The 2016 Olympic Games in Rio Must Not Proceed

Here is some very thoughtful commentary from Dr. Amir Attaran published in Harvard Public Health Review.

Here’s the clincher from that opinion article:

“Which leads to a simple question: But for the Games, would anyone recommend sending an extra half a million visitors into Brazil right now? Of course not: mass migration into the heart of an outbreak is a public health no-brainer. And given the choice between accelerating a dangerous new disease or not—for it is impossible that Games will slow Zika down—the answer should be a no-brainer for the Olympic organizers too. Putting sentimentality aside, clearly the Rio 2016 Games must not proceed.”

I agree. Either Zika in South America and the Caribbean is a Public Health Emergency of International Concern, in which case the games must not proceed… Or it isn’t. It is, and the games should not be carried out because the danger is real of the virus being taken back home by athletes and visitors.

Legionnaires’ disease numbers

One of the things that we often like to say when giving data is “All things being equal…” Of course, we know that all things are not equal. There are differences between people and populations. A city like New York may be close to Philadelphia, but the two have differences that make them unique. From the racial make-up of a city to its geographic location, we need to be very careful when presenting data to make sure that we are not deceiving the public in general and those who need to know in particular.

For example, look at the current situation with Legionnaires’ disease in the Bronx, New York:

“City health officials are investigating a spike in ­Legionnaires’ disease in The Bronx, The Post has learned. “Providers should consider Legionnaires’ disease when evaluating patients . . . with signs of pneumonia,’’ the Health Department said in an alert to medical ­providers. Last month, 11 cases of the disease were reported in The Bronx, the city’s poorest borough, compared to two or three in a typical December. The Bronx recorded 61 cases of the potentially deadly disease in all of 2014, substantially exceeding the citywide average. The disease struck 4.3 out of every 100,000 Bronx residents last year, compared to 2.5 per 100,000 citywide, ­according to the alert. The rate in the northeast Bronx was even higher — 9.4 per 100,000 residents.”

What is it about The Bronx that makes it different than the rest of the city?

Now look at the number of yearly hospitalizations associated with Legionnaires’ disease, a form of pneumonia, in the United States as a whole. According to the Centers for Disease Control and Prevention (CDC), there are between 8,000 and 18,000 hospitalizations from LD each year in the United States. Compare this to the number of reported cases of LD in 2012: 3,688. How can it be that there are more hospitalizations than reported cases? Continue reading

What’s up with this Enterovirus virus?

The Centers for Disease Control and Prevention are reporting today on the Enterovirus D68 outbreak in the Missouri and Illinois. It appears that the outbreak was detected by astute clinicians who noticed that there was something going on:

“On August 19, 2014, CDC was notified by Children’s Mercy Hospital in Kansas City, Missouri, of an increase (relative to the same period in previous years) in patients examined and hospitalized with severe respiratory illness, including some admitted to the pediatric intensive care unit. An increase also was noted in detections of rhinovirus/enterovirus by a multiplex polymerase chain reaction assay in nasopharyngeal specimens obtained during August 5–19. On August 23, CDC was notified by the University of Chicago Medicine Comer Children’s Hospital in Illinois of an increase in patients similar to those seen in Kansas City.”

This highlights the need for infection prevention specialists at hospitals to be in constant communication with their laboratory colleagues and with the healthcare providers in their organization. Communicating on what is going on, what each provider is seeing, allows for the early detection of outbreaks. When these lines of communication are not adequate, it may be later rather than sooner before these types of things are detected.

So CDC was notified and an investigation was launched:

“To further characterize these two geographically distinct observations, nasopharyngeal specimens from most of the patients with recent onset of severe symptoms from both facilities were sequenced by the CDC Picornavirus Laboratory. Enterovirus D68* (EV-D68) was identified in 19 of 22 specimens from Kansas City and in 11 of 14 specimens from Chicago. Since these initial reports, admissions for severe respiratory illness have continued at both facilities at rates higher than expected for this time of year. Investigations into suspected clusters in other jurisdictions are ongoing.”

I can tell you from my experience at the state health department that most of the work is being done by local epidemiologists and public health nurses. A case definition has probably been determined and cases falling within the “confirmed, probable, or suspect” case definitions are being interviewed by the local health department staff. Specimens are being collected and probably processed initially at local laboratories and then sent off to CDC for further characterization.

Here is the interesting part:

“Enterovirus infections, including EV-D68, are not reportable, but laboratory detections of enterovirus and parechovirus types are reported voluntarily to the National Enterovirus Surveillance System, which is managed by CDC. Participating laboratories are encouraged to report monthly summaries of virus type, specimen type, and collection date.”

By “not reportable,” CDC is telling us that there is no requirement for these infections to be reported to public health by healthcare providers. However, as you can see, reporting clusters and increased rates of cases is not a bad idea, especially in light of the sheer numbers of sick kids and the strain that this situation is likely to put on the pediatric healthcare system. Opening those lines of communication with the local and federal public health agencies allows for shared information and for the best situational awareness.

We’ll see how this progresses.

Ebola continues to spread just slightly slower than fear

The outbreak of Ebola in West Africa continues to spread. With over 3,000 cases and 1,552 reported deaths (as of August 31, 2014), the seriousness of the outbreak cannot be ignored. While Ebola Zaire is the one causing this outbreak, additional cases of Ebola in the Democratic Republic of Congo are raising fears that the contagion is spreading, even as scientists have told us that the Ebola in DRC is different than the one in West Africa. Those fears are the worst enemy to the people in Africa, even more than the virus itself.

Continue reading

Talking Tuesday: The Influenza Kids


What happens when a group of kids with the flu comes to the United States? You’d think that there was this big, huge response with lots of doctors and nurses. Nope. There was only one outbreak, so they only needed one epidemiologist: Me.

Sit back and enjoy this mini-podcast and why I’ll never run without personal protective equipment into a building full of sick people again.