Stewie's doing a hell of a job
November 11, 2005 4:37 PM   Subscribe

"Brownie's doing a hell of a job"... Part 2? Who is: The "well-connected, ideological, ambitious Republican with zero public health management or medical expertise whose previous job was as a corporate lawyer for Amtrak" who is in charge of the United States' planning for a possible influenza pandemic? A man who recently told a Congressional committee "We're learning as we go"? Meet Stewart Simonson.
posted by docgonzo (20 comments total)
heeere we go again !
posted by mishaco at 5:07 PM on November 11, 2005

Stewart Simonson is pretty nice compared to this appointee -- didn't torture anyone.
posted by johngoren at 5:10 PM on November 11, 2005

Wow, it sounds like Stewart couldn't even handle a squirrel flu outbreak.
posted by Mr_Zero at 5:15 PM on November 11, 2005

Too bad Louisiana already hired the qualified expert.
posted by Balisong at 5:48 PM on November 11, 2005

In that a killer flu has been projected as a serious risk since the early 1970s, there are a few realistic considerations about what, if anything, we can do about it.

The federal government got its first wake-up call with the Swine Flu, under Gerald Ford. He asked for, and got, a huge appropriation to the CDC in record time. And it not only didn't matter, it wouldn't have mattered. It didn't matter because just before the Swine Flu hit the US, it mutated to a much less lethal strain. So instead of 30k dead, we had 60k dead, still far fewer than the projected 500k-1M+.

But all that money *wouldn't* have mattered, either. There are practical limits to the production of vaccine, in scale, in distribution and delivery, and in the time it takes from start to finish. If you create the infrastructure to make more, you still have time constraints, and increase the risk that you will make a massive amount of vaccine that doesn't work.

But what about anti-virals, such as Tamiflu? Almost useless. Already the Avian Flu has mutated to such a degree that only one of the top five anti-virals still works, and may not for long.

So what *has* been done? First of all, the vaccination scheme has been changed. This matters. No longer are the very old and infirm and the very young the priority. The new scheme is that school-age children, the worst human vector for the disease, and outbreak areas, are to receive the vaccine. This is an old technique.

The federal government has directed the States to develop serious State plans for the outbreak, covering such things as banning public events, quarantine protocols, and communications/interweb with national health services.

The last thing the feds can effectively do is to prepare to isolate the US from additional outbreaks by restricting international travel, setting up quarantine stations in airports, creating Coast Guard inspection protocols, etc.

When the flu becomes Human-to-Human (H2H), agents will try to transport samples to Atlanta by the fastest possible means. From there, big pharma will begin production with the multi-billion dollar appropriation already available.

Most likely, the federal and State health authorities will begin broadcasting vital information to the public, and the entire US will be under a "health regime" until the threat has abated.

All told, this is about everything the federal government *could* do, no matter who was in charge.
posted by kablam at 6:41 PM on November 11, 2005

Honestly, I can only wish Bush had no power whatsoever to appoint people to anything outside of his personal trainer and coffee boy.

I mean, Dick Cheney would even be fine for that sort of thing. Sure, he's a living ball of anger with corruption flowing through his veins, but he'd at least make sure his business buddies had some sort of qualification for the task at hand.

Seriously, is Bush just sitting there, laughing about how he's still preznident for three more years and nobody can stop him? Or did he just think he could appoint his buddies and cronies to everything not in the Cabinet regardless of any sort of ability?

I shudder to think that I'm probably more qualified than some people in vital posts in the government right now. I almost cried when I realized that I'll hold a degree from the same university as Brownie himself.

On preview- Kablam, while I understand your sentiment that nature is going to have its way with us every now and then, it's still important that the ones in charge of these operations are competent enough to minimize damage where it's possible. If you want to give out political job favors, put these guys in bureaucratic spots that aren't involved in any sort of emergency service.
posted by Saydur at 6:45 PM on November 11, 2005

I just plan on taking out all those that I care about, and loathe, to spare them the ravishes of this disease until it brings me down.
posted by Balisong at 6:48 PM on November 11, 2005

Balisong- Always save one bullet for yourself. You don't wanna live as no gawddamn zombie.
posted by papakwanz at 7:06 PM on November 11, 2005

Truer words were never spoken.
posted by Balisong at 7:10 PM on November 11, 2005

you're doing a heck of a job, stewie.
posted by brandz at 7:28 PM on November 11, 2005

So, is there some kind of quota Bush needs to fill?
Does he walk in every morning and is greeted by his secretary saying, "Nice to see you Mr. President. It turns out, you need to give six more of your corrupt vermin idiot friends jobs that they're not even remotely qualified for. It's in the job description, y'know."
"I'll get right on that," he would reply. Sitting down at his desk, he'd look at the HR list for the White House maintenance staff, desperate to find an assistant janitor that he hasn't already placed in crucial national security post. "Wally The Trainable might do well running that, um, whatever it is down at the Justice Department for me. He does such a good job cleaning up the staff break room that, of course, he'd do a good job cleaning up corruption. I know his character and his heart," Bush would say. "Wally, get in here. I've run out of rich idiot friends. It's your turn for a promotion." "Yeth mithter prnesidthent," stuttered Wally, enthusiastically.

Just another typical fucking day at the motherfucking White House.

posted by Jon-o at 7:44 PM on November 11, 2005

I'm the last man alive!
posted by CynicalKnight at 8:43 PM on November 11, 2005

There are so many chickens in the U.S. A genetically uniform population
posted by longsleeves at 9:31 PM on November 11, 2005

kablam, there are some things that a competent federal government could be doing now or could do in the near future to respond to inevitable thread of a pandemic, and which they are not currently doing:

1) Force every state to adopt a state-specific pandemic plan; some still haven't!

2) Give much much more money to the states to fund their localized responses; right now, the federal government pandemic plan is expecting the states to pay for an awful lot of the costs of a pandemic on their own, such as buying and stockpiling and transporting and securing food, medicines, medical equipment (syringes, IV's, etc., many of which are made overseas and may not be available if trade shuts down temporarily). How are states with huge budget deficits and huge populations--like here in California--supposed to cope?

3) Lead a pandemic awareness campaign at the national level, being much more upfront about what an outbreak would mean for the country: trade and travel barriers, military-enforced quarantines, etc. was one of the few really good things to come out of the Homeland Security initiatives, and it needs to be promoted bigtime. Someone need to bite the bullet and lead a campaign to get people, way down at the household and business levels, really prepping for a possible quarantine. That will be months of food and water and supplies for households, months of logistics and operations contingencies to plan for businesses. Only one or two governors have said this publically so far, and only a few major doctors/scientists, like the straight-shooting Michael Osterholm at CIDRAP (who can say such things, because he's not employed by the government). That's irresponsible. The federal goverment really needs to step up here, be it the President or the CDC.

4) Commit federal funding to build new state-of-the-art vaccine plants in the United States. Right now we And it's kinda old. I happen to be pro-pharma, generally, but the profit motive, while condusive to creating breakthroughs in drugs to treat diseases and disorders (and get the pharma company rich selling those drugs), generally doesn't spur development of things to prevent people from getting sick. This is where the government needs to step in to fill holes left by the market.

By the way, it's not for sure that avian flu will be resistant to all anti-virals. The only Tamiflu-resistant version was found in 2004 in one case in Vietnam; the rest, as far as I know, are still able to be treated with it. Therefore, we can add a 5) to our list: why the hell don't we have a national stockpile of crucial drugs, including the key anti-virals like Tamiflu and amantadine? We couldn't spare a little cash? The drugs have like an eight year shelf life or something, it wouldn't have been that hard to buy and stock.
posted by Asparagirl at 10:14 PM on November 11, 2005

5) to our list: why the hell don't we have a national stockpile of crucial drugs, including the key anti-virals like Tamiflu and amantadine?

Amantadine may be useless now.
posted by homunculus at 12:03 AM on November 12, 2005

Like so many other instances when expert knowledge was discarded in the run-up to war, the bioterror obsession could well have long-term consequences. "It has been four years of throwing money at a perceived threat with very little to show for it," says Columbia's Dr. Redlener. Many public health experts say that the billions spent preparing for these imagined threats have left the country dangerously unprepared for actual ones, including the very real possibility of an avian flu outbreak, which is only now being addressed.

posted by sic at 2:09 AM on November 12, 2005

Great post. Keep it up. We have to keep hammering at Bush's staggering incompetence until those who support him finally get it -- and I mean those in Congress and the Reds who voted for him. He and his cronies have hijacked the country. And what do we usually do with hijackers? We try to take the plane back.
posted by Edward King at 5:11 AM on November 12, 2005

Bioshield 2 sounds like an interesting piece of legislation.

a powerful group of Republican lawmakers is pushing "Bioshield 2" through Congress. The legislation would strip people injured by vaccines of their right to sue manufacturers and would virtually eliminate pharmaceutical corporate accountability. The legislation would also make the newly created Biomedical Advanced Research and Development Agency the only federal agency exempt from the Freedom of Information Act.

So... they use taxpayer's money to pay a corrupt, failed biocorp to manufacture enough smallpox vaccine for everyone, even though there is no risk of smallpox. They hide the known risks of the vaccine. They force people to get vaccinated. Some people suffer side-effects, and even die from the vaccine. These people have no right to sue the manufacturers, who naturally make immense profits.

Now that's what I call a bioshield.
posted by cleardawn at 8:06 AM on November 12, 2005


(first the dry scientific stuff)

There are 2 distinct H5N1's, and 3 distinct H1N1's making the rounds in Asia. The H5N1's have identical 20 amino-acid deletions, and the H1N1's have identical 16 amino-acid deletions in the neuraminidase sequences. The net effect of these deletions is to drastically decrease the effectiveness of NA inhibitors such as oseltamivir (Tamiflu). The current substrains require 30 times the threshold dose of oseltamivir to effect control as similar strains last year. To date, of Vietnamese contracting the H5N1 strain, there have been no survivors among the group receiving Tamiflu as an anti-viral.

Other modifications include an M2 sequence change in all five strains that renders ion-channel blockers such as amantadine and rimantidine ineffective.

Of common anti-virals, only zanamivir (Relenza) at present appears to retain any effectiveness.

(second, the federal-state health care response.)

Unlike the USDA, which does have a huge staff of inspectors for its national program of agricultural inspection and enforcement, there is no equivalent for humans. Instead, almost all of the "boots on the ground" are State and local health authorities.

The federal organizations such as the CDC, and countless labs and other resources, act as "push-pull" resources for these State and local organization. That is, whatever is needed can usually be "pulled" from them; but they also require a "push" of mandatory data, such as communicable disease referrals and statistical information. Otherwise they are pretty passive, just doing their own projects.

State and local governments have almost complete control over their assets. Granted, some States are far ahead in the game. Arizona, for example, has had an epidemic plan for almost 6 years, completely bipartisan, and plans to seamlessly integrate the federal plan onto their own. (Note: not vise versa.) (Also note: AZ has a large number of MDs in its State legislature.)

The factors which matter the *most*, however, are what is called the "epidemological environment". That is, much the same way you could look at a forest and tell how susceptible it is to forest fires. The EE varies tremendously in the US.

To reach such an estimation about the avian flu and its potential for harm, just off the top of my head, factors you would have to consider: population density; animal vectors, both type and number; number of school-aged children (the #1 human vector); health services availability; and proximity to international ports of entry.

Unknown variables would include: disease virulence; availability of right kind of vaccine; most affected demographic; public information awareness; quarantine initiation; public sanitation and body removal/disposal.

Again, using the forest fire analogy, fires and disease do not progress evenly. Resources can only be committed once you can assess where it is going. Many natural "fire breaks" in the progress will occur, leaving large areas mostly unaffected.

Right now, the public is aware of the potential danger to some extent (at least judging from the long lines for this season's weaker flu shot). It is too soon to agitate them further, in that it could be 2-4 years before an avian pandemic.

The bottom line is that while you can do some things to mitigate the disease, the system now in place has proven effective through most of the 20th Century. Excepting some grand technological anti-flu innovation, which is always a possibility, little else remains to be done which we aren't already doing.
posted by kablam at 8:43 AM on November 12, 2005

Cronyism elevated to an art form.
Pioneers of the campaign trail now proving the GOP conjecture that federal government is the problem.

Don't trust these people with your money or your life.

What a miserable failure.
posted by nofundy at 10:40 AM on November 13, 2005

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