whether an epidemic is under way. There are no national data on pseudo-epidemics caused by an overreliance on such molecular tests, said Dr. Trish M. Perl, an epidemiologist at Johns Hopkins and past president of the Society of Health Care Epidemiologists of America. But, she said, pseudo-epidemics happen all the time. The Dartmouth case may have been one the largest, but it was by no means an exception, she said. There was a similar whooping cough scare at Children’s Hospital in Boston last fall that involved 36 adults and 2 children. Definitive tests, though, did not find pertussis. “It’s a problem; we know it’s a problem,” Dr. Perl said. “My guess is that what happened at Dartmouth is going to become more common.” Many of the new molecular tests are quick but technically demanding, and each laboratory may do them in its own way. These tests, called “home brews,” are not commercially available, and there are no good estimates of their error rates. But their very sensitivity makes false positives likely, and when hundreds or thousands of people are tested, as occurred at Dartmouth, false positives can make it seem like there is an epidemic. “You’re in a little bit of no man’s land,” with the new molecular tests, said Dr. Mark Perkins, an infectious disease specialist and chief scientific officer at the Foundation for Innovative New Diagnostics, a nonprofit foundation supported by the Bill and Melinda Gates Foundation. “All bets are off on exact performance.” Of course, that leads to the question of why rely on them at all. “At face value, obviously they shouldn’t be doing it,” Dr. Perl said. But, she said, often when answers are needed and an organism like the pertussis bacterium is finicky and hard to grow in a laboratory, “you don’t have great options.” Waiting to see if the bacteria grow can take weeks, but the quick molecular test can be wrong. “It’s almost like you’re trying to pick the least of two evils,” Dr. Perl said. At Dartmouth the decision was to use a test, P.C.R., for polymerase chain reaction. It is a molecular test that, until recently, was confined to molecular biology laboratories. “That’s kind of what’s happening,” said Dr. Kathryn Edwards, an infectious disease specialist and professor of pediatrics at Vanderbilt University. “That’s the reality out there. We are trying to figure out how to use methods that have been the purview of bench scientists.” The Dartmouth whooping cough story shows what can ensue. To say the episode was disruptive was an understatement, said Dr. Elizabeth Talbot, deputy state epidemiologist for the New Hampshire Department of Health and Human Services. “You cannot imagine,” Dr. Talbot said. “I had a feeling at the time that this gave us a shadow of a hint of what it might be like during a pandemic flu epidemic.” Yet, epidemiologists say, one of the most troubling aspects of the pseudo-epidemic is that all the decisions seemed so sensible at the time. Dr. Katrina Kretsinger, a medical epidemiologist at the federal Centers for Disease Control and Prevention, who worked on the case along with her colleague Dr. Manisha Patel, does not fault the Dartmouth doctors. “The issue was not that they overreacted or did anything inappropriate at all,” Dr. Kretsinger said. Instead, it is that there is often is no way to decide early on whether an epidemic is under way. Before the 1940s when a pertussis vaccine for children was introduced, whooping cough was a leading cause of death in young children. The vaccine led to an 80 percent drop in the disease’s incidence, but did not completely eliminate it. That is because the vaccine’s effectiveness wanes after about a decade, and although there is now a new vaccine for adolescents and adults, it is only starting to come into use. Whooping cough, Dr. Kretsinger said, is still a concern. The disease got its name from its most salient feature: Patients may cough and cough and cough until they have to gasp for breath, making a sound like a whoop. The coughing can last so long that one of the common names for whooping cough was the 100-day cough, Dr. Talbot said. But neither coughing long and hard nor even whooping is unique to pertussis infections, and many people with whooping cough have symptoms that like those of common cold: a runny nose or an ordinary cough. “Almost everything about the clinical presentation of pertussis, especially early pertussis, is not very specific,” Dr. Kirkland said. That was the first problem in deciding whether there was an epidemic at Dartmouth. The second was with P.C.R., the quick test to diagnose the disease, Dr. Kretsinger said. With pertussis, she said, “there are probably 100 different P.C.R. protocols and methods being used throughout the country,” and it is unclear how often any of them are accurate. “We have had a number of outbreaks where we believe that despite the presence of P.C.R.-positive results, the disease was not pertussis,” Dr. Kretsinger added. At Dartmouth, when the first suspect pertussis cases emerged and the P.C.R. test showed pertussis, doctors believed it. The results seem completely consistent with the patients’ symptoms. “That’s how the whole thing got started,” Dr. Kirkland said. Then the doctors decided to test people who did not have severe coughing. “Because we had cases we thought were pertussis and because we had vulnerable patients at the hospital, we lowered our threshold,” she said. Anyone who had a cough got a P.C.R. test, and so did anyone with a runny nose who worked with high-risk patients like infants. “That’s how we ended up with 134 suspect cases,” Dr. Kirkland said. And that, she added, was why 1,445 health care workers ended up taking antibiotics and 4,524 health care workers at the hospital, or 72 percent of all the health care workers there, were immunized against whooping cough in a matter of days. “If we had stopped there, I think we all would have agreed that we had had an outbreak of pertussis and that we had controlled it,” Dr. Kirkland said. But epidemiologists at the hospital and working for the States of New Hampshire and Vermont decided to take extra steps to confirm that what they were seeing really was pertussis. The Dartmouth doctors sent samples from 27 patients they thought had pertussis to the state health departments and the Centers for Disease Control. There, scientists tried to grow the bacteria, a process that can take weeks. Finally, they had their answer: There was no pertussis in any of the samples. “We thought, Well, that’s odd,” Dr. Kirkland said. “Maybe it’s the timing of the culturing, maybe it’s a transport problem. Why don’t we try serological testing? Certainly, after a pertussis infection, a person should develop antibodies to the bacteria.” They could only get suitable blood samples from 39 patients — the others had gotten the vaccine which itself elicits pertussis antibodies. But when the Centers for Disease Control tested those 39 samples, its scientists reported that only one showed increases in antibody levels indicative of pertussis. The disease center did additional tests too, including molecular tests to look for features of the pertussis bacteria. Its scientists also did additional P.C.R. tests on samples from 116 of the 134 people who were thought to have whooping cough. Only one P.C.R. was positive, but other tests did not show that that person was infected with pertussis bacteria. The disease center also interviewed patients in depth to see what their symptoms were and how they evolved. “It was going on for months,” Dr. Kirkland said. But in the end, the conclusion was clear: There was no pertussis epidemic. “We were all somewhat surprised,” Dr. Kirkland said, “and we were left in a very frustrating situation about what to do when the next outbreak comes.” Dr. Cathy A. Petti, an infectious disease specialist at the University of Utah, said the story had one clear lesson. “The big message is that every lab is vulnerable to having false positives,” Dr. Petti said. “No single test result is absolute and that is even more important with a test result based on P.C.R.” As for Dr. Herndon, though, she now knows she is off the hook. “I thought I might have caused the epidemic,” she said.

If you're excited about tamiflu and steadily growing stockpiles, consider this: "To date, most patients with H5N1 have been treated with Tamiflu. Studies of Tamiflu for use in H5N1 influenza have produced varying results. Two studies of patients with H5N1 influenza in 2004 and 2005 revealed no difference in outcome between those who received Tamiflu and those who did not. However, some of the patients received an antiviral only later in the disease, and the studies were not large enough to produce meaningful conclusions. 'The numbers are so small that it's hard to know whether Tamiflu is efficacious at mitigating disease, but it's all we have, so it's worth trying because it has very limited toxicity' says Stephanie Black, MD, assistant professor of medicine at Rush University Medical Center in Chicago." The good thing about Tamiflu is that it doesn't do any harm, in other words. "A 2007 study of the effectiveness of Tamiflu in improving the survival rate of ferrets exposed to the H5N1 virus found that giving the drug within 4 hours of exposure (ie, before illness) resulted in 100% survival. When the treatment was delayed 24 hours after exposure, a higher dose was needed to achieve the same result." 4 hours, 24 hours: this is obviously not a very realistic temporal frame for pandemic times. The practice of stockpiling Tamiflu makes preparedeness visible, tangible, and countable. "You can count on it," as an expert phrased it. At the same time, neither the federal nor state governments have been willing to invest in things like ventilators and hospital beds. In this domain a different rationality prevails: The rationality of prioritization.

The cautious city of Edmonton decided to add ginseng product to its pandemic influenza stockpile. A waste of public funds? Why ginseng and not ventilators, for instance? - Two comments. First, the common cold is not the same thing as the flu. The two are mixed up in the article to the point where it is not clear what this is all about. Second, the study mentioned in the article was conducted midway through the influenza season when subjects may already have been exposed to the circulating strain! Of course, if you can refer to a "randomized, double-blind placebo-controlled study" it sounds terribly scientific - and helps sell your product. Edmonton adds ginseng product to pandemic stockpile Lisa Schnirring Staff Writer May 11, 2007 (CIDRAP News) – The city of Edmonton, Alta., recently announced that it was stockpiling an herbal supplement in the hope of boosting the immunity of police, firefighters, and other essential workers during an influenza pandemic. By buying a ginseng product from CV Technologies, Inc., a company based in Edmonton, the city has become the first in North America to add an herbal supplement to its pandemic stockpile, according to media reports. The supplement, COLD-fX, is a proprietary extract of North American ginseng that contains what the company calls unique polysaccharide components. It is Canada's top-selling over-the-counter cold and flu remedy, according to an Apr 23 company press release. Warren Michaels, CV Technologies' vice president of media relations, told CIDRAP News the company launched COLD-fX in the United States in October 2006 and that sales have been modest. City says decision took time Bob Black, Edmonton's director of emergency preparedness, said in the CV Technologies press release that COLD-fX is another tool the city can use for pandemic preparedness. "There are so many unknowns in planning for a possible pandemic that anything we can do to be prepared makes sense," he said. "We need to take every reasonable precaution to help our emergency personnel stay on the job, so they can help others." The stockpile will be used to treat 5,000 key city employees, such as police, firefighters, paramedics, and waste disposal workers. It consists of 600,000 pills, an 8-week supply, according to an Apr 25 report by the Toronto Globe and Mail. CV Technologies, which pitched the stockpiling idea to Edmonton's pandemic planners, said it would split the $250,000 cost of the program with the city as part of the company's social responsibility program. Black told CIDRAP News that the agreement stipulates that Edmonton will pay $30,000 up front to secure access to a stockpile of COLD-fX and will be required to pay its remaining share only if and when the city needs the remedy in a pandemic setting. The product has a 5-year shelf life, but the company said it would make sure the city has access to a fresh supply regardless of when it uses the stockpile. Jacqueline Shan, PhD, DSc, CV Technologies' chief executive officer and chief scientific officer, said that in a pandemic, "COLD-fX may help provide additional protection to front line workers by enhancing their immune systems" until an effective vaccine becomes available. Black said the city spent more than a year considering if it should stockpile COLD-fX. Senior officials and an epidemiologist from the city's occupational health and safety office were involved in the discussions. "It wasn't a spur-of-the-moment decision. On the balance, it seemed like a prudent thing to do" he said. Emergency preparedness officials are faced with tough questions about whether workers, particularly those in health and public safety jobs, like paramedics, firefighters, and police, will come to work during a pandemic, Black said. Having an herbal remedy on hand that might boost immunity could potentially make employees feel more confident about showing up for work, he said. Canadian health officials may have a heightened sensitivity about protecting workers during a public health emergency because of their experience with SARS (severe acute respiratory syndrome) in 2003, Black said. A final report on the outbreak that was issued in January faulted hospital officials for not doing more to protect their workers; nine hospital workers in Toronto contracted SARS while caring for critically ill patients. Studies suggest possible benefits Some randomized, double-blind, placebo-controlled studies have suggested that COLD-fX can help people reduce their number of colds and the duration and severity of symptoms. Two controlled trials were described in one report in the January 2004 issue of the Journal of the American Geriatrics Society. The researchers evaluated the effect of COLD-fX on the number of laboratory-confirmed acute respiratory illnesses in 198 nursing home and assisted-living residents (average ages, 83.5 and 81) in the 2000 and 2000-01 flu seasons. Ninety percent of the subjects had received the influenza vaccine. Half received a 200-mg COLD-fX tablet twice a day, while the others received placebo tablets. Investigators found that more people in the placebo group (9 of 101 subjects) than in the treatment group (1 of 97 subjects) were diagnosed with flu or respiratory syncytial virus. They calculated that the overall risk was reduced by 89% in the treatment group and concluded that COLD-fX was a safe, well-tolerated, and potentially effective treatment for preventing acute respiratory illnesses. During the 2003-04 cold and flu season, another research group, headed by Gerald N. Predy of the regional public health agency based in Edmonton, studied whether the ginseng supplement could prevent colds in a group of 323 Edmonton adults aged 18 to 85 who had not received seasonal flu vaccination. Their findings appeared in the October 2005 issue of the Canadian Medical Association Journal (CMAJ). The volunteers, who had a history of at least two colds the previous season, randomly received two COLD-fX capsules or a placebo daily for 4 months. Colds were verified by a symptom scoring system and graded on a 4-point severity scale. Researchers found that those who took COLD-fX had fewer colds and the colds they did have were milder and less persistent. The authors concluded that the treatment appeared to reduce the number of recurrent colds by almost 13%, the severity of colds by 15.4%, and the average duration of colds by 2.4 days. In a commentary published in the same issue of CMAJ, Ronald B. Turner, MD, professor of pediatrics at the University of Virginia School of Medicine in Charlottesville, wrote that problems with natural remedy studies typically include a lack of information about the active ingredients they contain, lack of a clear understanding of the mechanism of action, and lot-to-lot variability in the products. However, he said the COLD-fX was standardized to reduce such variability. Turner wrote that it was not clear how the effects of North American ginseng relate to viral respiratory infections. "Enhancement of interferon-gamma activity might be expected to reduce the severity of symptoms, but enhancement of the elaboration of inflammatory cytokines might be expected to increase the severity," he wrote. Few rigorous, reproducible studies have shown either conventional or alternative cold treatments to be beneficial, Turner wrote. Further studies involving well-characterized and standardized ginseng preparations were needed to confirm the results of the CMAJ study, he stated. Public health experts weigh in Paula Steib, communications director for the Association of State and Territorial Health Officials (ASTHO) in Washington, DC, told CIDRAP News in an e-mail that it's not surprising to see a metropolitan area like Edmonton stockpile a natural remedy. Canada, along with Australia, Britain, and other European countries, has a long tradition of using homeopathic and herbal remedies, which are available in pharmacies and often prescribed by physicians, she said. "The situation is very different in the US where most homeopathic and herbal remedies are scoffed at by the medical establishment," Steib said. "ASTHO is unaware of any state that is stockpiling remedies that are not part of the CDC's strategic national stockpile program." Jeffrey Duchin, MD, chief of communicable disease control for Seattle King County Public Health in Washington, said Edmonton's plan to stockpile COLD-fX for its essential employees sounded interesting, but he said it was unclear from the studies whether the remedy would be of value. "It appears safe and inexpensive, but it shows how little else people feel they have to turn to," he said. Communities that consider adding an alternative remedy to their stockpiles should weigh the costs and benefits, Duchin said. If they have met other stockpiling needs, such as having adequate supplies of oseltamivir (Tamiflu) and personal protective equipment, and still have money left in their pandemic preparedness budgets, then it might be reasonable to consider adding something extra, he said. Black said the city has increased its supplies of personal protective equipment and other items its employees would need and noted that other public health functions, including stockpiling vaccines and antivirals, are handled by the province and its health authorities. NIH says ginseng may have potential The CMAJ study caught the attention of the US National Institutes of Health (NIH), which in September 2006 included it in its annual bibliography of significant advances in dietary supplement research. "These findings suggest that North American ginseng may be an attractive natural prophylactic for upper respiratory tract infections," the NIH said. "Additional studies are needed to confirm these findings." In January, the Nutrition Action Health Letter, a publication of the Center for Science in the Public Interest, a health advocacy group, included COLD-fX in a review of eight popular over-the-counter cold remedies. The publication said that more studies are needed to confirm that COLD-fX can shorten or prevent colds or flu. "Even so, COLD-fX is the only remedy we found with any evidence that it might improve your chances of getting through the cold and flu season without coming down with something," the article said. Michaels said CV Technologies doesn't want to overstate COLD-fX's potential in a pandemic situation, but he said the company believes the product has merit and is a legitimate candidate for incorporation into pandemic plans. The company is exploring the possibility of applying for US Food and Drug Administration approval to market COLD-fX specifically as a preventive for colds and is conducting a phase 3 clinical trial for that purpose. The company also recently launched a trial to see if COLD-fX improves the immunity of healthcare workers and is investigating the precise biochemical pathways by which the product affects the immune system, according to information on the company's Web site. See also: McElhaney JE, Gravenstein S, Cole SK, et al. A placebo controlled trial of a proprietary extract of North American ginseng (CVT-E002) to prevent acute respiratory illness in institutionalized older adults. J Am Geriatr Soc 2004 Jan;52(1):13-9 [Abstract] Predy GN, Goel V, Lovlin R, et al. Efficacy of an extract of North American ginseng containing poly-furanosyl-pyranosyl-saccharides for preventing upper respiratory tract infections: a randomized controlled trial. CMAJ 2005 Oct;173(9):1043-8 [Full text] Turner B. Studies of "natural" remedies for the common cold: pitfalls and pratfalls (commentary). CMAJ 2005 Oct;173(9):1051-2 [Full text]

MILVAX, or vaccines.mil, is the military's vaccination related website. It includes this crossword puzzle and a variety of other interesting stuff, like a map of regional analysts. I'm sure people like Lyle are hip to this, but I was quite impressed, given the generally sad state of web resources in this domain. That is, of course, coming from citizen weirdness like this...

CHICAGO, May 8 — For months, Gov. Kathleen Sebelius of Kansas and other governors have warned that their state National Guards are ill-prepared for the next local disaster, be it a tornado a flash flood or a terrorist’s threat, because of large deployments of their soldiers and equipment in Iraq and Afghanistan. Then, last Friday night, a deadly tornado all but cleared the small town of Greensburg off the Kansas map. With 80 square blocks of the small farming town destroyed, Ms. Sebelius said her fears had come true: The emergency response was too slow, she said, and there was only one reason. “As you travel around Greensburg, you’ll see that city and county trucks have been destroyed,” Ms. Sebelius, a Democrat, said Monday. “The National Guard is one of our first responders. They don’t have the equipment they need to come in, and it just makes it that much slower.” For nearly two days after the storm, there was an unmistakable emptiness in Greensburg, a lack of heavy machinery and an army of responders. By Sunday afternoon, more than a day and a half after the tornado, only about half of the Guard troops who would ultimately respond were in place. It was not until Sunday night that significant numbers of military vehicles started to arrive, many streaming in a long caravan from Wichita about 100 miles away. Ms. Sebelius’s comments about the slow response prompted a debate with the White House on Tuesday, which initially said the fault rested with her. Tony Snow, the White House press secretary, said the governor should have followed procedure by finding gaps after the storm hit and asking the federal government to fill them — but did not. “If you don’t request it, you’re not going to get it,” Mr. Snow told reporters on Tuesday morning. The debate was reminiscent of the Bush administration’s skirmishes with Gov. Kathleen Babineaux Blanco of Louisiana, also a Democrat, after Hurricane Katrina. But after an angry flurry of words, both sides seemed to back down a bit later Tuesday. Ms. Sibelius said she now had enough equipment and personnel to deal with the problems in Greensburg, and the White House acknowledged that the governor had requested several items that the federal government supplied, including a mobile command center, a mobile office building, an urban search and rescue team, and coordination of extra Black Hawk helicopters. Nonetheless, the governor and officials in other states again expressed concern that the problem could occur again as the stretched National Guard system struggled to respond to disasters at home while also fighting overseas. As State Senator Donald Betts Jr., Democrat of Wichita, put it: “We should have had National Guard troops there right after the tornado hit, securing the place, pulling up debris, to make sure that if there was still life, people could have been saved. The response time was too slow, and it’s becoming a trend. We saw this after Katrina, and it’s like history repeating itself.” The Federal Emergency Management Agency, which came under strong criticism after Hurricane Katrina, seemed to respond more quickly in Kansas. Several of the agency’s mobile disaster recovery centers are in Greensburg assisting residents, and the agency said it had moved in 15,000 gallons of water and 21,000 ready-to-eat meals, enough to feed 10,000 people. State officials said the problem with the National Guard’s response had more to do with equipment than personnel. In Kansas, the National Guard is operating with 40 percent to 50 percent of its vehicles and heavy machinery, local Guard officials said. Ordinarily, the Guard would have about 660 Humvees and more than 30 large trucks to traverse difficult terrain and transport heavy equipment. When the tornado struck, the Guard had about 350 Humvees and 15 large trucks, said Maj. Gen. Tod Bunting, the state’s adjutant general. The Guard would also usually have 170 medium-scale tactical vehicles used to transport people and supplies — but now it has fewer than 30, he said. On the other hand, General Bunting said, it had more cargo trucks than it needed. The issue is not confined to Kansas. In Ohio, the National Guard is short of night vision goggles and M-4 rifles, said a Guard spokesman, Dr. Mark Wayda. “If we had a tornado hit a small town, we would be fine,” Dr. Wayda said. “If we had a much larger event, that would become a problem.” The California National Guard is similarly concerned about a catastrophic event. “Our issue is that we are shortchanged when it comes to equipment,” said Col. Jon Siepmann, a spokesman for the Guard in California. “We have gone from a strategic reserve to a globally deployable force, and yet our equipment resources have been largely the same levels since before the war.” In Arkansas, Gov. Mike Beebe a Democrat, echoed the concerns of Ms. Sebelius. “We have the same problem,” Mr. Beebe said. “We have had a significant decrease in equipment traditionally afforded our National Guard, and it’s occasioned by the fact that it’s been sent to the Middle East and Iraq.” He added: “Our first and foremost consideration is to guarantee that our soldiers have the resources, including equipment, to do the job and protect themselves. Having said that, my preference would be for the federal government to provide that equipment and not strip the state’s resources, which could adversely impact the state’s mission in times of crisis, which is what happened in Kansas.” Last year, all 50 governors signed a letter to President Bush asking for the immediate re-equipping of Guard units sent overseas. But officials in several states, including Kentucky, Minnesota and Texas, said Tuesday that they were not facing equipment shortages. National Guard units overseas are often assigned engineering missions, and the skills and equipment — bulldozers and trucks, for example — are also what might be required to deal with a natural disaster at home. White House officials said that the Kansas National Guard had at its disposal in the Midwest and the Plains states, everything it needed. By Mr. Snow’s count, that included 83,000 National Guard soldiers; 99 bulldozers; 61 loaders; 246 dump trucks and 59 graders. “There’s a lot of stuff available,” Mr. Snow said. “So, again, I think this is one where the equipment was available and everybody was moving as rapidly as possible.” In Congressional testimony, senior National Guard officials have said that since Sept. 11 units under their command had equipment shortages as forces deployed to Iraq and Afghanistan. Responding to concerns that the National Guard would not have sufficient personnel or equipment to respond to natural disasters, Guard leaders and state officials developed plans to ensure that if a state is in short supply of people or gear when a hurricane or tornado strikes, it can borrow from other states. But borrowing does not solve every problem, state officials said, and coordination can take time. The destruction from Hurricane Katrina ultimately required the help of 50,000 troops — and they came from all 50 states. Training is another issue. At a Washington news conference in February, Ms. Sebelius said, “The Guard cannot train on equipment they do not have.” She added later: “And in a state like Kansas, where tornados, floods, blizzards and wildfires can seemingly happen all at once, we need our Guardsmen to be as prepared as possible.” Two recent reports have raised questions about Guard preparedness. An independent military assessment council, the Commission on the National Guard and Reserves, released a report in March that stated: “In particular, the equipment readiness of the Army National Guard is unacceptable and has reduced the capability of the United States to respond to current and additional major contingencies, foreign and domestic.” Another report, released in January by the Government Accountability Office, concluded that the ongoing operations in Iraq and Afghanistan have “significantly decreased” the amount of equipment available for National Guard units not deployed overseas, while the same units face an increasing number of threats at home. Late Tuesday, in a statement, Ms. Sebelius repeated her message: “I have said for nearly two years, and will continue to say, that we have a looming crisis on our hands when it comes to National Guard equipment in Iraq and our needs here at home.”

On "From China to Panama, a Trail of Poisoned Medicine": As with many of the vital systems security domains, the creation of modern medical infrastructure produces new vulnerabilities. Contaminated medicine is its own "epidemic". Also interesting is the contemporary configuration of medical contamination and counterfeiting as a 'global' problem: “This is really a global problem, and it needs to be handled in a global way,” said Dr. Henk Bekedam, the World Health Organization’s top representative in Beijing. The exact chemical (diethylene glycol) culpable in Panama's deaths killed over 100 people in the U.S. SEVENTY years ago, leading to the creation of the FDA. What security measures will be put in place on a global scale?

Ambrogina Conobbio -- a former student at New School International Affairs now working in New York City public health -- sends along "critical releases in Homeland Security," described by DHS as follows: "Every two weeks, the Homeland Security Digital Library identifies 'Critical Releases in Homeland Security,'a targeted collection of recently-released documents that are expected to influence homeland security policy & strategy development." The list of documents (below) is itself kind of fascinating, if only to get a sense of what a confused creature "Homeland Security" is in the United States (you have to create an account on their website to actually see the docs). Climate change, aviation security, country terror threat reports...How in the world could one agency possibly be concerned with all these things? Clearly, as we already know, "Homeland Security" is an answer to a question that has not been clearly posed. National Strategy for Aviation Security United States. White House Office Nuclear Energy; Balancing Benefits and Risks Council on Foreign Relations United States Intelligence Community (IC) 100 Day Plan for Integration and Collaboration United States. Office of the Director of National Intelligence Task Force on Returning Global War on Terror Heroes United States. Department of Veterans Affairs. Task Force on Returning Global War on Terror Heroes Country Reports on Terrorism 2006 United States. Dept. of State National Security and the Threat of Climate Change CNA Corporation

"World Without Oil" is an alternative reality game--not a video game or a "world" but more like a cross between a writing contest and a role-playing game. It asks participants to imagine what an oil shock would look like, and what living without oil will do to their lives, in real time, as the "oil shock" scenario unfolds. Thus it shares something with the scenario stylings of our vital systems friends, but one that is going directly to the people--albeit probably to preteens, hipster bloggers and youtube users first. What makes it so interesting is that it is actually very technically thin: just a web site where you submit links to content you create on your website, blog, video or by telephone. The site "masters" grade the content and choose the winners--presumably with the aim ofcollecting  a set of scenarios that might otherwise be difficult to generate. I'm skeptical that this particular game will get interesting, but the real issue is that it is pure genius.  I'm sure there will be others... DHS, please take note.