Tuesday, May 19, 2009

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Big News, Little Time

TUE 19 MAY - 8:45 AM. The development of this year's first tropical system signals the annual shift on this site to tracking Atlantic basin storms. (5/21 Edit- "invest 90L" apparently dissipated but heavy tropical rains will affect Florida and the southeast coast all weekend.) To speed your access to relevant information, I have many improvements planned, and hope the tropics will permit time to complete the upgrades.

A larger issue looming on the climate analysis horizon is the start of a neutral to weak El Nino trend heading into summer. This shift will most certainly impact the outcome of Atlantic basin tropical systems. Long range projections suggest a weak to moderate Nino persists into the winter month. If this coincides with the slowly rebounding solar minimum, the Northern Hemisphere could be in for one heck of a blockbuster winter regarding coastal snowstorms and frequent cold spells.

Spread of H1N1 Influenza A remains a top concern with regard to the inter-disciplinary aspects of climate, weather and infectious diseases. Consider looking over this intriguing Accuweather report about the connections between El Nino and Influenza. The CDC believes cases among school-age children should decrease once summer vacation begins, but the increasing rate and severity of infections reinforces the uncertainty on what's really driving the virus right now. A separate website, called "Foot's Flucast" is being developed to monitor flu activity heading into our summer, and the southern hemisphere winter.

Frequency of posts will decline after June 29, as I am joining the Baltimore Ecosystem Study as part of a Summer Research Fellowship with Towson University. It will be an exciting time of hands-on field investigations throughout the Baltimore region, as I will assist a research scientist from UMBC in the areas of urban hydrology and geomorphology (that's the study of how ground water behaves in urban environments and landforms.) Where appropriate and approved by my mentor scientist, I hope to post an overview of the project later in the summer.

Thursday, May 7, 2009

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Humidity & Flu: A connection?

THU 7 MAY - 10:00 AM. Loyal and new readers alike have been waiting patiently for a return to normalcy on this site. I have heard your pleas! To start the transition, I present this "bridge" topic to further our understanding of the synergistic relationships between climate and human health. A February 2009 report to the National Academy of Sciences raised intriquing theories about the apparent increased ability of viruses to survive and transmit among humans in cold and dry conditions versus that which is warm and wet. Talk about relevant weather and relationships to climate. Adding influenza to this mix creates an inter-disciplinary concept so big it's going to take some time to wrap my head around it! A direct quote from the article:
"It seems that the influenza virus' ability to survive and be transmitted person-to-person is greatly affected by how dry or wet the air is," says Jeffrey Shaman, Ph.D., an atmospheric scientist at Oregon State University in Corvallis, who specializes in ties between climate and disease transmission, and a co-author of the new study.

This introduces a whole new world of research possibilities that are just fresh out of the gate. I encourage any of you or your students to investigate, including:

(1) Cross-referencing spread of the H1N1 outbreak with April daily humidity data in Mexico, New York, Texas and California: what patterns or indications might this reveal?

(2) Comparing that data to climate norms: Was it more or less humid than normal at onset? Could this have influenced the March-to-April outbreak phase in Mexico?

(3) Real-time tracking of current humidity and temperature data as compared to spread of the virus in the Maryland or the eastern U.S. Has our recent washout slowed progress of the virus?

(4) Historical analysis of temp/humidity data in the fall of 1918: Did this influence velocity of the lethal second wave that swept the globe in two months (when trans-Atlantic travel alone took a week or more?) For a glimpse at early research on this very idea, review a 1923 report by the Canadian Medical Association Journal. Now that's what I call back in the day.

The organizing question going forward would be: Could weather data be used to predict how a reassorted virus might spread in a second wave this fall? Things that make you go hmmm....

Tuesday, May 5, 2009

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TUE 5 MAY - 10:00 pm. A sigh of relief is heard across the country as the CDC issues updated interim guidance on K-12 school closures. It would appear that while the virus remains high transmissible, it has a low infectivity rate, which is the technical way of saying: "Not everyone who gets exposed will get sick." There is much good news from this development, but health officials at the CDC and WHO remain very cautious about what may come this fall. It's just as important to recognize that Mother Nature has given the entire world a full dress rehearsal for how we might react in a severe pandemic. This is not to suggest the suffering of those whom lost loved ones is merely a statistic in order to better our lives through their pain.

On the contrary, all societies will stand to benefit from the volumes of knowledge disease researchers have gained the past few weeks. That knowledge will go on to save and improve lives this fall and beyond should H1N1 reassort in the southern hemisphere or elsewhere. All those who fell ill or passed away in this outbreak did not do so in vain. Their "involuntary participation" in an startlingly-fast influenza epidemic will serve the greater good of all humanity for a long time to come. The unfortunate news is that for public health professionals and governments alike, the real surveillance period has just begun. We're still at WHO Phase 5, signaling that a pandemic is imminent, and it may be some time before that backs down. In preparation for that day, the gathering of research continues.

Over the next week, the majority of flu monitoring links on this site will be transferred to a new website titled "Foot's Flucast" complete with it's own URL. From there you will continue to have quick glance access to the latest auto-updating features in order to track the H1N1 situation in the US and around the world. On-going research about this virus and the mitigation strategies for a secondary outbreaks will remain priority topics on that site.

To the many faithful readers, please accept my thanks and appreciation for your patience during this whip-lash of a topic shift from weather to influenza. I'm sure many of you are suffering from "flu fatigue" by now, and would welcome back the good old days of simply tracking hurricanes. That time will be here soon enough my friend, soon enough.

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TUE 5 MAY - 9:30 AM. I suppose that today is a happier "Cinco De Mayo" for some but not for others. Ten days into the world's first brush with a pandemic-like outbreak, it is encouraging to hear cafes in Mexico city are re-opening and some Queens, NY students are back to class. Still, doesn't it feel we're caught in some twilight zone of uncertainty? Many want to be cautious, but are not sure how to interpret conflicting expert opinions on where to go from here. If you find yourself in that grouping, good company abounds. For example, the Montgomery County, MD School superintendent is taking steps to challenge whether Rockville High School should remain closed. Signals from the CDC indicate the K-12 school closure guidance may be scaled down this week based on data and feedback. With statewide assessments and senior finals bearing down, a decision is eagerly anticipated.
This recent article by Time magazine appropriately captures our current state of "pandemiconium" yet reminds us all that viruses, a freak of nature to begin with, have one predictable constant: unpredictability. (Source: Atlanta Journal & Constitution article - 5/3/09)
Public health officials know that if history is valued for this situation, then we know two lessons about all pandemics since 1889: (1) more than one wave; (2) the second wave was not mild. Whether our society can truly internalize those lessons, only time will tell.

Sunday, May 3, 2009

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Containing the confusion

MON 4 MAY - 2:00 PM. Despite contradictory reports in the media, this virus could be noticeably present in the human population for the 6 to 18 months regardless of it's severity. While Mexico's outbreak should begin declining as this is near the end of their first six- to eight-week wave, the World Health Organization (WHO) cautions against complacency going forward. To that end, this is a unique opportunity to learn about the policies and rationales that now govern closing of schools in a pandemic, so you can be an informed observer of the situation.
To deepen understanding about this virus, the Center for Infectious Disease Research and Policy (CIDRAP) has published this excellent and in-depth "study sheet" on all available scientific knowledge on H1H1 at present. ProMED mail is a daily report from the International Society of Infectious Disease detailing all credible public health threats and providing extensive background or explanation behind data reported in regular media.
Consider these two issues below regarding the different environments this virus will encounter, and the natural human tendency to "let our guard down" at the first sign of improvement. In designing this site, the objectives are to you with provide authentic sources and credible reporting that emphasize scientific facts, not false hopes.
(1) THE HEMISPHERIC FLU SEASON PROBLEM: The seasonal flu period is about to begin in the southern hemisphere, and this introduces a new set of concerns. (Source: Google news article - 5/4/09). On the BBC world map, it is clear H1N1 is appearing below the equator in places like Colombia and New Zealand. This increases the likelihood over the next few months for this virus to infect someone already possessing seasonal human influenza. Would that not provide ideal opportunities for genetic reassortment and emergence of a novel strain that may be more lethal and transmissible? This is the prime reason why public health authorities across the globe are mobilizing their pandemic plans.
Highly regarded administrators such as Dr. Margaret Chan, WHO Director-General said in a weekend interview with the London Financial Times that an apparent decline in mortality rates outside and within Mexico does not mean the (epidemic) was ending. “We hope the virus fizzles out, because if it doesn’t we are heading for a big outbreak.” She went on to say: “I’m not predicting the pandemic will blow up, but if I miss it and we don’t prepare, I fail. I’d rather over-prepare than not prepare.”

(2) THE WEAKENING HURRICANE PROBLEM: With the first inkling of a decrease in new cases within Mexico, US and British news media seem eager to sound the "all clear." Contrast this with the start of an exponential rise in new cases worldwide outside of Mexico, and we are encountering the same misconception epidemic that pervades hurricane season. Effect Measure, a forum operated by public health professionals, has a short but thought-provoking essay on this same topic.
Remember how the media seem to enjoy hyping up an approaching hurricane? Then, once the storm is actually a destructive Category 3 or above, and has slight decrease in it's maximum sustained winds, we start hearing: "it's weakening!" Even more deadly to some was that same misperception of risk when Hurricane Ike dropped from a catastrophic 4 to a just-as-destructive 3 prior to landfall? How many residents of Galveston, upon hearing the storm was weakening and would not hit them head on, decided to stay? How well did that work out for them?
In my opinion, we are watching an apparent mild "herald" wave of a pandemic unfold across the globe in real-time. Every global epidemic since 1889 resulted in 2 or 3 successive waves of infection over an 18 to 24 month period. (Source: CNN article, 4/30/09) As the number of cases in this "mild" outbreak continue to rise in the US and across the world, it is irresponsible to suggest the threat posed by this virus is "fizzling out" as has been implied by some. An analogy I believe best fits this situation is what happened with Hurricane Katrina. Imagine if the media and public officials had lead the public into believing evacuations were not necessary, because despite the storm's size and intensity, it was not clear where it would make landfall and how strong it might be upon arrival?
Closing statement: I hope these discussions and the straight-forward source material helps to contain your confusion. Granted, this is a hugely complex situation we're all in, so I understand and respect that many are beyond overwhelmed in how to deal with it all. This site is designed to arm you with hard facts and sound science, so that knowledge can be used to reduce uncertainty and increase informed decision-making.

Saturday, May 2, 2009

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SAT MAY 2 - 7:00 AM. (Updated 5/3/09) Whether this virus produces a pandemic occurs or not, the genetic material of 2009 H1N1 will eventually join the flu cocktails that routinely traverse the globe during seasonal influenza. While it may be good news in the short term that this flu causes just "mild cases," some infectious disease experts such as Dr. Michael Osterholm from the University of Minnesota view that data in a different light. Consider listening to this 4/30/09 interiew with him conducted by Minnesota Public Radio.

The unnerving part of how this virus performs is very similar to what happened in the spring and summer of 1918. You might cry foul with that idea, claiming: "What about technology and advances in modern medicine, surely we can do better than relying on data almost a century old?" To that I would respond by echoing what epidemiologists have said for years: The key to to understanding the next influenza pandemic is to study every available aspect of past ones. The situation now closely resembles that of the Spanish Flu and the Hong Kong Flu of 1968: A "herald wave" of a highly transmissible virus with low lethality. This enabled those viruses to spread quickly, infect a high number of hosts, and provide astronomical opportunities for antigenic shift, or reassortment of the recombinant DNA into another new novel strain.

What disease researchers hope will not happen is H1N1 infects a host (whether human, pig or bird) which has or may catch a pre-existing virus such as season human influenza A, (H3N2) or avian influenza subtypes (H5N1, H6N1 or H9N2). Update: Canadian farmer infects swine flock with H1N1. (Source: UK Times Online article - 5/4/09). This is why every health agencies around the world are working around the clock to glean as much data from this virus. Now the CDC has begun that drumbeat of concern for what may come this fall. (Source: Bloomberg article - 5/3/09)

Why would that be a problem? A long-studied theory is the idea of reassortment. Let's say today's virus reaches a host in Southeast Asia who has just been exposed to the bird flu, a virus with a 50% case fatality rate (421 confirmed cases, over 200 deaths). Inside that person's cells, both viruses exchange RNA and reassort into a completely new pathogen which retains the worse elements of both parents: Easily transmissible, highly lethal to certain populations. That is a snapshot of what may have happened in 1918: an entirely new strain that was so unusual, it even "tricked" the host's immune system into turning against itself. This describes the much-theorized "cytokine storm." (Source: Dr. Osterholm in Washington Post, 11/9/2005)
The result was that healthy young adults ages 15-34 experienced the highest mortality rate in the U.S. In extreme cases, some victims started their day with no symptoms, and by nightfall had drowned in their own blood-choked mucus as their lungs filled with fluid. Too alarmist for you? Then ignore history at your own peril. Remember the saying: "those who fail to understand history are" .... (you finish the sentence.)

Since we're on the cusp of WHO declaring a full-blown pandemic, it's time you come face-to-face with what it means. No doubt the parents and school community of Milford Mill Academy in Baltimore County are quickly finding out what it means to "shelter-in-place" or implement "social distancing." The best part about a mild case of pandemic influenza is those individuals might have a better shot at overcoming the virus should it reassort prior to a second wave this fall. I am not making this up, it is based on volumes of research into what happened with the three previous major global epidemics. Nature and science have given us fair warning, because this changes everything.

Friday, May 1, 2009

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Balancing caution with consistency

FRI 1 MAY - 7:00 am. This issue is no doubt on the mind of Montgomery County, MD school officials, who temporarily closed Rockville High School starting today "until further notice." Many of us, from school officials to parents to teachers alike, are somewhat perplexed on how to remain consistent to our day-to-day priorities while addressing influenza concerns in a cautious, balanced manner. To that end, readers have forwarded these useful and appropriate links from Johns Hopkins University.

On this site, the approach remains the same, balancing accurate data without conveying undue alarm. The Centers for Disease Control are putting their best face forward in keeping us informed, yet keeping an eye on data such as the Case Fatality Ratio and the implications for all of us if the US ratio rises. If you want a serious look at CDC strategies for mitigation of a major epidemic, this 4/27/2009 report covers it all, from the simple to the scary. If anyone is interested in collaborating on identifying authentic research and information about all this, you can email me at footsforecast@comcast.net.
The next Q & A session will address these issues: (1) Effectiveness of N95 masks; (2) The difference between infection, contagion and incubation; (3) The flu and your house: what steps are worth taking versus what's over-kill? (4) Those "ity" terms: morbidity, mortality and why they are not the same; (5) The burning question YOU want answered.