Yesterday I visited the Centers for Disease Control in Atlanta and was taken inside the command center, where almost 100 staffers have been working around the clock to monitor and stem the current outbreak of flu.
I first spoke to Toby Crafton, the manager of the command center, who oversees the day-to-day operations. He and his team have been preparing for a possible pandemic of flu or another infectious illness for years. I also spoke to Michael Shaw, Ph.D., who heads up the virology labs that are studying the H1N1 virus causing the current outbreak. He's spent a career learning the laboratory techniques that are so urgently needed right now. The third person I spoke to was Dr. Richard Besser, Acting Director of the CDC, who has been working at the agency for 13 years and is an extensively published expert in infectious diseases.
I mentioned that last week I had received an email notification from the New York City Department of Health (NYCDOH) about how I should be managing my patients with flu-like symptoms. The advice was actually not intuitively obvious to me. For example, the Department of Health said that for patients with mild illness, treatment with anti-viral meds like Tamiflu and Relenza was only recommended for patients who also had underlying conditions that increased their risk for complications due to influenza. Dr. Besser pointed out that it was especially important right now for physicians to stay up to date with the recommendations being made by public health officials. Doctors can contact their local department of health and sign up for the same type of email notification that I received.
This brings us to the main point of today's blog. Many of us -- patients and physicians alike -- have been thinking about the influenza virus for about a week. Public health officials like the teams at the CDC and the NYCDOH have been thinking about it for years. Physicians, me included, are used to practicing medicine based on "clinical judgment." We understand that medicine is an art and not a science, that there are many different ways to approach a problem, that there's often no clear "right" or "wrong." We are also used to doing things "our way," whatever that way is. But this is not a time for doing things "our way" if it's at significant odds with strong recommendations being made by public health officials. There are recommendations that may seem logical -- like prescribing medication for somebody with mild flu symptoms "just in case" -- that nevertheless go against the judgment of people who have trained for years to think about how to deal with an epidemic.
What if you're a physician who strongly disagrees with a suggestion of public officials? Then challenge that recommendation publicly. Bring the discussion to light; maybe you're right. While this is no time to go rogue, doctors have an obligation to think carefully and independently and to challenge recommendations that seem illogical. But don't silently do things your own way.
"Only On The Web:" CBS News medical correspondent Dr. Jon LaPook speaks with Dr. Richard Besser, acting director of the Centers for Disease Control, about the H1N1 flu outbreak:
Centers for Disease Control and Prevention
CDC - Influenza (Flu) | Swine Influenza (Flu)
CDC H1N1 Flu | H1N1 Flu and You
Swine influenza - Wikipedia, the free encyclopedia
Influenza A virus subtype H1N1 - Wikipedia, the free encyclopedia
To use an illustrative extreme - for a catastrophically dangerous fictional plague (something we see often in horror movies), the doctors may want to enter a region and save the patients individually, but the epidemiologists may instead consider the risk of contagion so extreme that the towns have to be sterilized with napalm. Both are considering safety and trying to exercise sound judgement, they are just used to treating entirely different things. It's the press/public/government's job to find a balance between the two that suits the level of danger.
I feel Mr. Biden was unnecessarily and undeservedly criticized. Don't embarrass him and scold him simply because we have to make sure the airline industry does not get offended!
Grabbing head... rolling eyes... disbelieving the level of discourse on Huffpo.
You know the immunizations they give animals do not contain mercury since 1991 and we are still ingesting it in the immunizations for humans....specially the flu shots and it is not even a good preservative,,(,just like asbestos and nicotine.... big lies...forever in this country while the rest of the world gets serious).
1. The more we use these medications on mild problems, the higher the chance swine flu will develop an immunity to one or both of the two weapons we have to treat serious cases. The "just in case," dose to keep a healthy individual from a .01% chance of problems could very well lead to multiple deaths.
2. There is a good chance that if this swine flu becomes a pandemic, there will be a shortage of these medications, so every dose wasted would mean that a person dies because the doctor was "putting something else above the interest of the individual patient."
Grabbing head... rolling eyes... disbelieveing the level of intelligence of the trolls on Huffpo
To that end, I am calling on Congress to order the immediate closing of the border with California. Additionally I demand that the states of Arizona, Nevada, and Oregon mobilize their respective National Guard Units to secure not only their borders with the Ground Zero Swine Flu state but the stockpiles of TamiFlu as well while their respective health departments of each state should use all means necessary to distribute face masks to its 12,890,407 citizens.
I have a few more ideas posted at www.BuriedLogic.com
And I am glad that I don't have to look at any more of your ideas...
Until these public health agencies move away from an obsession with specific organisms to a systems approach which looks at organism-host-environment interactions we will continue to fail.
See my blog on the CDC at http://medicalcrises.blogspot.com
Dr. Rick Lippin
Southampton,Pa
:-)
Dr. Rick Lippin seems to me much more adept in the art of medicine because he seems to have an open mind which is essential when you deal with such a complex domain as people"s health.
People with high blood pressure and cholesterol have been told by your kind for years not to eat magarine and avoid fat fish which is the opposite of what they should have done and that's just one among others.
A flu that kills 2% instead of a fraction of a percent is not rather weak, it is rather strong...
Disappointing post.
Many in the public have lost trust in our US health agencies and the docs who blindly follow their lead,
Pathetic and dangerous situation
Dr. Rick Lippin
Southampton,Pa
That sets an example for other practicians
The real issue is that no one really knows how this new strain will pan out. It is all guesses. Whether it is as virulent as they first suspected based on the early Mexican cases is still to be determined.
That said all we can do is take reasonable precautions and not panic.
There's extensive information available for physicians and citizens there and at http://www.fightflu.ca/
Canada's federal, provincial, and local health authorities have been preparing for something like this since SARS. SARS was a huge deal here and its impact has changed how we do things. We're still learning but I think we are doing a decent job. The public news campaign starts today.
Tamiflu has been handed out by officials as a preventative - been around sick chickens? Have some Tamiflu. If a person in the household has this flu, the family is given it as a precaution.
Then there was an article in the NYT's about shortages and in France they are limiting it to the hospitals, which to me sounds like a huge mistake, why make anyone who suspects they have the flu crowd ER rooms? Then there are articles almost making fun of people being paranoid about their symptoms going to the ER.
By the time you know you have the flu, or your doctor has determined that it is the flu and not something else the 48 hours have most likely gone by. The only other option is to take it when you just start to feel bad.