Vital Systems Security

The blog Effect Measure argues that it is too early to write off the severity of this H1N1 influenza strain.  The blogger notes that the most common “underlying medical condition” is asthma (30% of hospitalized adults and 33% of hospitalized children).  And “we’re not talking about uncontrolled asthma. Just having asthma and having it mentioned in the medical record is enough to put you in the “underlying medical condition” category.”

The novel H1N1 virus has been elected the “virus of the year.” According to the journal Science, the pandemic was a “near miss.” As the authors of the short piece argue, the “H1N1 virus was less virulent than feared, but the next pandemic could be worse.” Prepare for the next pandemic is the message.

What kind of work is the trope of the Next Pandemic doing? Might it not be worth investigating the current pandemic first, before we jump to the next? Before we orient ourselves towards the near future, it might be necessary to first inhabit the recent past in some meaningful way. What, in fact, has just happened? Apparently, it is easier for experts to take responsibility for the future than for the past.

Just to remind ourselves:

1. Most experts predicted the emergence of an H5 virus. It was an H1 virus.

2. Most experts predicted that the pandemic would start off in South-East Asia. It turned out to be closer to home.

3. Most experts predicted that it would be a devastating event. WHO now calls it a “moderate” pandemic.

4. Most experts predicted serious consequences for critical infrastructure.

Good luck with the next predictions! Trust your expert!

Calculations of the severity of the novel H1N1 influenza pandemic have been sorely lacking.  As Laurie Garret and other experts noted early on, the lack of an index of severity in WHO’s pandemic alert system perhaps led some governments—and certainly much of the public—to consider ‘pandemic’ as an indication of danger rather than a reflection of geographical prevalence.  H1N1 was responded to as if it were the actualization of the potential H5N1 outbreak everyone was waiting for.  Or it was for a moment.  For no sooner did some numbers start coming in then the threat began to be downplayed: death rates appeared far lower than seasonal flu.

Now, in a report issued on December 12th by CDC, we have some more numbers about how many people have caught the pandemic flu, how many have been hospitalized and how many have died in the United States.  The summarized data presented in the media is distilled in the number 9,820: deaths from H1N1.  This is usually presented either to downplay the severity, by comparing the number to the 36,000 seasonal flu deaths estimated to occur each year; or, conversely, to demonstrate the danger of the outbreak through a comparison with the previous estimate, one month ago, of only 3,900 H1N1 deaths.  But as we know with influenza, it is important to get behind the numbers.  How are these calculations made?
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Behemoth – A peer-reviewed journal published by the Akademie Verlag, Berlin

Special Issue: Epidemic Orders

In the past few years, epidemic events, both actual and virtual, have made a spectacular comeback. Emerging and re-emerging infectious diseases such as avian and swine flu have generated great anxiety the world over, resulting in a pervasive sense of vulnerability, insecurity, and uncertainty. A powerful spirit of urgency, based on a genuine concern for human health and well-being, overdetermined by a variety of scientific, political, and economic interests, engendered a real flurry of action. In the epic battle against germs, the biopolitical state mobilized material and symbolic resources at an unprecedented scale.

In the shadow of the emerging infectious disease threat, significant shifts in public health, medical care, and scientific research have occurred. The aim of this special issue of Behemoth is to offer an initial set of diagnostic accounts. What are the domains in which fundamental shifts have occurred over the past few years? Who are the actors involved and what are the underlying logics animating these shifts in public health, medical care, and scientific research? The key aim of this issue is to draw analytic attention to recent reconfigurations and to identify the kind of epidemic orders that are taking shape today at the heart of the biopolitical state.

Please send abstracts for this special issue of Behemoth to the editor Carlo Caduff (carlocaduff@access.uzh.ch) and to Kathrin Franke (behemoth@rz.uni-leipzig.de). Deadline for submission of abstracts: 30 January 2010. Deadline for submission of articles: 30 June 2010.

The President’s Council of Advisors on Science and Technology has released its assessment of the coming swine flu resurgence and the US Government’s preparedness efforts. Press release here and full report here.

Hopefully some of our resident second order observers of pandemic preparedness can do some parsing for us…

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, 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, 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., 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, Texas, or Mexico within the past 7 days
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A World Health Organization official today signaled that the agency is stepping back from plans to develop a way to grade pandemic severity, because its experts believe severity will vary from place to place, making the development of a severity index difficult and its use impractical.

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), defined as the number of cases one case generates on average, is a key measure of transmissibility.

http://www.sciencemag.org/cgi/content/abstract/1176062

The register also has a lovely article lamenting the lack of really good panic.