The "new" gold

I know that they tell you to have some cash in your emergency kit "just in case," but I think Westerners know what is even more important - water.

You couldn't go anywhere a couple of summers ago when drought was all over the news here in Colorado.

This time, there is a salmonella outbreak in the San Luis Valley city of Alamosa. Best evidence so far shows a problem with a municipal water system.

Everyone is scrambling to get bottled water to them. The traffic on those two-lane roads is sure to be heavy with many semis pulling in to town.

When they get enough bottled water, city officials will shut down the water system completely by flushing it out and using chemicals, which generally isn't needed in that part of the state.

When the clean-out begins, the advisory will be, "Do not use tap water for any purpose except flushing the toilet."

Think about that - the logistics of feeding and caring for a family seem overwhelming in this situation. People are being advised to use paper plates and disposable utensils. They have to buy ice. Some restaurants are closing, just to be sure. Others may close, when they discover how impossible it will be to operate safely under these conditions.

So if this doesn't make you go out and buy some more water "just in case," nothing will.

There's more information online at www.cdphe.state.co.us/epr/alamosa.html.

The coming pandemic and antivirals (again)

The anti-viral controversy has raised its head yet again.

Today, the Rocky Mountain News published an opinion piece from two members of an organization called the Colorado Coalition for Pandemic Preparedness. Read it for yourself at http://www.rockymountainnews.com/news/2008/mar/10/speakout-is-colorado-prepared-for-a-flu-pandemic/.

The writers think that Colorado has "been slow to react to the Health and Human Services request to secure our own antiviral stockpile that we can immediately access in a flu pandemic."

While I appreciate the efforts to bring pandemic flu and public health preparedness back to our consciousness, on this point, they are just plain wrong.

As soon as the feds made their "generous" offer to the states to pay one-quarter of the cost of a state stockpile of Tamiflu, the Colorado Department of Public Health and Environment gathered its resident experts to consider the options. Then, as now, there were two possibilities:

1. Colorado could buy extra antivirals at a cost of about $7 million. We also would have to figure out how to store them properly, an additional ongoing cost for refrigerated storage. It would mean eliminating staff and several programs devoted to public health preparedness for all-hazards situations -- whether flu, blizzard, tornado, plane crash, bioterrorism or explosion. And it would mean a reduction in funding to local public health departments all over the state. And, since the feds won't extend the shelf life for the state stockpiles (only their own), we'd have to throw it out and buy more in five years.

2. Colorado could focus its efforts on the "other tools in our toolbox" to combat a pandemic, since we have no idea whether a pandemic virus would respond to Tamiflu or other available antivirals.

When we last visited this topic (see December 19, at http://breadybhealthybinformed.blogspot.com/2007/12/to-tamiflu-or-not-to-tamiflu.html), I posted 10 reasons for Colorado to abstain from purchasing extra antiviral medication. And I still stand by those 10 reasons... and we could keep adding to the list.

No one can just dismiss the writers' concerns for themselves and other first responders and medical professionals. They are our heroes time and time again.

But Colorado is providing for the people on the front lines of pandemic flu. In fact, the Governor's Expert Emergency Epidemic Response Committee heard from a medical ethics expert before taking pen to paper (or fingers to keyboards) and creating a list of priorities for medication and vaccinations in an epidemic. And with our allocation from the Department of Health and Human Services, Colorado would have plenty of meds for firefighters and nurses called to those front lines.

So, what do you think? Have you changed your mind as a result of this opinion column? Do you think Colorado is on the right track for public health preparedness?

Ready or not?

See Channel 7 here in Denver for information on the campaign resulting from a partnership between the Colorado Department of Public Health and Environment and Wal-Mart/Sam's Club stores beginning next week.
http://www.thedenverchannel.com/news/15348315/detail.html

In this editorial, our director of public health preparedness and response issues a challenge to everyone.

It's not so much a "be prepared or be scared" warning, but he offers some useful info on being ready for anything.

Most relevant to me? How about:
"Spread out the cost by buying a few items each time you shop."
"Work... with neighbors or friends to develop and store items together."

How about you?

What is the best piece of advice you have received about preparing for any emergency? Let us know.

Public health and "unintended consequences?"

Social distancing. Community resiliency.

These are two phrases that are used a lot by experts who analyze the potential impacts of a pandemic - an unfamiliar disease that is causing serious illness around the world.

A commentary in the February 6 issue of JAMA, the Journal of the American Medical Association, brings the conflicts to the surface again (JAMA, vol. 299, no. 5, pp 566-568, subscription required).

The state epidemiologist from Florida writes of the American respect for diversity, based on shared goals and aspirations. But, he says, recommendations for "social distancing" are "based on limited current scientific evidence and could have serious adverse unintended consequences for the social fabric of society..."

Dr. John Middaugh is concerned. This public health leader believes that public health is changing its longstanding, science-based recommendations for flu that focus on protecting the most vulnerable people with either vaccinations or antiviral medications.

The new messages from public health, he says, tell us that we each have the power and responsibility to prevent exposure to a pandemic flu virus and it will be up to us to take action to reduce the effects of a pandemic on everyone.

Hmmm, I can see what Dr. Middaugh is saying.

When the U.S. secretary of Health and Human Services visited Colorado, his main point seemed to be, "Don't count on us [the feds] for help."

Is that what all of public health is saying now?

That would really be a shame. It kind of takes the "public" out of "public health," doesn't it?

What do you think?

• If we encourage social distancing, do we risk weakening our commitment to community? Does social distancing = social disorder during a crisis?

• Will social distancing mean that we abandon those who would not survive a pandemic without the support of others -- the ill, the young, the old, the disabled?

Here's another take on the JAMA commentary:

http://scienceblogs.com/effectmeasure/2008/02/toughening_a_community_for_a_p.php

Oh, and P.S.
Dr. Middaugh also talks about fear-mongering around seasonal flu and flu vaccination campaigns. Is he right that flu shot campaigns are really our government's approach to increasing the demand for vaccine so vaccine manufacturers will expand production? And, he says, "The campaign to increase use of influenza vaccination for seasonal influenza adds to the fear of this disease and fuels separation and isolation." Yikes. What does this mean for public health?

Did you know your neighbors at your precinct caucus?

Last night, in spite of the cold and my cold, I dragged myself out to the precinct caucus to help Colorado make history. For our very first Super Tuesday, there was quite a turn-out. There were thousands of people trying to get into a middle school and adjacent high school for I don't know how many precincts.

It occurred to me that I had never seen so many of my "neighbors" in one place. It was relatively orderly, but pretty confusing.

Two things came to mind. First, evacuations and shelters - what if we all had to go to those schools for shelter? How would we have coped with temporary communal living? Would I have been able to grab anything from our "go-kit" on the way out? My emergency supplies container is huge - and that's even without food and water. I resolved to make backpacks for each of us with our bare essentials for an evacuation on foot.

Second, my neighbors - there were three people there from my block that I knew by name and possibly a few more by sight. I wish that I had thought about this before the caucus, but wouldn't it have been nice to start a neighborhood registry? I think I will call my city council representative about having a neighborhood event to help people get to know each other.

Finally, I skimmed through a few blogs this morning and saw that our friends at READYColorado posted a piece about planning for our pets. When I thought about sheltering, I forgot about this - even though we have two dogs.

Check out that information about how to prepare for your pets during an emergency. It's great information. http://breadyblog.com/

The scientist who cried "WOLF"?

What do you think, have they snowed us on pandemic flu?

The New York Times has an article today called "A Pandemic That Wasn't but Might Be." You can read the whole thing at http://www.nytimes.com/2008/01/22/science/22flu.html?ref=science .

There are some who are beginning to step back from the ominous predictions about the coming pandemic.

But, while 2007 saw a decline in the numbers infected with bird flu, it's still with us, and it's still deadly.

One doc has been saying that he doesn't think H5 viruses will cause a pandemic, but he quickly adds that another subtype of the influenza virus very well could set off an international outbreak of a lethal flu.

In other reports, scientists are arguing about the stability of the virus that causes bird flu.

• If it is stable, it is less likely to change into a form that is more human-friendly.
• If it is not stable, it could change into what many fear would be the scourge of the 21st century - a new virus causes serious illness and that is easily transmitted from person to person.

Denial seems to be part of the human condition. No one wants to believe that a pandemic could turn life as we know it upside down. I wonder what will be written in the history books someday.

What do you think?

Are conditions ripe for a pandemic?

Vote today above!

Someone you love needs this

Just read a good publication for people who have a disability that would make evacuation difficult. Read pp. 4-6 about 9/11, and you will see how important it could be to make plans for and practice rapid evacuation.

http://www.cdihp.org/evacuation/emergency_evacuation.pdf

It was a good consciousness-raising experience for me, a non-disabled person (or, as some might say, temporarily able-bodied, or TAB).

The document encourages people to take responsibility for their own special needs, to the extent possible, yet also makes it clear that everyone needs to pitch in. And isn't that exactly what everyone has been saying about emergencies in general? No one agency, person, family, or jurisdiction can implement an effective response in a vacuum. Just as we hope that our federal, state, and local officials will work together, individuals will have to, also.

If you know someone who has a communication or mobility impairment in particular, show him or her that you care, and share this information today.

Seasonal flu, bird flu, pandemic flu…. What’s the difference?

Here's something from a Georgia health department that very clearly explains the types of flu that make the news these days:

Seasonal, avian (bird) flu, and pandemic flu have gotten a lot of attention, and understanding the differences can be difficult.

Seasonal flu happens every year. In the U.S., it hospitalizes 114,000 and kills 36,000 annually. Most people who get it feel awful for a while and recover. There are many flu viruses, and there is an annual vaccine which contains the three strains experts believe to be the biggest threat each year.

Avian flu affects mostly birds. There are several avian flu viruses. Wild birds carry avian flu, seldom get sick from it, and even more rarely die from it. However, domestic birds, such as chickens, do not have immunity against some avian flu viruses, so they can get sick and die.

The H5N1 virus is a deadly strain of avian flu. H5N1 has been found in birds in Asia, Africa, and Europe. Millions of chickens have been destroyed to try to control spread of the virus. Human cases have been identified in Asia, the Middle East and Africa. So far, it has not been identified in the western hemisphere. Since 2003, about 300 people worldwide have been known to get H5N1, and about half have died. Nearly everyone who has gotten ill has caught H5N1 from infected poultry.

Experts think the H5N1 virus could cause a worldwide outbreak of flu in people, called a pandemic. To do that, the virus must mutate to spread easily from person to person. No one knows when or if H5N1 (or another virus) will become capable of causing a pandemic. There is no pandemic flu anywhere now, but it makes sense to prepare for it.

The 20th century saw three significant flu pandemics. The 1918-1919 Spanish Flu was the biggest and many millions of people died, including 675,000 Americans, and millions more were ill. Milder pandemics happened in 1957-1958 (“Asian Flu”) and 1968-1969 (“Hong Kong Flu”).

If a flu pandemic like the 1918-1919 Spanish Flu were to happen today, it would be devastating. Lots of people would be sick, and millions could die. We can all do things now to prepare, which you will learn about through this series. In the meantime, visit http://www.pandemicflu.gov/ to learn more.

--Rhiannon Brewer is the public relations and information specialist for the Northeast Health District in Georgia and can be reached at rcbrewer@dhr.state.ga.us.

Should I clean the toilet or the doorknob?

Do you live with anyone else?

(The dogs don’t count.)

Everyone has at one point or another had to deal with someone else in the household having a cold.

Even if you don’t live with anyone now, when you were younger you did. Remember how the whole household suffered along with Mom’s cold?

Here is a challenge for you this winter: Stay well.

Kids get up to 12 colds a year. Ick. (I know someone who calls kids “little incubators” for germs.)

And, each year, five to 20 percent of the US population gets the flu and 36,000 people die. (Did you know that seasonal influenza is the leading cause of vaccine-preventable death in our country?)

Here is the simple truth: Respiratory illnesses are spread by coughing or sneezing and unclean hands.

It really is that simple – we probably would not get a cold or the flu this winter if we can avoid people who cough and/or sneeze, wash our hands frequently and avoid touching our faces. Getting a flu shot every year will help you boost your immunity to flu viruses, too.

If you have a cold or the flu, cover your mouth/nose when you cough/sneeze with a tissue – then throw it away immediately and wash your hands. If you don’t have a tissue, cough/sneeze into your upper sleeve – not your hands. If you can’t wash, used an alcohol-based hand cleaner. Most importantly, stay home when you are sick.

Model these easy behavior changes with your coworkers and teach your children these simple steps to avoiding a cold or flu this winter and not only will you stay well, but the people around you will be well, too.

And, oh yeah, the answer to the question in the title? The doorknob.

I-70 closing tests travelers

What a way to end the year -- I-70 closed late Sunday, December 30th, stranding people returning to the metro area after a day of skiing.

The hotels, already full with holiday travelers, accommodated as many people as possible, and emergency shelters kept most from spending a cold night in their cars. The Red Cross, which opened 11 shelter sites, reports that it housed 2,400 people that cold night. And the Salvation Army opened an additional two.

But what if peoples' cars had been stranded on the highway for the same 20 hours, due to heavy snow or avalanches? Would skiiers and vacationers have been able to wait out the storm?

And what would it take to spend a freezing cold Summit or Eagle County night in your car?

I asked an expert at the Colorado Division of Emergency Management this very question.

His suggestions: blankets, winter clothing (including hat, mittens, boots), water, portable radio, and at least some food, for comfort if not nutrition (most of us could live much longer than 20 hours without food!). And oh, yes, he added, "another warm body" is part of his planning!

I might add some basic car safety supplies, such as a shovel and flares.

What about you? Would you have had the basic supplies and equipment with you if you had planned a day trip? What would be most important to you?

Send in your comments today!

What If? Colorado

"What If? Colorado" was a unique method of getting the public involved in emergency preparedness. Read more at http://www.whatifcolorado.com/ and the American Public Health Association blog at http://getreadyforflu.blogspot.com/2007/10/colorado-reality-competition-spotlights.html.

Best wishes to all for a healthy 2008.

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:
http://www.rockymountainnews.com/news/2007/dec/19/colorado-scores-high-in-report-on-public-health/
http://www.denverpost.com/search/ci_7752620
http://www.gjsentinel.com/search/content/gen/ap/CO_Pandemic_Readiness_Colorado.html

See the full report at http://healthyamericans.org/reports/bioterror07/.

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.

Endnotes:
[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.

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 barbara.beiser@state.co.us. We're still figuring out how the blogging technology works best.

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

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 http://dola.colorado.gov/dem/public_information/emergency_kit.htm. That's from the State Division of Emergency Management here in Colorado, one of our sister agencies.