Wednesday, April 04, 2007

Shut Down The Cities To Stop Pandemic Flu Spreading

Studies Reveal Pandemic Spread Could Be Reduced By Closing Schools, Cinemas, Workplaces, Shopping Malls And Borders

A remarkable story from yesterday on the results of two comprehensive studies that looked at how authorities in American cities tried to stop the spread of the 1918-1919 bird flu pandemic.

The studies conclude that American states that rapidly brought in restrictions on public gatherings - including theatres, schools, and large funerals - were able to reduce the overall infection rates and eventual death tolls. In comparison to cities that were slow to introduce such bans, the difference in death tolls may have been as high as 50%

The cruncher in these conclusions is that banning people from gathering in crowds in any social environment may be more effective at stopping pandemic-related deaths than the use of anti-virals or vaccines. At the very least, such bans would delay the onset of larger numbers of people becoming infected and, theoretically, buy more time for effective vaccines to be developed.

Therefore, the studies conclude, it is more effective to stop people becoming infected in the first place, by cutting off their physical contact with one another, than it is to try and stem the effects of bird flu infection with medicines.

But how long would authorities need to enforce bans on public gatherings? Be they in schools, cinemas, subways, restaurants, weddings, large funerals, shopping malls, office blocks?

Perhaps as long as three months.

Apparently, some American states and cities already have bans on public gatherings included in their emergency response plans to fight pandemic bird flu.

But will local, state and federal governments have the willpower or political strength to enforce such bans? Will National Guard troops be ordered to shoot people who break curfews or quarantine zones? What will happen to local economies if people stop going to work?

There's literally thousands of such questions that haven't even begun to be addressed or debated, let alone answered.

Clearly the effect of such bans on public gatherings would devastate economies and isolate entire populations of city dwellers, not to mention the psychological impact and the issues of sanitation that would result from people isolating themselves in their homes for extended periods.

You will know how seriously the conclusions of such studies are being taken worldwide by the frequency of warnings from your country's leaders, in the coming months, that go like this : "We may need to discourage people from going to concerts and nightclubs, for their own good, should a pandemic break out."

Once the idea of the need to restrict social outings in the event of a pandemic settles into the general public consciousness, and becomes a reasonable idea, then the idea of shutting down subways, shopping malls and work places will slip into the debate.

Not mentioned explicitly in the story, but an obvious conclusion, is that such lengthy bans on public gatherings would need to be introduced in the earliest days of human-to-human transmission of the H5N1 virus, as they were in the US cities with significantly reduced death tolls during the 1918-1919 pandemic.

As the virus can live inside a human for one to two weeks without showing itself, a 'hot' person could pass the virus on to literally thousands of people in the space of 14 days in a big city.

Presumably, then, authorities would need to launch and enforce wide scale bans on public gatherings when the first few cases of human-to-human transmission show themselves in the larger cities of the world.

But what governments will be brave enough to shut down the economic lifeblood of their cities after only a few people have died from communicable H5N1?

The likelihood is that most governments would leave such public bans to the very last minute, under pressure from corporations and local businesses, and deny the existence of communicable H5N1 for as long as possible. Just in case organisations like the World Health Organisation are wrong about the severity of a bird flu pandemic.

It's quite an amazing concept to imagine a government or city council announcing to the public that, "All public gatherings will be banned for 10 to 12 weeks to stop the spread of this deadly virus."

Three months at home?

With the family?

Three whole months?

Let's hope there's something good on TV, if the electricity continues to flow, of course.

From France24 :

Scientists with their eye on the possible outbreak of a bird-flu epidemic found from studying past practice that by intervening early and aggressively to restrict the public's freedom of movement, they may be able to curb the transmission of a virus in the early phase of an epidemic and buy time for investigators to come up with a vaccine.

The findings come from two analyses of US cities in the 1918 Spanish influenza pandemic that killed 600,000 people in the United States and tens of millions around the world.

In 1918, many US cities sought to contain the epidemic by closing schools, theatres, churches and dance halls. Kansas City banned weddings and funerals involving more than 20 people while San Francisco and Seattle ordered their citizens to wear face masks.

...US researchers found that in cities where officials responded to the epidemic early and with numerous bans on social or other gatherings, the peak weekly death rate was about 50 percent lower than it was in cities that responded more slowly.

In St. Louis, the peak mortality rate was one-eighth that of Philadelphia, the worst hit city of all the 17 metropolises included in the survey.

Officials in St. Louis moved with broad public health measures within two days of the first reported influenza cases, while their counterparts in Philadelphia waited two weeks to act.

"Our results show that non-pharmaceutical interventions may substantially slow the spread of a pandemic," said Neil Ferguson, a researcher at Imperial College London, who led the European research team.

"However, if we want these measures to save substantial numbers of lives, they really need to be kept in place until we have enough vaccine to immunize the population."

But he cautioned that there would be "huge social and economic consequences of imposing such measures for the three or more months that would be required for optimal effect."

US authorities have already incorporated many of the lessons of 1918 into planning, drawing up guidelines for closing schools, canceling public gatherings, teleworking strategies and voluntary isolation of cases. infectious disease specialist noted, much will depend on the political will to make unpopular decisions that could cost the economy a bundle.

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