Tuesday, April 28, 2009

Swine flu facts and the Model State Emergency Health Powers Act

Mexico has closed all public functions and schools, restaurants too, through Cinco de Mayo, until May 6 and beyond. Other countries are following suit with various travel restriction bulletins or other warnings.

The military is monitoring the outbreak, something they would naturally do since the CDC invoked the "declaration of public health emergency." Doing so can invoke the Model State Emergency Health Powers Act (MSEHPA) which in turn (depending on which state you are in that has passed it) use the military.

Under the Model State Emergency Health Powers Act, upon the declaration of a "public health emergency," governors and public health officials would be empowered to:

1. Force individuals suspected of harboring an "infectious disease" to undergo medical examinations.
2. Track and share an individual's personal health information, including genetic information.
3. Force persons to be vaccinated, treated, or quarantined for infectious diseases.
4. Mandate that all health care providers report all cases of persons who harbor any illness or health condition that may be caused by an epidemic or an infectious agent and might pose a "substantial risk" to a "significant number of people or cause a long-term disability." (Note: Neither "substantial risk" nor "significant number" are defined in the draft.)
5. Force pharmacists to report any unusual or any increased prescription rates that may be caused by epidemic diseases.
6. Preempt existing state laws, rules and regulations, including those relating to privacy, medical licensure, and--this is key--property rights.
7. Control public and private property during a public health emergency, including pharmaceutical manufacturing plants, nursing homes, other health care facilities, and communications devices.
8. Mobilize all or any part of the "organized militia into service to the state to help enforce the state's orders."
9. Ration firearms, explosives, food, fuel and alcoholic beverages, among other commodities.
10. Impose fines and penalties to enforce their orders.

Considering that Executive Order 51, signed by President Bush last May allows the President to establish an "enduring Constitutional Government" under which the Executive Branch alone has authority and powers, (martial law) and considering that Rahm Emanuel, chief of staff for President Barack Obama is on record as saying that "you should never want a serious crisis to go to waste... an opportunity to do things you think you could not do before..." and considering that CDC and Homeland Security shared the podium at yesterday's news conference (well, you connect the dots as to the next steps in this public health emergency.

The CDC reports that it has spread to six states with 64 confirmed cases. When a swab comes in for testing, they first test for Influenza-A, then go forward if positive for sub-set testing to conform the swine variation. However, that two-step process is slowing down the testing considerably, so California announced that "From now on when we are unable to sub-type Influenza-A virus, we have been directed to conclude the test has, in fact, detected swine flu," and New Zealand declared the same. At the same time, the WHO declared that containment is no longer possible and they just want to slow the spread.

CDC's list of US cases is up to 40 , 50, 64 cases. If it gets to 80 today that is a doubling since yesterday and certainly worth noting.

FYI, New York Times also has a world map-flu tracker here.

There are many reasons that local and national governments, the CDC, and WHO are concerned. Even though there have been no deaths in the US or elsewhere yet, there are items to consider about this particular version of the flu:

waves: pandemics occur in waves. The second wave is more fatal than the first. In the case of this 2009 outbreak, scientists fear that the first wave may have largely gone undetected, allowing wide spread virus transmission.

"In the 1918–1919 pandemic, a first or spring wave began in March 1918 and spread unevenly through the United States, Europe, and possibly Asia over the next 6 months (Figure 1). Illness rates were high, but death rates in most locales were not appreciably above normal. A second or fall wave spread globally from September to November 1918 and was highly fatal. In many nations, a third wave occurred in early 1919." source

Scientists are concerned because they are not sure if they are seeing the first or the second wave. If it is the first, this disease will seem to have died down and then in the fall it would reappear with devastating results. So...pray!

recombinant "Although the airborne virus is called swine flu, it is a recombinant mixture of DNA segments from pigs, birds and humans. The virus is a new genetic strain, which medical experts say could mutate into an even more dangerous variant of potentially pandemic proportions, since no one would have immunity to it." source. It is what makes the second wave so deadly: the virus re-adapts.

cytokine storm: As it was in the 1918 flu pandemic, it attacked adults in the demographic of 25-55 year olds, with healthy immune systems. The normal flu attacks young children and the elderly first. The difference is that in 1918 as it is now with this version of the swine flu, it causes a cytokine storm. When the immune system is fighting pathogens, cytokines signal immune cells such as T-cells and macrophages to travel to the site of infection. In addition, cytokines activate those cells, stimulating them to produce more cytokines. Normally, this feedback loop is kept in check by the body. However, in some instances, the reaction becomes uncontrolled, and too many immune cells are activated in a single place." The immune system gets overswamped, and you die.

Interestingly, scientists cannot figure out why the flu is lethal in Mexico and has not been anywhere else.

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