Friday, December 28, 2007

What If? Colorado

"What If? Colorado" was a unique method of getting the public involved in emergency preparedness. Read more at and the American Public Health Association blog at

Best wishes to all for a healthy 2008.

Wednesday, December 19, 2007

You might want to move after you read this....

I had a really interesting meeting yesterday with two leaders of the Heritage Eagle Bend neighborhood in Aurora. Both are "retired" men, both fathers and husbands, but you would be amazed at their dedication to making their community safe.

Heritage Eagle Bend is a community of older adults, age 55 and over. (You're going to wish you were older, too...).

It is a relatively new area of Aurora, but its residents have the advantage of many years of experience and a desire for real community. People move there because of the active lifestyle, with a golf course, two pools, many clubs, a restaurant, and tons of social activities for couples, singles, and grandkids.

Heritage Eagle Bend created an emergency response committee a few years ago. The committee has come a long way. One of the first of its activities was distribution of a survey to help them identify the needs of their residents. They had an incredible return rate and were able to find out a lot. They diligently seek assistance to build their stockpile of emergency equipment, ranging from donated blankets and cots from the civil defense era to brand new generators to help them maintain essential operations during power failures. They are encouraging residents to stock supplies for seven to 10 days, promoting self-sufficiency while building community.

Their most recent success is the formation of a partnership with Parker Adventist Hospital. Through this partnership, they have formed their own Medical Reserve Corps unit. This effort makes them eligible for funding that will allow them to purchase radios and other needed communication technology, among other important equipment.

Watch for more news of this up-and-coming community of volunteer responders.

What about you? What can you do to help your community prepare? Maybe you can drop off a READYColorado brochure about packing an emergency kit to one of your neighbors; or you could encourage a friend to create an emergency communications plan? How are you doing your part for your community?

Send in your comments today!

To Tamiflu or Not to Tamiflu?

Several newspapers around Colorado made mention of yesterday’s report from the Trust for America’s Health in which Colorado received a rating of 9 out of 10 on pandemic preparedness.

Good news, right? For those of us in public health preparedness, it is always nice to hear some good news about our efforts. But it really doesn’t tell the whole story, like most evaluations of this sort.

According to this organization, Colorado’s primary shortcoming is in its decision not to stockpile antiviral medications for pandemic flu. While we are glad to hear that they think we have made great strides in the other nine areas, we didn’t get to tell you why Colorado is not buying huge quantities of antivirals.

During a news conference yesterday, the Trust for America’s Health representatives made a really important point. I’m paraphrasing, but the message was, “Antivirals are just one tool in the whole toolbox for pandemic response.”

I wanted to cheer – but I just breathed a sigh of relief. We have felt misunderstood by the Trust folks ever since they started their annual report on preparedness five years ago because their indicators seemed rather arbitrary and superficial. So, it was nice to hear that they agree with us on the antiviral issue, in spite of ranking Colorado as “deficient” in this area.

Why hasn’t Colorado (and six other states) jumped on board with antiviral stockpiling?

You need to know some background to understand the big picture, so here’s the top 10 reasons why Colorado is not stockpiling antiviral medications such as Tamiflu:

10. The federal government only pays 25 percent of the cost of the antiviral stockpile. That means that state governments are expected to come up with nearly $350 million (collectively)!

9. Since we don’t know what a pandemic virus will actually be, we also don’t know what antiviral medications will work best!

8. Since we don’t know what a pandemic virus will actually be, we also don’t know if antiviral medication will be the best approach to preventing the spread of disease. Right now, the research is leaning toward what we call “social distancing” as the most useful control mechanism – also known as a “non-pharmaceutical intervention.” Social distancing can be the simple act of staying home when you are sick – or it can be the more complex process of closing schools and canceling events.

7. There have been reports of serious side effects from Tamiflu, currently the most effective antiviral for bird flu virus that has spread in other parts of the world in recent years.

6. Antiviral medications, just like the medicines you have at home, have a limited shelf life. Right now, Tamiflu is only useful for five years. What happens in five years – do the states cough up another $350 million?

5. States are not allowed to rotate the stock of medicines. That means that the antivirals stay on a shelf in a locked facility until and/or if there is a pandemic. They can’t be used for any other purpose. Colorado had been negotiating with a big health care provider to host the storage site and rotate the stockpile, so the medication would not expire all at once and be thrown away, but the federal government would not permit this arrangement.

4. Disposal of mass quantities of antiviral medications could be a problem. There are ecotoxicologists (that was a new one for me, too) who predict that wild birds will develop drug-resistant strains of influenza if they are exposed to antiviral medication waste by-products in our water sources. And, it is possible that up to 80 percent of the active chemicals in Tamiflu remain in our wastewater, due to the amount that is excreted by the human body and the way that the chemicals breakdown after disposal.

3. As noted in the Trust for America’s Health report, the Strategic National Stockpile has only 6,000 courses of treatment for children (pediatric antiviral suspension). The federal government has not set any target for stockpiling pediatric antivirals even though children and adolescents are known to often be disproportionately affected by contagious respiratory illnesses.[1]

2. Also noted in the TFAH report are three barriers to stockpiling antivirals at the state level: (i) not all states have the fiscal resources to pony up 75 percent of the costs; (ii) antivirals are all states’ priority for pandemic response; and (iii) states have concerns about storage, rotation, and shelf-life extension strategies.[2]

1. And finally, as Dr. Ned Calonge (NOT Colange), the state’s chief medical officer, said to the media yesterday when the report was released, “We're really talking about using precious state resources to pay for a drug of really uncertain benefit that would be used to address an event of uncertain timing and uncertain severity.”

Here are three newspapers with the Associated Press article:

See the full report at

So what do you think?

Did Colorado and the remaining six states make the wrong choice?

To Tamiflu or not to Tamiflu? That is the question for our survey this week.

[1] Trust for America’s Health, “Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism,” December 2007, page 23.

[2] Trust for America’s Health, “Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism,” December 2007, page 26.

Wednesday, December 12, 2007

SNS and Remembering Hurricane Katrina

Colorado is hosting a workshop for the Strategic National Stockpile this week.

The SNS is the federal government's way of setting aside lots of supplies, including medicines, in case of a large-scale public health emergency.

With us today in Denver are people from all over the mountain states and several others. I am particularly impressed with a pharmacist from Nebraska and his commitment to making the SNS work for his state.

Colorado has a really well managed SNS program.

In fact, the Centers for Disease Control and Prevention evaluated the Colorado program recently and rated us 90 percent on the assessment, a significant improvement for the state's planning efforts over the last year.

Of course, there is always room for improvement, and we keep working toward that 100 percent.

Thinking about SNS and medical needs makes me remember Hurricane Katrina - there were many unanticipated medical needs during that real-life "exercise."

Colorado learned a lot from the Hurricane Katrina evacuation. When all those people landed on our turf, the responders had a crash course in setting up a small city to help meet the immediate and ongoing needs of the evacuated people.

Lo and behold, the responders quickly found out that it wasn't medical needs related to the hurricane or the evacuation that were the problem. It was problems related to chronic health conditions and poor medical care among the poorest of the poor from Louisiana and Mississippi.

There were two particularly interesting issues to me.

First, it was the already established personal relationships among public health staff that really made the public health/medical response work.

The chief medical officer quickly realized that we needed to bring the medical care to the people, because of the enormity of the needs. He just had to make one phone call to a physician friend at Denver Health to make that happen.

The Lesson? The personal relationships you make along the way in your career can really make a difference.

Second, did you know that oral health - dental health, that is - is a key to general health? If your teeth hurt, you can't eat healthy food, and if you can't eat healthy food, you aren't going to get well.

The low-income population of Louisiana that had to be evacuated to Denver and other areas of the country didn't have good dental care at home. Some of them had dental work such as bridges and false teeth that were lost in the storm and the evacuation. The state's oral health coordinator helped get a mobile dentistry unit out to the site.

I wouldn't have thought that dental care would be a priority in an emergency response, would you?

The Lesson? We have to anticipate meeting critical/chronic medical needs that are totally unrelated to a public health emergency or natural disaster.

How about you?

Did you learn anything valuable from watching the Hurricane Katrina response unfold, or from actually helping with the response in some way?

And, hey, let's keep it clean, okay? FEMA has been bashed enough!

Please post your comments, or, if that doesn't work, let me know at We're still figuring out how the blogging technology works best.

And, don't forget to take the poll that we posted yesterday!

Tuesday, December 11, 2007

It's really snowy today...

...and it makes me wonder if I would really be able to stay home for three days if I had to.

I'm such a gear-head that I've got all the gadgets -- lantern, flashlights, butane stove, portable TV, a hand-crank radio, even a butane heater. I think I am pretty well set with my first aid kit. We even have the recommended bucket with lid and lots of bags just in case the plumbing isn't usable.

There's lots of food in the house, even canned milk. But what if the power goes out and we can't microwave (my favorite type of "cooking!")? How would we do when we run out of fresh fruits and vegetables?

And do I really have enough water if Denver Water goes down? Let's see... that would be one gallon a day times three days times two people -- hey, what about the two dogs?!

That reminds me - I think I am running out of medication for our high-maintenance greyhound...

How about you? What keeps you from being able to say,

YES! I can easily stay home for three days if needed.

You can find out what should be in your emergency kit at That's from the State Division of Emergency Management here in Colorado, one of our sister agencies.