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By: Lyle Fearnley
Posted in swine flu on May 22nd, 2009

Order ativan online cheap, I have for a while now encountered skepticism from people who believe that the number of Novel Swine-Origin H1N1 influenza cases (especially in New York and Massachussetts) is being vastly underreported by public health authorities.  The claim is intriguing because of the fact that public health authorities are not testing comprehensively for H1N1, instead only testing cases of severe illness.  Thus the cases of “confirmed” H1N1 may be far lower than the actual total number of cases.

How is influenza diagnosed and why isn’t every suspected case tested?  First, Hawaii HI , Price of ativan, testing for influenza is a multiple-tiered process.  Tracking the NYC Department of Health “Health Alerts” over the course of the epidemic demonstrates the rationale and infrastructure behind the shifting diagnostic policies in one public health department.  In the first report, from April 24th, order ativan, Koop korting ativan, the Department requested that physicians seeing patients in the following categories test for influenza A using a nasopharyngeal swab and a commercially available rapid test, PCR or immunofluorescence test (e.g., ativan cheap, Acheter en ligne ativan, DFA or IFA):
(1) hospitalized patients with severe febrile respiratory illness of unknown etiology, or
(2) outpatients with influenza-like illness (ILI) who have traveled to California, Idaho ID , Ativan sale, Texas, or Mexico within the past 7 days

One essential point about the tiered dignostic infrastructure emerges here.  Physicians primarily have access only to the commercially available rapid tests.  This CDC website provides a list of the complicated and redundant variety of commercial tests.  Some, buy ativan, Delaware DE Del. , but not all, are able to distinguish between Influenza types A and B in addition to a basic diagnosis of influenza.  At this initial stage, Alabama AL Ala. , Billige ativan apotek, influenza A diagnoses would be sent to the Public Health laboratory for subtyping with “possible further testing to occur at CDC.”

In the health alert from April 25th, the Department reports that cases from the NYC high school were identified as Type A, Arkansas AR Ark. , Købe ativan online, and were unsubtypable as H1 or H3 by the City Public Health Laboratory and were therefore sent to CDC.  At this moment, there are at least three tiers of testing: physicians can distinguish Type A or B, Nebraska NE Nebr. , Ativan for sale, City health department can distinguish known influenza strains of H1 or H3, and CDC can diagnose Novel H1N1.  At this point, osta alennus ativan, Köpa ativan, while they continued to advise testing with severe febrile respiratory illness of Influenza Type A, they also strongly discouraged testing of people with mild influenza-like illness, Minnesota MN Minn. . Wisconsin WI Wis. , “At this time, we are not recommending routine influenza testing and/or antiviral
treatment for persons with mild influenza-like illness, ativan ordine on-line, Florida FL Fla. , unless they meet the usual
criteria for empiric influenza treatment based on underlying illnesses that put them at higher risk for complications of any type of influenza.”

As explained in the most recent health alert, updating those reccomendations, New Jersey NJ N.J. , Buy ativan online, “At the beginning of the Novel H1N1 Influenza outbreak in late April, DOHMH initially recommended that rapid testing NOT be used for patients with mild ILI due to concerns that this newly emerging virus might lead to a severe pandemic.  This recommendation was made in order to conserve supplies of rapid test kits, buy ativan online legally, and to prioritize testing for hospitalized patients with more severe disease.”
At least in the early stages, then, there was concern that commercially available rapid tests would be over-used, leading to shortages that could be critical if the outbreak increased in scale or severity.  The alert also adds more detail to the multiple tiers of diagnosis.  Again, physicans and hospitals primarily utilize commercially available rapid tests that (at best) are able to distinguish between Type A and B.  New York City's public health laboratory utilizes RT-PCR that is able to diagnose seasonal influenza strains H1N1 and H3N2, and--by May 12, but not at the outset--confirm probable Novel H1N1.  Commercial laboratories were--as of May 12th--unable to diagnose Novel H1N1.  Viral culture diagnosis for  Novel H1N1 is only possible at CDC.

Finally, as of May 12th (the last health alert) the testing policy has been toward practices used for diagnosing and treating seasonal influenza.

“Testing for influenza is strongly recommended for:
• All patients being admitted or currently hospitalized with acute febrile respiratory illness, including
fever>100.4G F or 38.0 CG AND influenza-like illness, ARDS, pneumonia or respiratory distress.
• All patients admitted to the hospital with non-respiratory syndromes who develop acute febrile
respiratory illness > 48 hours after hospital admission.
Testing for influenza should be considered for the following patients with ILI:
• Outpatients who are at high risk for complications of influenza (see Table 2. List of underlying
conditions).
• All patients who are household contacts of persons with conditions placing them at higher risk for
complications due to influenza (including pregnancy).”.

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By: Carlo Caduff
Posted in avian flu, biopolitics, bioscience, risk, swine flu on May 14th, 2009

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By: Andrew Lakoff
Posted in Uncategorized on May 13th, 2009

In a recent Newsweek article Order ativan without prescription, on the swine flu pandemic, Laurie Garrett ties together two seemingly disparate problems: the global meat industry and "viral sovereignty." First, she analyzes the swine flu outbreak through the lens of disease ecology, whose vision of pathogenic globalization was a central element in the “emerging disease” framework as initially articulated in the late 1980s.  In this vision, new diseases are constantly emerging due to the conjuncture of natural ecological processes and massive human transformations of the environment:

“We live in a globalized world, filled with shared microbial threats that arise in one place, are amplified somewhere else through human activities that aid and abet the germs, and then traverse vast geographic terrains in days, even hours—again, thanks to human activities and movements. If there is blame to be meted out, buy ativan no prescription, Billig kaufen ativan, it should be directed at the species Homo sapiens and the manifest ways in which we are reshaping the world ecology, offering germs like the influenza virus extraordinary new opportunities to evolve, West Virginia WV W.Va. , Ativan, mutate and spread.”

She then argues, from the vantage of disease ecology, comprare ativan, Buy ativan overnight delivery, that the global meat industry is the appropriate site of blame for the emergence of the new strain of H1N1 – and for further pandemics to come: “It is a strange world wherein billions of animals are concentrated into tiny spaces, breeding stock is flown to production sites all over the world and poorly paid migrant workers are exposed to infected animals… This is the ecology that, online ativan, Ativan online cheap, in the cases of pigs and chickens, is breeding influenza, Osta ativan online. Michigan MI Mich. , It is an ecology that promotes viral evolution. And if we don’t do something about it, Jotta ativan verkossa, Buy ativan without prescription, this ecology will one day spawn a severe pandemic that will dwarf that of 1918.” What is striking here is that it is not Mike Davis making the argument that the US meat industry is a zone of virulence, but rather a Senior Fellow at the Council on Foreign Relations, pharmacy ativan. Cheapest ativan, The article then moves from the danger posed by the global meat industry to another danger: what she calls “viral sovereignty.” Here she refers to the claim made initially by Indonesian Health Minister Siti Supari that nation-states have intellectual property rights to H5N1 viruses found in the country, which Supari has used as the basis for refusing to share these viruses with WHO as part of its influenza early warning system (GISN), Oklahoma OK Okla. . Kjøpe ativan online, Garrett writes: “The principle of viral sovereignty directly imperils the entire global community--as well as Supari's own people.”  The Muslim Brotherhood in Egypt has now adopted this position against virus sharing, and further, cheap ativan, Køb billige ativan, has demanded that the US Naval Medical Research Unit in Cairo be shut down.

What brings Garrett's two diagnoses - of the pathogenic meat industry and of dangerous virus politics - together, buy ativan c.o.d.. Comprar en línea ativan, Disease ecology indicates that we need global transparency to track and contain outbreaks of novel pathogens.  Thus, for Garrett, cheap ativan online legally, Order ativan pills, Mexico provides a model of compliance with the needs of global health surveillance – showing the world “how a responsible nation can respond to a potential pandemic.”. Cheap ativan. Cheap ativan from canada. Ativan generic.

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By: Carlo Caduff
Posted in avian flu, biopolitics, bioscience, swine flu on May 13th, 2009

Buy klonopin c.o.d., A new study on the swine flu virus by Neil Ferguson and his colleagues, published in Science, has shown that transmissibility of the swine flu virus is substantially higher than seasonal flu and comparable with lower estimates of R0 obtained from previous pandemics. The reproduction number (Ro), order klonopin from canada, Klonopin en ligne afin, defined as the number of cases one case generates on average, is a key measure of transmissibility, New Hampshire NH N.H. . Kjøpe klonopin online, http://www.sciencemag.org/cgi/content/abstract/1176062. Köpa rabatterade klonopin. Osta alennus klonopin. Klonopin online. Cheap klonopin pills. Klonopin without prescription. California CA Calif. . Klonopin generic. Klonopin pedido en línea. Billiga klonopin apotek. Ohio OH . Acheter klonopin bon marché. Klonopin prescription. Discount klonopin. Indiana IN Ind. . Rabatt kaufen klonopin. Ordering klonopin from canada. Halvalla klonopin apteekki. Order klonopin pills. Klonopin pharmacy. αγοράζουν online klonopin. Buy klonopin online.

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By: Stephen Collier
Posted in Uncategorized on May 12th, 2009

Buy klonopin cod, Over the last few weeks – both before and after they were officially released – a great deal of critical attention has been turned to the “stress tests” that were organized by the Treasury Department to determine the health of major U.S. Cheap klonopin overnight delivery, banks. A major criticism of these tests has been that the “adverse scenario” used in them is actually not that adverse, order klonopin overnight delivery. Buy klonopin no rx, It makes assumptions about economic growth, employment, Tennessee TN Tenn. , Ordering klonopin pills, rates of mortgage default, and other factors that hardly constitute a “worst case scenario.” Consequently, comprar klonopin de descuento, Buy klonopin, argue these critics, the “stress tests” do not really “stress” the banks at all. 


In light of this criticism, klonopin without a prescription, Generic klonopin, a discussion has emerged about what the point of these stress tests really are, and I think that this secondary discussion is quite interesting for us in understanding how these stress tests relate to some of the phenomena that we have been thinking and writing about, pharmacie klonopin bon marché. Buy klonopin c.o.d., A major argument that has been made by defenders of these stress tests – and it is an argument that I find quite convincing – is that in fact the “adverse scenario” is in no way shape or form intended to present a “worst case” scenario. We know what would happen in a worst case scenario: the government would take these banks over and guarantee their deposits, buy klonopin cod. Instead, North Carolina NC N.C. , Köpa klonopin online, the stress tests are supposed to present a “moderately bad” scenario, one in which it is possible that a system of regulation based on mandated reserve ratios or capital requirements would allow banks to weather the storm without further government intervention.


The point I would make here is this: In some important ways, Idaho ID , Comprar en línea klonopin, the stress tests resemble catastrophe modeling on a technical level. That is, goedkope klonopin apotheek, Cheap klonopin online without prescription, they collect a tremendous amount of data about the banking system, and then run simulations to understand how it would respond to certain adverse conditions, where to buy klonopin. Arkansas AR Ark. , But on the level of political technology it works differently. In areas such as civil defense, West Virginia WV W.Va. , Georgia GA Ga. , pandemic preparedness, or catastrophe insurance, comprare klonopin sconto, Comprare klonopin, the point was really to understand how a system would respond if the worst imaginable thing actually came to pass. In the case of the stress tests, New York NY N.Y. , Buy klonopin overnight delivery, the question is whether the system could make it through a reasonably adverse economic scenario without external intervention.


Taking this point one step further, it seems that what is emerging is perhaps a two-tiered system for financial system security. On the one hand, there is continued acknowledgement that in the absolutely worst cases – the “unthinkable” economic emergencies – the remedy will be government intervention to save the banking system. On the other hand, mechanisms like the stress test are intended to ensure that the banking system could survive on its own under moderately adverse economic conditions. In the future, the stress test might, of course, serve another role as well, as was suggested yesterday in the New York Times Breaking Views blog: It could be institutionalized as the basis for a more flexible kind of financial regulation, one that did not set hard and fast rules about capital requirements or reserve ratios, but that used much more intensive exchange of data to assess banks financial position, and to try to prevent the kinds of risk exposures that led to the current crisis.


How does this map onto our thinking about emerging concepts like systemic risk regulation as an example of vital systems security?

.

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By: Stephen Collier
Posted in Uncategorized on May 7th, 2009

Gary Becker and Richard Posner Buy klonopin online cheap, on the economics of pandemic preparedness. Can't say it is massively enlightening, cheap generic klonopin. Købe klonopin, But the Posner in particular has an interesting update of Foucault's cost-benefit analysis of vaccination (in this case related to vaccine developement and other preparedness measures) to the modern global pandemic. Acquistare online klonopin. Buy klonopin from canada. Ordering klonopin. Billige klonopin Apotheke. Kjøpe klonopin. αγοράσετε klonopin. Klonopin online stores. Cheap klonopin online cheap. Cheap klonopin online. φτηνές φαρμακείο klonopin. Ordering klonopin online legally. Osta klonopin. Buy klonopin without prescription. Order klonopin online cheap. Comprar klonopin. Kjøpe billig klonopin. Rhode Island RI R.I. . Pharmacy klonopin. αγοράζουν φτηνά klonopin. Missouri MO Mo. . Where to buy cheap klonopin. District of Columbia DC D.C. . Købe klonopin online.

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By: Lyle Fearnley
Posted in Uncategorized on May 7th, 2009

People are actively attempting to infect Buy cheap klonopin online, themselves with the "mild" strain of H1N1, hoping to give themselves immunity in case more severe strains appear in the future. Resonates with the DIY Bio folks, Wyoming WY Wyo. . Osta klonopin online, Also, another example of the power of the 1918 pandemic analogy: the rationalization is that the 1918 flu had a mild spring wave, cheapest klonopin online, Cheapest klonopin, and two severe fall and winter waves. My sense is that there is no reason to assume this strain will behave similarly, buy klonopin online without prescription. Klonopin. Klonopin prices. Klonopin discount. Mississippi MS Miss. . Köpa billiga klonopin. Ordering klonopin no rx. Acheter klonopin discount. Connecticut CT Conn. . Ordering klonopin overnight delivery. Ordering klonopin no prescription. Cheapest klonopin prices. Cheap klonopin online. Delaware DE Del. . Cheapest klonopin in the world. Price of klonopin. Buy klonopin without prescription. Buy cheap klonopin. Acquistare a buon mercato klonopin. Køb discount klonopin. Acheter en ligne klonopin.

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By: Andrew Lakoff
Posted in Uncategorized on May 5th, 2009

Buy klonopin without prescription, “What things are contemporary. Consider a late model car, Minnesota MN Minn. . Klonopin farmacia a buon mercato, It is a disparate aggregate of scientific and technical solutions dating from different periods. One can date it component by component: this part was invented at the turn of the century, Nebraska NE Nebr. , Cheap klonopin no prescription, another, ten years ago, αγοράσετε klonopin έκπτωση, Buy generic klonopin, and Carnot’s cycle is almost two hundred years old." - Michel Serres (1995)

“Rabadan suggests the way to think of this flu is like a homemade car with parts from different vehicles. The parts have all been in several different vehicles before, Texas TX Tex. . Wisconsin WI Wis. , Sometimes the combination of parts is a dud and the car doesn't move. And sometimes you get a race car, cheap klonopin online legally. Alabama AL Ala. , A pandemic is a race car.” - Associated Press (5 May 2009). Cheap klonopin no rx. Order klonopin c.o.d.. Klonopin no prescription. Purchase klonopin. Nevada NV Nev. . Florida FL Fla. . Klonopin over the counter. South Carolina SC S.C. . Billige klonopin apotek. Cheap klonopin from canada. Buy cheap klonopin online. παραγγείλετε online klonopin. Kaufen klonopin. Ordering klonopin online cheap. Um klonopin online.

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By: Stephen Collier
Posted in Uncategorized on May 4th, 2009

Order klonopin without prescription, "We are far from out of the woods" seems to be the mantra among the public health officials who have to speak to the public. Jotta klonopin verkossa, But for right now, it seems clear that this round of H1N1 is not nearly as serious as many initially feared, Kentucky KY Ky. . Cheap klonopin without prescription, In this light, I wanted to provoke all those of you following this more closely to brainstorm a bit about what exactly the "lessons learned" might be from this event for different experts and policymakers, Køb billige klonopin, Oklahoma OK Okla. , and what, for us, order klonopin online legally, Billig kaufen klonopin, are the emerging sites of reproblematization, where existing undersatndings and practice are called into question, ordering klonopin online. Billig klonopin apotek, One possibility is that there will be a certain amount of derision about the level of alarm that was raised. But my sense is that this will mostly be limited to late night comedy and right wing talk, cheap klonopin.

Another possibility is that there will be intensive discussions about the issues that Carlo has been raising, concerning the relationship between the current "phase" definitions and levels of political and medical mobilization and response, order klonopin without prescription. Kjøp Discount klonopin, As Carlo wrote:

One of the interesting questions is the following: If this virus (which we are not allowed to name anymore …) continues to circulate among humans, will the WHO announce phase 6, kopen goedkope klonopin, Farmacia klonopin baratos, i.e. a full-scale pandemic, order klonopin no rx. Illinois IL Ill. , With a virus that seems to cause not much mortality, this will be a difficult question, buy klonopin cod. Acheter klonopin, I really doubt that they will announce phase 6, even if all the criteria of phase 6 are essentially met, buy klonopin no prescription. The pandemic alert scheme might soon need extensive revision …

Order klonopin without prescription, A third area of reflection might have to do with interpreting the performance of health authorities in Mexico and drawing conclusions for global health surveillance. Hawaii HI , It seems to me that the initial sense is that once the Government got into its disciplinary lockdown mode, it did pretty well, klonopin online cheap. Maine ME Me. , But it is also obvious that everyone would have liked for there to be more laboratory capacity right at the beginning, such that the case and death counts would not have been exaggerated at the beginning, Montana MT Mont. . Order klonopin without prescription, Everyone knows that basic public health surveillance globally is crucial to a global health preparedness system, but investment in basic lab capacity is a different issue, Virginia VA Va. . Pennsylvania PA Penn. , A fourth area has to do with the question of how seriously to take H1N1 moving forward, what measures to take in preparation for a more serious outbreak, and what measures to take to prevent such an outbreak. In the former case, one key question is obviously going to be vaccine development, order klonopin without prescription. My understanding is that there is no decision about whether to proceed, but I don't understand what the issues are. In the latter case there may be a whole series of questions, such as farm biosecurity. I have heard that one of the major concerns is large-scale transmission to pigs (again) which would create conditions for recombination into more virulent forms.

Thoughts on these or others.

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By: Carlo Caduff
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