Puerto Rico nearing becoming a public health catastrophe | Miami Herald

Every time you hear about Americans in Puerto Rico with no water, no fuel to boil water, no way to get rid of waste water…think water-borne infectious disease. This will be an epic disaster. One that was entirely predictable.

Public health officials should be shoulder to shoulder with the military, staged for response. I’ve searched the CDC and looked at the reporting coming out of the island in the many days since the storm, and I see no trace of action.

I pray they are not waiting for a call.

Below, from the Miami Herald, is an appeal from the Dean of Florida International University’s College of Social Work and Public Health, Tomas R. Guilarte, describing what the chaos looks like to a public health expert:

In the days since Hurricane Maria ravaged Puerto Rico, conditions on the island continue to deteriorate and become a humanitarian and public health catastrophe that could rival the damage caused by Hurricane Katrina in New Orleans.

The fact that the power grid failed creates many obvious problems and some that are not so evident. When the sewer system stops working, wastewater—aka human feces and urine—and seaborne bacteria contaminate the water supply.

This leads to bacterial infections — such as cholera, dysentery, E. coli and typhoid — that can be disastrous. The typical treatments, like tetanus shots or powerful antibiotics, are not readily available on the island, where medical supplies are quickly running out.

Source: Puerto Rico nearing becoming a public health catastrophe | Miami Herald

Some of the information wants to be free

CDC queries= my mood boards.

SO lots of facts and figures this week. The gun deaths data used by every pundit, editorial author, and Facebook meme maker (well maybe not) in this country can be found in our national database of mortality statistics compiled by the CDC and available for anyone with internet access to search. I did a therapeutic amount of searching this morning. This is a great tool and resource and one of the public health biggies with open access. It’s government data and PubMed abstracts for me until I decide to drop out of life and get that sweet academic journal access that comes with being a Ph.D candidate. Pffft. Right though: http://wonder.cdc.gov/

Mortality and morbidity statistics are tracked by ICD medical billing codes. Because if there’s two things you can count on it’s death and your survivors being billed for your death.

The design is not good but what were you expecting? That’s how you know it’s authentic. I could spend all week in this.

CDC databases

Narrow your search. Slightly less easy that learning how to properly use MeSH search terminology.

CDC table layout

Results for all codes under “firearm” reporting data from the entire United States in the year 2014. But go have a look for yourself, too. Compare it to cancer. Compare it to car accidents. Dare to look at medical error, too. It’s in your hands. We need help.

CDC databases results

CDC Recommends Antiviral Drugs For At-Risk Patients : NPR

CDC Recommends Antiviral Drugs For At-Risk Patients : NPR.

The flu is awful this year. I’m in the bathroom washing my child’s hands all Lady Macbeth the second he gets home from school. In this interview Tom Freiden, Director of the CDC, explains plainly why the flu is so bad right now and why people who have gotten the flu shot are still getting sick. He also talks about antiviral use in flu patients.

I’m concerned for public health and the future success of flu shot campaigns. The strain that is infecting people despite vaccination was chosen for the vaccine, but between it’s selection and the beginning of our flu season it mutated. ARGH. This wasn’t a failure on the part of the CDC but it will lose them good faith in a year where we already had our eyes set to roll at their very next press release. So now add to the giant list of reasons people won’t get their flu shot “they messed it up last year.” Which is bad for community immunity.

Below, data for health districts reporting in VA (two weeks old). The red is the sub-type of flu the vaccine does not cover.

flu data
http://www.vdh.virginia.gov/Epidemiology/flu/WklyPhysReport.pdf

Knowledge cures ignorance so here is the back story of the flu vaccine and why this year was a one-off to convince you to please get your flu shot next year, too:

How are the viruses selected to make flu vaccine?

The influenza (flu) viruses selected for inclusion in the seasonal flu vaccines are updated each year based on which influenza virus strains are circulating, how they are spreading, and how well current vaccine strains protect against newly identified strains. Currently, 141 national influenza centers in 111 countries conduct year-round surveillance for influenza and study influenza disease trends. These laboratories also send influenza viruses to the five World Health Organization (WHO) Collaborating Centers for Reference and Research on Influenza located in Atlanta, Georgia, USA (Centers for Disease Control and Prevention, CDC); London, United Kingdom (National Institute for Medical Research); Melbourne, Australia (Victoria Infectious Diseases Reference Laboratory); Tokyo, Japan (National Institute for Infectious Diseases); and Beijing, China (National Institute for Viral Disease Control and Prevention) for additional analyses.

The influenza viruses in the seasonal flu vaccine are selected each year based on surveillance-based forecasts about what viruses are most likely to cause illness in the coming season. WHO recommends specific vaccine viruses for inclusion in influenza vaccines, but then each individual country makes their own decision for which strains should be included in influenza vaccines licensed in their country. In the United States, the U.S. Food and Drug Administration (FDA) determines which vaccine viruses will be used in U.S.—licensed vaccines.

Now everyone feels bad about the pies.

(Image from CDC)

Happy day after Thanksgiving. Now that we’re all in regret mode, diabetes! This is a slow-motion public health train wreck, amiright? And it’s another marker of race disparity in health… but I’ll save that for another day.

Diagnostic for diabetesHemoglobin A1C>=6.5 OR 8 hour fasting plasma glucose of >= 126 mg/dl OR oral glucose tolerance test of >= 200 mg/dl OR random plasma glucose of >=200 mg/dl.

Super user-friendly.

So diabetes is a clear medical diagnosis to make, but telling someone with a fasting blood sugar of 120 that they do not have diabetes is the wrong message. You either have HIV or you don’t. Diabetes is a disease on a continuum. Even with moderately high sugars the vessels of the fingers and toes and heart are getting damaged. The delicate vasculature of kidneys and eyes is getting all junked up, and pancreas… oh poor pancreas you will never be the same.

So it would make sense to do some intensive nutrition education for people that fall into that pre-diabetic category, you know, maybe keep them from become full-blown diabetic? As it stands, Medicare does not reimburse (pay for) nutrition consults until you have the official diagnosis of diabetes. So we are giving nutrition education to people in the hospital after they have had their toes amputated, between debridements of wounds that won’t heal, and in dialysis while they wait for a kidney transplant. These are miserable, life-limiting procedures. All of which are way pricier than some front-end nutrition education. And the cost of diabetes has increased 41% over the past 5 years.

My mom falls into the pre-diabetes category. I write little lists and send texts and talk to her on the phone about how she is managing a blood sugar that is next door neighbors with diabetes. Based on my very limited knowledge of nutrition (nursing schools could really fortify this part of our education), here are some of tips I’ve given her: First, 5 a day, lots of fiber, and minimal processed foods. Look for added sugar in all all foods, especially processed. If a product is labeled low or non fat, you can assume that they replaced that fat with sugar. Check the label. Also, exercise helps your cells metabolize sugar, bringing down your blood sugar. Even if you don’t lose pounds. What else can I do? I’m genuinely asking.

Whooping cough outbreak at Grand Traverse Academy nearly doubles to 161 probable cases

Image NIAID

Whooping cough outbreak at Grand Traverse Academy nearly doubles to 161 probable cases | MLive.com.

Herd immunity/community immunity: when enough people are immune to a disease, that disease will not spread through the population. As a result those who are not or cannot be vaccinated (pregnant women, infants, immunocompromised) are protected from the disease as well.

Infants are eligible to receive their first pertussis immunizations at 2 months. Pertussis/whooping cough in the first three months of life is frequently severe and often fatal. Pertussis is a respiratory disease that in early stages has the same symptoms of a cold. Babies are most likely to get the disease from a parent or a sibling. (American Academy of Pediatrics)

I’m not going to ruin my night by getting on the soap box because it’s Saturday and ACA open enrollment is not a total disaster so far and I was just destroying at Jeopardy, but y’all are picking up what I’m putting down, right?

Ebola, Epidemiology

So far this semester of nursing school we’ve spent less than an hour talking about Ebola in America. There is legitimate concern for good guidance on PPE. CDC guidelines have been in evolution, which makes health care workers nervous.

PPE(NY Times)

BUT, epidemiology views the population as the patient. And right here right now we are looking pretty healthy. Ebola is an epidemiologist’s dream since you are not contagious until you are showing symptoms (no latency), and the course is long (outbreaks spread from patient to patient relatively slowly). It is fairly easy to find people who may have been exposed and quarantine them before they have a chance to pass along the virus. Contrast these characteristics with those of the flu, and you can see why the CDC isn’t sweating too much.

Also, what does this even mean? No.
cnn ebola