North Korea claims the US released Ebola in Africa

     While this headline is hardly newsworthy (or credible), given North Korea's historical record of making claims against the United States, it is a reminder of the same pattern of conduct that we should recognize. http://www.telegraph.co.uk/news/worldnews/asia/northkorea/11269553/North-Korea-accuses-US-of-developing-Ebola-virus.html  Quoted in the article, is a law professor from the University of Illinois (who teaches international law) who gave an interview in October 2014 that supports their claim. I had to listen to his interview before accepting the quote as accurate -- perhaps he was misquoted?  But I found he was not misquoted. He makes several claims that the U.S. is involved in making bioweapons and presents as proof our work in national laboratories on vaccines for exotic diseases like Ebola.  This is similar to the logic supporting the claim made by North Korea in the early 1950s during the Korean War (1950-53) that the U.S. had used bioweapons against them partially based on the logic that because the U.S. was vaccinating troops against yellow fever that it was likely the disease they would use against them with insect-vectors, Japanese style.  (See, M. Furmanski, "Misperceptions in preparing for biological attack:  an historical survey," (Rev. sci. tech. Off. int. Epiz., 2006, 25 (1), 53-70).
      There was more and the U.S.S.R. archives revealed when opened in 1998 that North Korea was being coached by the Soviet Union. In May 1951, North Korea charged that the U.S. had used smallpox and also multiple species of arachnids, clams, insects, mammals, paper leaflets etc. to spread plague, cholera, and other diseases on multiple occasions. A formal complaint was made to the UN Security Council. Long investigatory meetings followed and no allegations were ever proved. It was not until January 1998 when the Soviet archives revealed that the claims were not only wrong they were fraudulent.  For a full account and excellent footnoting of the case study of North Korea and their allegations of biowarfare against the United States see, Milton Leitenberg's chapter "False Allegations of U.S. Biological Weapons Use During the Korean War," in the book, "Terrorism, War or Disease?" (Stanford Univ Press, 2008).
      The trouble with misattribution in biological weapons and epidemics will continue to be difficult, even with advanced genomic identification of strains and the evolution of quickly evolving bacteria and viruses that can help to identify a timeline and origin of the disease. For example, the outbreak of cholera in Haiti during the earthquake disaster was traceable to the UN Peacekeepers and a group from Nepal who brought it into a country that had not seen cholera in 150 years.  However, even this clear evidence was not taken as a liability or calling for compensation from the United Nations.  We have a long way to go in attribution but even further in compensation for mass injury.
    These kinds of claims by North Korea and unsubstantiated claims by people who should know better just seem to keep us in the dark ages of bio-literacy.

Are new regulations called for? Study on bacteria and viruses found on planes is troubling

I made it a personal goal to bring attention to the problem of SARS and the benefits of a HEPA filter system on flights.  Trouble is, that we already have HEPA filter systems on flights, but the inability to change the filters can make them ineffective. I suggested an easier solution -- use ultraviolet light at the portal boarding the flight. I was told that the wind effect at the doorway into the plane would make all of that UV-disinfection pointless.  When I returned from my political appointment to my faculty position, I proposed a study to see if there really were hosts of bacteria and viruses on flights, and in TSA bins, etc.  I was pleased to see that these type of studies were funded recently at Auburn and University of Arizona and we have some hard data, at least about infection patterns and the presence of bacteria and viruses on surfaces with which passengers come in contact.

A microbiology study published in May 2014, found dangerous bacteria and viruses on surfaces on commercial flight seats, armrests, tray tables, bathrooms and just about everywhere else.   American Society for Microbiology. "Harmful bacteria can linger on airplane seat-back pockets, armrests for days." ScienceDaily. ScienceDaily, 20 May 2014.   I had always counted on the wisdom that viruses and bacteria are generally very fragile and cannot live long on surfaces not conducive to thriving.  However, this report shows the dangerous bacteria and viruses can last to infect passengers long after they were left by a previous host occupying the seat as much as 168 hours earlier.  Without disinfection of seats and armrests and tray tables between flights, it provides a regular garden of infection opportunities.  Here's a quote from the article announcing the findings:

In order for disease-causing bacteria to be transmitted from a cabin surface to a person, it must survive the environmental conditions in the airplane. In the study Vaglenov and his colleagues tested the ability of two pathogens, methicillin-resistant Staphylococcus aureus (MRSA) and E. coli O157:H7 to survive on surfaces commonly found in airplanes. They obtained six different types of material from a major airline carrier (armrest, plastic tray table, metal toilet button, window shade, seat pocket cloth, and leather), inoculated them with the bacteria and exposed them to typical airplane conditions.

 MRSA lasted longest (168 hours) on material from the seat-back pocket while E. coli O157:H7 survived longest (96 hours) on the material from the armrest.

Another study, by Dr. Gerba of University of Arizona, followed the passengers who were infected from another passenger with influenza. The findings appeared only in news articles and I was unable to substantiate this report by finding a peer-reviewed publication on this study by Dr. Gerba.  This graphic was provided in the news article and shows who was infected.

Further burdening the airlines with more regulations is a consideration, but the potential for sickness and spreading a global pandemic is reason enough for me to support mandatory wipedowns of the surface of planes between each flight. 

Ebola Updates --New app for iOS and Android devices

http://app.lk/sos-ebola This application is a central place to find the latest news about Ebola in any country, travel restriction information and general information. It is for both iOS and Android devices.  The U.S. media is uneven with its coverage of other countries and Ebola and this app is a good source for Ebola news around the world.  

CDC's ratings by Americans fell 10% since last year

Not surprisingly, the CDC has lost some confidence of the American people over its lack of responsiveness to the need for guidance in dealing with Ebola patients in the U.S., as well as perhaps CDC Director, Frieden's misstatements about the risk of Ebola, and remarks colored with criticism of anyone other than CDC. Lack of Presidential leadership on the Ebola crisis has hindered CDC's response, and that is unfortunate for everyone, including the American people. Gallop's headlines, just out read as follows:

Americans' Ratings of CDC Down After Ebola Crisis

Americans' ratings of the job the Centers for Disease Control, or CDC, is doing are down significantly from last year, whereas ratings of other key government agencies measured both years are the same or better.  . . . .In May 2013, 71% of Democrats and 65% of Republicans said the CDC was doing an excellent or good job. Since then, Democrats' ratings have fallen eight percentage points to 63% while Republicans have dropped 25 points to 40%.   Gallop Poll Report

Can the President mandate national hospital standards?

     The National Nurses United organization is circulating a petition to urge the President to demand standards for hospitals to follow for caring for Ebola patients. 
      The California Nurses United, the state affiliate of NNU, held a strike of 18000 nurses on Tuesday and Wednesday, against health care providers throughout the state to demand better protection standards. As a result the California Department of Industrial Relations and the California Department of Public Health issued regulations last Friday (11/14/2014) that are more stringent than the CDC guidelines as described by the media:

The new guidelines, which build on the department’s Interim Guidance for Ebola released Oct. 15, require workers at risk of contracting the virus to be covered head to toe in fluid-resistant protective garb. The measures go a step further than the current Centers for Disease Control and Prevention standards by requiring battery-powered air purifying respirators, which must include full hoods to cover the face, neck and torso. They also require the hospital to provide in-person training to staff on the donning and removal of the equipment.

Read more here: http://www.sacbee.com/news/local/health-and-medicine/healthy-choices/article3960436.html#storylink=cpy

       October 10, 2014, the Department of Health and Human Services through their two agencies, CDC and ASPR, sent this memorandum outling a "policy" and "strongly" "urging" hospitals to comply.  The National Nurses United are asking in their petition for a "must" from the President.  California issued new standards, which is a state issue and within their jurisdiction.  So, the question is whether the President can mandate hospital standards?
   Previously, I have written how the President could declare a National Public Health Emergency, which would allow the President to take greater authority to mandate action. Even the suspension of  narrowly selected regulations for a short period of time may be reasonable in a declared national public health emergency, but not otherwise. Because the President has not had his DHHS Secretary declare a national public health emergency, it is unlikely that he would impose standards on hospitals that are regulated by federal law, like EMTALA, for emergencies.  That said, without a declared national public health emergency, the President could mandate such standards as long as it is not contrary to law and is not a constitutional violation of federalism by trying to replace or contradict state law. Given these choices, it is not likely the President will mandate hospital standards.
   Here is the National Nurses United petition:

Nurses across America demand that President Obama and Congress act now.

On behalf of registered nurses and other healthcare workers across the United States, we understand that the only way to adequately confront the Ebola crisis, which the World Health Organization has termed the most significant health crisis in modern history, is for the President to invoke his executive authority to mandate uniform, national standards for care and protocols that all hospitals must follow to safely protect patients, registered nurses, other front-line healthcare workers, and the public. Every healthcare employer must be directed to follow the Precautionary Principle and institute optimal protocols and personal protective equipment for Ebola that meets the highest standards used by Nebraska Medical Center, or a higher standard, including:

• Full-body hazmat suits that meet the American Society for Testing and Materials (ASTM) F1670 standard for blood penetration, the ASTM F1671 standard for viral penetration which leaves no skin exposed or unprotected.
• National Institute for Occupational Safety and Health-approved powered air purifying respirators with an assigned protection factor of at least 50 — or a higher standard as appropriate.
• Continuous interactive training with the RNs who are exposed to patients, continuous updated training and education for all RNs that is responsive to the changing nature of disease, and continuous interactive training and expertise from facilities where state-of-the-art disease containment is occurring.
• If the Employer has a program with standards that exceed those used by Nebraska Medical Center, the higher standard shall be used. The Ebola pandemic and the exposure of healthcare workers to the virus represent a clear and present danger to public health. We know that without these mandates to healthcare facilities, we are putting registered nurses, physicians and other healthcare workers at extreme risk. They are our first line of defense. We would not send soldiers to the battlefield without armor and weapons.

In conclusion, not one more patient, nurse, or healthcare worker should be put at risk due to a lack of healthcare facility preparedness. The United States should be setting the example on how to contain and eradicate the Ebola virus. Nothing short of President Obama's mandate, that optimal safety standards apply, will be acceptable to the nurses of this nation. We demand protection for all healthcare workers.  http://www.nationalnursesunited.org/train-site?gclid=CKres9Kng8ICFWFgMgodwDAACg 

Dallas Hospital Settles with Duncan Family for "mistakes"

News Release Texas Health Dallas Amicably Resolves Matters with Family of Thomas Eric Duncan 11/12/2014 DALLAS — Texas Health Presbyterian Hospital Dallas today announced that it has amicably resolved all matters with the family of Thomas Eric Duncan. We know that this has been a terribly sad, difficult and trying time for Mr. Duncan’s family and friends, and they will continue to be in the hearts and prayers of the entire Texas Health Presbyterian family. As part of the healing process, we have again extended our sincere apologies to the family and shared our regret that the diagnosis of Ebola Virus Disease was not made at the time of Mr. Duncan’s initial Emergency Department visit. The hospital is honoring Mr. Duncan’s memory by facilitating creation of the Texas Health Dallas Thomas Eric Duncan Memorial Fund for the express purpose of providing assistance to victims of Ebola in Africa. Texas Health Dallas greatly appreciates acknowledgment by the family’s attorney that Mr. Duncan’s inpatient care was excellent. We are grateful to reach this point of reconciliation and healing for all involved. Today’s resolution with the Duncan family serves as an example of the common-sense Texas laws that allow discussions to take place immediately and be resolved quickly. As a result, health care organizations, patients and family members are able to resolve matters fairly and equitably. Contact: Wendell Watson, Director Public Relations Media Hotline: 800-314-7722

US Army Public Health Command releases 21-day control guidelines for returning personnel from Ebola-stricken regions

The Joint Chiefs of Staff released an action memorandum for managing the 21-day controlled monitoring for personnel returning from Ebola stricken areas.  The video above, is the newest video information on EVD (Ebola Virus Disease) from the U.S. Army Public Health Command.

Quarantine of Doctors returning from West Africa

Today, The Washington Post writer, Max Ehrenfreund, authored an article that quotes my colleagues, Lawrence Gostin and Mark Rothstein, both longtime public health law professors.  Max did not call me, or I would have given him a different perspective. (I have had interviews with The Wall Street Journal, FOX, Time Magazine, the Atlanta Journal Constitution,  over the past months since the Ebola epidemic began to emerge in the United States, but not The Washington Post.)
The article suggests that Governor Christie's action in quarantining people who have had contact with Ebola may be unconstitutional -- the word "may" is key to understanding the way quarantine law is applied.
As Mark Rothstein noted, the court will decide if the risk to the public is high enough to burden the freedom of the individuals detained because of their contact with Ebola patients. In addition, this detention must be the least burdensome means possible.  That is the test the court will apply.
My recommendation to Governor Christie is that returning individuals be detained long enough to give them a more in depth interview about their exposure which would reveal more about the risk of that individual contracting Ebola, because we know certain exposures make it more likely that an individual will become sick, i.e., handling the bodies of people who have died of Ebola when the viral load is at its highest.  After this interview process, instructions will be given to them to log into a website and self-report their temperature each day. This requires little in the way of additional staff for the public health agency and when the computer program would notify the agency when the temperature is rising, or when the individual fails to report.  The first time there is a failure to report, the individual would be detained in quarantine for the duration of the 21-day period. 
This is the least burdensome method of protecting the public health, and that is the question the court will ask about this quarantine order.

Creation of the Texas Task Force on Infectious Disease Preparedness and Response

   Making national news, the Governor of Texas appointed a Task Force to provide recommendations on the current Ebola response and to develop plans for coordinating with local governments in their responses. Here is the Executive Order: Governor Rick Perry's Executive Order RP 79 Relating to the creation of the Texas Task Force on Infectious Disease Preparedness and Response, Monday, October 6, 2014  .
   Governor Perry noted the "significant expertise of medical professionals" in Texas, as a resource. In fact, we have the National Biodefense Laboratory at UTMB-Galveston, one of two BSL-4 laboratories in the nation and the only one, that is fully functional at this point.  The federal government relies on this laboratory for confirmation of suspected diseases and information and analysis.  Many of the scientists and medical professionals here in Texas are among the virus hunters who fearlessly enter hot zones to help analyze and assist in outbreaks. 
   In full disclosure, I will add that I was included in the named members to the Committee and my role is to provide insight where legal issues are important to responding and planning to this incident and others.  It is an honor to work with these scientists and medical professionals, developing a strategy to address the threat made very real by the recent appearance of Ebola in Texas, September 30, 2014.
  Here is the full text of Governor Perry's Executive Order:

RP 79 - Relating to the creation of the Texas Task Force on Infectious Disease Preparedness and Response

WHEREAS, infectious diseases are responsible for more deaths worldwide than any other single cause; andWHEREAS, the State of Texas has a responsibility to safeguard and protect the health and well-being of its citizens from the spread of infectious diseases; and
WHEREAS, on September 30, 2014, the first case of Ebola diagnosed in the United States occurred in Dallas, Texas; and
WHEREAS, addressing infectious diseases requires the coordination and cooperation of multiple governmental entities at the local, state and federal level; and
WHEREAS, public health and medical preparedness and response guidelines are crucial to protect the safety and welfare of our citizens; and
WHEREAS, Texas has nationally recognized infectious disease experts and other highly trained professionals across the state with the experience needed to minimize any potential risk to the people of Texas;
NOW, THEREFORE, I, Rick Perry, Governor of the State of Texas, by virtue of the power and authority vested in me by the Constitution and laws of the State of Texas, do hereby order the following:
1. Creation and Duties. The Texas Task Force on Infectious Disease Preparedness and Response (the "Task Force") is hereby created to:
• Provide expert, evidence-based assessments, protocols and recommendations related to the current Ebola response and a strategic emergency management plan for the incident command team and their partners at the state and local level of government.
• Develop a comprehensive plan to ensure Texas is prepared for the potential of widespread outbreak of infectious diseases, such as the Ebola virus and other emerging infectious diseases, and can provide rapid response that effectively protects the safety and well-being of Texans.
• Serve as a reliable and transparent source of information and education for Texas leadership and citizens.
The Task Force will establish this plan by:
• Using the significant expertise of medical professionals in Texas and elsewhere;
• Collaborating with local government officials and local health officials;
• Utilizing, where possible, the Texas Emergency Preparedness Plan and structure;
• Identifying the various responses necessary in the event of an epidemic of infectious disease;
• Establishing a command and control structure that will ensure effective preparations and response that may be included in Chapter 418 of the Government Code or related statutes and that also ensure the authority of a Governor to take emergency action as needed; and
• Coordinating with appropriate entities to ensure public awareness and education regarding any pandemic threat.
2. Composition and Terms. The Task Force shall consist of the following members:
Dr. Brett Giroir, Executive Vice President and CEO, Texas A&M Health Science Center, shall serve as the Director of the Texas Task Force on Infectious Disease Preparedness and Response.
Other members include:
Dr. Gerald Parker, Vice President, Public Health Preparedness and Response, Texas A&M Health Science Center. Dr. Parker shall serve as the Deputy Director on the Task Force.
Dr. Tammy Beckham, Director, Veterinary Medical Diagnostic Laboratory and the Institute for Infectious Animal Diseases, Texas A&M University.
Dr. Peter Hotez, Founding Dean, National School of Tropical Medicine, Baylor College of Medicine; Professor, Departments of Pediatrics and Molecular Virology & Microbiology; President, Sabin Vaccine Institute.
Richard Hyde, Executive Director, Texas Commission on Environmental Quality.
Tim Irvine, Executive Director, Texas Department of Housing and Community Affairs.
Dr. Kyle Janek, Executive Commissioner, Texas Health and Human Services Commission.
Nim Kidd, Division Chief, Texas Division of Emergency Management.
Dr. Thomas Ksiazek, Virologist and expert in the field of epidemiology/ecology and laboratory diagnosis of hemorrhagic fevers and arthropod-borne viral diseases, The University of Texas Medical Branch at Galveston.
Dr. David Lakey, Commissioner, Texas Department of State Health Services.
Dr. James LeDuc, Ph.D., Director, Galveston National Laboratory; professor of Microbiology and Immunology; Director, Program on Global Health, Institute for Human Infections and Immunity.
Dr. Scott Lillibridge, Professor of Epidemiology and Assistant Dean, Texas A&M Health Science Center School of Public Health.
Colonel Steve McCraw, Executive Director, Texas Department of Public Safety.
Major General John Nichols, Adjutant General, Texas National Guard.
Dr. Victoria Sutton, Associate Dean for Research and Faculty Development; Director, Center for Biodefense, Law and Public Policy, Texas Tech University School of Law.
Lt. General Joseph Weber, Executive Director, Texas Department of Transportation.
Michael Williams, Commissioner, Texas Education Agency.
The Governor may fill any vacancy that may occur and may appoint other members as needed. All appointees serve at the pleasure of the Governor.
Any state or local employees appointed to serve on the Task Force shall do so in addition to the regular duties of their respective office or position.
3. Report. The Task Force shall make written reports on its findings and recommendations, including legislative recommendations, to the Governor and the Legislature. The first report is due by December 1, 2014, which should include preliminary recommendations that require legislative action. A second report is due by February 1, 2015, and should contain, in part, any additional recommendations for legislative action during the 2015 legislative session. The Task Force may issue other regular reports as it deems necessary.
4. Meetings. The Task Force shall meet at times and locations as determined by the Director. The Task Force may meet telephonically. The Task Force may hold public hearings to gather information; when conducting public hearings the Task Force shall meet in various parts of Texas to encourage local input. The Task Force also may meet in executive session to discuss matters that are deemed confidential by state or federal statutes or to ensure public security or law enforcement needs.
5. Administrative Support. The state agencies involved shall provide administrative support for the Task Force.
6. Other Provisions. The Task Force shall adhere to guidelines and procedures prescribed by the Office of the Governor. All Task Force members shall serve without compensation or reimbursement for travel expenses.
7. Effective Date. This order shall take effect immediately.
This executive order supersedes all previous orders inconsistent with its terms and shall remain in effect and in full force until modified, amended, rescinded or superseded by me or by a succeeding Governor.
Given under my hand this the 6th day of October, 2014.
RICK PERRY
Governor

Gallup polling may not analyze the most important question.

      Does fear of getting Ebola relate to confidence in government to contain it?
     Yesterday, Gallup released a poll, comparing fears of Americans to getting Ebola to previous polls asking similar questions about H1N1(2009) and Bird Flu (2005-6).  The most interesting finding, I thought, was this:  The poll found that more Americans were concerned about getting Ebola than they were concerned about getting H1N1, even though there was a lot more of it in closer proximity to Americans. 
     Could this be related to confidence in the federal government to contain Ebola?  The poll data suggests it might be.  When asked about confidence in the federal government to contain Ebola, 61% were confident; while the poll during the 2009 H1N1/Swine Flu outbreak, confidence in the federal government to contain it was 74%. 
     While Gallup did not make this association, I suggest that there may be a correlation if the data were analyzed with these two bivariate responses and if the same people who were concerned about getting Ebola were also not confident in the government at a frequency that was statistically significant, then that could be one of the most important findings in the poll, if they had taken this next step in their analysis.
    Here's the report if you would like to read it more closely:  Gallup poll report .

Connecting the dots . . . national security and ebola

   After a long silence, but for the one moment when the National Security Council representative said the equivalent of "gee, this Ebola thing is bad in West Africa," President Obama has taken action. Connecting the collapse of these nations and their economies affected with Ebola to a threat to global security, President Obama took action.  The WashingtonTimes reported Tuesday that the U.S. would deploy 3,000 American troops to build treatment centers.

“It’s spiraling out of control, it’s getting worse, it’s spreading faster and exponentially,” Mr. Obama said of the epidemic while touring the Centers for Disease Control & Prevention in Atlanta. “The world is looking to us, the United States. It’s a responsibility that we embrace.”

Mr. Obama said the crisis is a national-security threat to the U.S. because “we could be looking at hundreds of thousands” of dead if the epidemic gets worse, which could lead to governments and societies collapsing.

“It’s a potential threat to global security if these countries break down, if their economies break down, if people panic . . .” 

PBS Frontline in Sierra Leone with the Ebola epidemic

PBS Frontline went to Sierra Leone to produce the best documentary yet on the Ebola epidemic.  http://www.pbs.org/wgbh/pages/frontline/ebola-outbreak/ .
  The method of eliminating Ebola is much like what was done to eliminate smallpox.  Workers go village to village and house to house to identify anyone who is sick.  Just like the WHO elimination of smallpox operation in the 60s and 70s, people with Ebola symptoms are hiding from discovery because of the high mortality rate for those who leave to go to the Ebola hospital. Privacy in the traditional human rights sense is diminished, balanced against the need to protect the public from infection. In a country with strong civil rights traditions, the door to door operation in the event of a pandemic would be a major transformation in expectations of privacy in a social sense, but also in a legal sense.  

ISIS laptop with bioweapons 19-page document

     The news broke this week that an ISIS laptop had been captured and a document outlining bioweapons was found on the computer harddrive. The owner of the laptop was purportedly a Tunisian member of ISIS who had attended a university in Tunisia in physics and chemistry.  Foreign Policy was the first to break the story and it has been reported by so many news outlets and blogs that I never reached the end of my Google string query.  That said, I will add only what I think has not been said about the information that was found.
     The "19-page document" on the laptop harddrive that serves as the article's only source contains such quotes as:

"Use small grenades with the virus, and throw them in closed areas like metros, soccer stadiums, or entertainment centers. . .Best to do it next to the air-conditioning. It also can be used during suicide operations."

     The Foreign Policy authors write, "The ISIS laptop contains a 19-page document in Arabic on how to develop biological weapons and how to weaponize the bubonic plague from infected animals."

Then the authors quote from the 19-page document:

"The advantage of biological weapons is that they do not cost a lot of money, while the human casualties can be huge," . . . 

    Then some instructions on testing a plague weapon, according to the authors:

"When the microbe is injected in small mice, the symptoms of the disease should start to appear within 24 hours. . . ."

    These few phrases tell us a world of information about the stage of development and level of understanding of ISIS's members ---and this is not to be ignored.

 

Ebola Clinics are Overwhelmed and Help is NOT on the Way

   The shocking video in today's The New York Times shows the reaction in Liberia to a man walking out of an Ebola clinic.  If a picture is worth a thousand words, these two videos are worth a million words. The situation is dire and the lack of funding and human resources from and through the World Health Organization is now clearly failing to turn back this disaster. 
   Phone calls from victims go unanswered because the government system is too overwhelmed to pick them up or care for them.  Even food and water is apparently scarce in the Ebola clinic and the pressure is mounting on those who are brave enough to be on the ground helping staff the Ebola clinics. 
   The World Health Organization is an international intergovernmental organization --nothing more than the sum of its parts --- and depends completely on its member nations to respond to calls for funding and help.  Doctors Without Borders may be the riskiest profession in the world and to them we owe a tremendous amount of respect and gratitude, along with other organizations funding medical missionaries to these areas like Samaritan's Purse and others.
   There is no governmental solution except in retrospect, it would have helped to have funded better infrastructure for public health surveillance and perhaps an epidemic could have been averted.  Lawrence Gostin, law professor and friend, at Georgetown University School of Law, authored an article in today's Lancet that makes that argument and offers suggestions of setting up a fund for funding better infrastructure for prevention of biodisasters. Here's the article: Ebola: towards an International Health Systems Fund.
  Meanwhile, the peak of the epidemic is still rising and I expect a rally at the World Health Organization in another call for assistance to its member states.  But with multiple global disasters unfolding at the same time, it is going to be a challenge.

CDC finally issues Ebola guidance for travelers and students

   CDC finally posted guidelines for travelers regarding the Ebola epidemic in West Africa, August 29, well after students have returned to campuses and schools all over the U.S. from summer travels.  In The Chronicle of Higher Education today, one epidemiologist had this to say,

"These guidelines reinforce what a lot of colleges are doing already, but it would have been nice if they’d come out two weeks ago," when students were arriving and health centers were unsure what to do, said Craig M. Roberts, an epidemiologist with the University of Wisconsin at Madison’s student health service."

   Students are advised to monitor their health for 3 weeks if they have been in "countries where the Ebola outbreaks are occurring?"  But CDC does not give anyone a clue what those countries are and never mentions Senegal where the first case was brought into the country with subsequent in country infections.
   CDC also advises colleges and universities to postpone all non-essential travel to these three countries until further notice, but no such warning for Nigeria -- all education travel is still open to Nigeria with precautions to protect yourself. Yes, that's right.  This includes tips to
   But the most important legal aspect of the announcement is typical of most Department of State warnings about travel to other countries, and here, they have crafted the warning to cover the risk of travelers being detained due to a government-issued quarantine:

The US Department of State takes action to protect US citizens who travel outside the US through a number of diplomatic channels. However, in the event of an outbreak, any country has the right to enact measures (such as quarantine of exposed people, isolation of sick people, and screening of people entering or exiting the country for sickness or disease exposure) to protect its citizens and to prevent the spread of an outbreak to other countries. These measures may infringe on the individual rights of those who appear to be infected with or exposed to a disease of public health concern—including visiting US citizens. The ability of the U.S. Department of State to intervene in such situations is limited. See the US Department of State’s Emergency Resources page for more information.

   U.S. citizens traveling abroad are often taken by surprise that the civil rights they enjoy in the U.S. are not practiced in many other countries.  Although human rights in international law is expected to be observed in every country, the concept of human rights may vary from one culture to the next, and many countries do not feel bound by international law despite their signatures and ratifications of treaties.  No doubt one of the reasons that the television series, Locked Up Abroad, has enjoyed so much success.

Department of Homeland Security has "Nothing to Report"

   Normally, I would not think it important to write a post on three words, but these words were rather jolting as I looked under the heading of the Public Healthcare sector, in the DHS Daily Infrastructure Report, an area of jurisdiction for the Department of Homeland Security.  The global news media is ablaze with following the rapid spread of Ebola, not to mention the Sunday edition focus by the Atlanta-Journal Constitution with the arriving Ebola patients a couple of weeks ago.  Wouldn't the Department of Homeland Security have something to say about it this week?
   The strange omission by the Department of Homeland Security seems odd especially given their office of the Chief Medical Officer who should certainly be involved, even if DHS does not have the federal government lead on the issue.  The Department of Health and Human Services in the early turf battles over biodefense, won the "lead" on public health matters, but why would DHS be left completely out of the looming threat of Ebola to the global community, including the U.S.?
   Having spent a substantial amount of time in the White House and other Executive Branch offices, I understand the turf wars, but to leave DHS completely out of this issue seems counterproductive to any organized domestic response to a potential biothreat.  If there is a plan out there for the U.S. to address the potential arrival or spread of Ebola in the U.S. could someone please comment and post it here?

Ebola mapping accomplished

  The completion of genomic mapping of the Ebola virus shows that the epidemic originated from a faith healer in Guinea who attracted Ebola cases from all over the region.  When the faith healer died of Ebola, she attracted man followers to her funeral which triggered the spread all over the region, as now-infected mourners returned to their homes. 
  The genomic map was uploaded to the internet so more scientists would have immediate access to it and pharma companies checked to see how the new information might reveal markers indicating their drug was effective. 
  The discovery that the Ebola virus has mutated 300 times since the first case is troubling since this is fast and suggests it is "learning" to adapt and evolve to improve its infectiousness.

Air travel suspended to Ebola-affected Regions and the IHR

   Airlines British Airways, Emirates Airlines, Arik Air, ASKY Airlines, Cameroon Airline, Korean Air and Kenya Airways have all suspected flights to Liberia, Guinea and Sierra Leone.
  The International Olympic Committee has barred athletes from Ebola-affected countries from competing in the Youth Olympic Games which opened on Saturday, Aug 23, in China.  WHO believes that screening that has been implemented in Liberia, Guinea and Sierra Leone is sufficient to protect air travelers.  However, the IOC may be facing many other countries which might opt to stay away, if the IOC did not take this precautionary measure of excluding athletes who might bring Ebola to the games.

    The IHR International Emergency Committee on the West African Ebola epidemic met on Aug 6, 2014 and issued recommendations including this one:   "There should be no general ban on international travel or trade; . . ." 

Despite their recommendation, there is a growing number of states barring trade and travel with Sierra Leone, Guinea and Liberia. This WHO recommendation is consistent with the IHR (2005) overall purpose which reads:

Art. 2. Purpose and scope. "The purpose and scope of these regulations are to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade."

By all accounts, the Ebola epidemic still has months to run its course in West Africa and whether the economic impact can be lessened seems to be increasingly unlikely.

Do Ebola quarantines make good neighbors?

    It's not even a mixed metaphor, but do quarantines, like fences, help or hurt? Diplomatic relationships between the nations of West Africa are being tested in the worst ebola epidemic ever, exceeding the previous largest outbreak in Uganda in 2000-2001 by almost 600% , as of Aug 22, with more than 2,615 human cases as reported by CDC, plagues the region. (Plague has become such a common colloquial verb that we forget the frightening origins of the term-- disease and epidemic.)
    The International Health Regulations (2005), implemented in 2007, have an objective to avoid hurting nations already under pressure from serious outbreaks of contagious diseases, in addition to protecting global health.  Avoiding travel restrictions and trade embargoes against countries reporting these outbreaks are part of the recommendations that are designed to keep the world from unnecessarily impoverishing and crippling the economies of countries particularly in need of response and recovery from a disease outbreak.
  Consistent with the International Health Regulations (2005) the World Health Organization has cautioned countries NOT to impose sweeping bans on travel and trade.  World Bank officials have already predicted a drop from 4.5 to 3.5 percent as the estimate for economic growth in Guinea this year.
  Quarantines, called "unified sectors", established in these countries are considered to be largely ineffective due to their vast size and the inability to control what goes on inside these areas.  Further, food and water are not going into these areas and supplies will soon run out.  There is no law enforcement and there is little to no medical care inside these areas.  The people in this unified area of Liberia are shown in a stand-off with police trying to enforce the quarantine in this photo from The New York Times, Aug. 21, 2014.  WHO recommendations are not being followed, but the Liberian President expressed her reasons why when she said that she took these extreme measures because no one listening to the public health instructions and advice. 
   When it comes to local politics, the Presidents of these nations will have to act in accordance with the fears and pressures of their constituents to keep order, and that may be in contradistinction to any advice they receive from the global community.  That is the reality.  In the end, quarantines may make better neighbors than showing no control efforts at all.

   
   Here is a map produced by CDC, Aug 14, showing the closed borders of West Africa and the intensity of the number of human cases.

Ebola is not caused by witchcraft

A radio message about Ebola is being used in ten different indigenous languages in West Africa to help reduce misinformation about diagnosis and treatment:

'The Ebola virus lives in the bats and does not make them sick. The Ebola virus is released from the bats from time to time and can infect monkeys, chimpanzees, and humans, and other wild animals.

So, can Ebola be caused by witchcraft or a curse, or any other cause? No. Remember: the Ebola virus lives in bats.

And remember: with the right information, and together with our health care workers, we can protect ourselves from Ebola."

This is not as strange as it seems, because Guinea, Liberia, Sierra Leone, Cote D'Ivoire and Nigeria all have social beliefs about the use of witchcraft to harm others, and some have laws to prevent the harm to people stigmatized and harmed by the belief that they are witches or caused harm through witchcraft.  Ghana, on the eastern border of Cote d'Ivoire, for example, has witch and wizard camps for women and men, respectively, and these people never return to their villages and if they do, they are often killed.  Nigeria has anti-witchcraft laws, which criminalize particular crimes against people stigmatized and harmed because they are believed to be witches or caused someone's illness or death.  This is no small problem in West Africa.

Other radio messages warn listeners that if they are sick it is probably malaria and not Ebola, another spot cautions that if there is no fever, there is no Ebola.

Public risk communication is critical in a public health emergency and even in the United States, despite the Executive Order which identifies the Secretary of HHS as the official source of public health information in a public health emergency, it is very likely that the federalism lack of clarity will have any state initiating their own public health information which will lead to a mix of information.  This lack of clarity in where government leadership and authority lies in a public health emergency will lead to problems in our own sophisticated western approach to risk communication and it should be clarified and practiced.

Registered pesticides that become chemical weapons--a rose by any other name is still a rose

    I am going to shift focus from biological threats to the Chemical Weapons Convention and the prohibition against the use of chemical weapons in warfare, because of a recent tragedy.  The dual use of many useful chemicals makes the CWC much less effective in preventing fatalities than it might be. On Aug 9, 2014 two more needless deaths were caused by aluminum phosphide, a precursor to a chemical weapon.
     The recent deaths of two children in Dubai due to the use of a chemical used as a precursor in chemical warfare -- aluminum phosphide -- was not due to maliciousness but due to gross negligence.  It is used as an agricultural fumigant and not intended to be used as a pesticide. When it comes in contact with moisture or dropped in water, it produces phosphine, a gas that was related to phosgene a primary chemical weapon in World War I. It is illegal to use in Dubai but the underground pesticide market is still a threat. It is also a problem in developing countries like India.  But if you think this happens only outside of the U.S., think again. In 2010, two young girls in Utah were also killed in an application of aluminum phosphate at or in their home.  Illegal use of pesticides by unregistered or grossly negligence applicators can still occur.
    The efforts to regulate this pesticide by EPA have led to limiting the use of this chemical to fumigating for agricultural uses, only, and not for home pesticide use. In 2000, the U.S. EPA signed an MOA (Memorandum of Agreement) with pesticide registrants to amend its registration to put more restrictions on the use and labeling of the product. The FIFRA statute considers economics as part of the balance of risk management in deciding on registrations. Notice of importation of a pesticide is required by FIFRA and in Nov 2011 EPA took enforcement action against an illegal importation of 25 tons of pesticide including 50,000 pounds of aluminum phosphide from China.
    This chemical can still be used for residents killing of rodents in burrows and some of the risk extends to and beyond the area in use to the neighborhood.  Aluminum phosphide is identified as a risk among chemicals in Houston.  The Department of Homeland Security lists aluminum phosphide in a sabotage/contamination category of "Chemicals of Interest" but stops short of listing it as a CWC precursor.  Because it is regulated under FIFRA, it can escape the CWC list of prohibited chemical weapons, like chlorine for swimming pools, but it is nonetheless, a deadly chemical weapon.
    I believe that FIFRA works and to take into account the usefulness of aluminum phosphide as a fumigant to protect billions of people from rodents eating the same grain we eat is going to prevent a illness and deaths.  Unfortunately, situations like this should call for more urgency to fund research to find better substitutes for aluminum phosphide. But have we made the administrative process for registering pesticides so difficult that we are willing to accept these needless deaths, in exchange for the uncertainties in testing a new or better substitute?  Incentives are needed to replace these pesticides with safer ones, and modeling toxicological risks could speed up the registration process without increasing the risks to the public. It is time to revisit FIFRA.

In case you were wondering....

     In my July 24, 2014 post, I told you that despite wearing my nano-fiber-infused insect-repellant clothing, once it was removed I was bitten by a mosquito in Dominica in the Eastern Caribbean. In my May 31, 2014 post, you saw that Chikingunya virus had appeared in the Caribbean and the number of infected people was growing.
   In case you were wondering....I survived without contracting any mosquito-borne illness, at least any acute ones.  I had a ten day flu-like illness which was a little disconcerting, but nothing extraordinary, and I probably got it by drying out my throat and becoming susceptible to viruses of all kinds, caused by sleeping in front of a blowing air conditioner unit on my overnight in San Juan, returning from Dominica.
   Chikingunya is not on the regulatory list of diseases that are required to be reported by states. Since it is not a nationally reportable illness (but can be reported to ARBOnet).  Because of the distribution of  constitutional federalism, public health laws and information is in the jurisdiction of the states, and the federal government (i.e., CDC) is not empowered to require that states report any illness not adopted by regulatory processes.  In fact, the list of diseases that states are required to report is fairly short. April 23, 2003 was the last update to the reportable disease list:

Ex. Ord. No. 13295. Revised List of Quarantinable Communicable Diseases

Ex. Ord. No. 13295, Apr. 4, 2003, 68 F.R. 17255, as amended by Ex. Ord. No. 13375, §1, Apr. 1, 2005, 70 F.R. 17299, provided:

By the authority vested in me as President by the Constitution and the laws of the United States of America, including section 361(b) of the Public Health Service Act (42 U.S.C. 264(b)), it is hereby ordered as follows:

Section 1. Based upon the recommendation of the Secretary of Health and Human Services (the “Secretary”), in consultation with the Surgeon General, and for the purpose of specifying certain communicable diseases for regulations providing for the apprehension, detention, or conditional release of individuals to prevent the introduction, transmission, or spread of suspected communicable diseases, the following communicable diseases are hereby specified pursuant to section 361(b) of the Public Health Service Act:

(a) Cholera; Diphtheria; infectious Tuberculosis; Plague; Smallpox; Yellow Fever; and Viral Hemorrhagic Fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named).

(b) Severe Acute Respiratory Syndrome (SARS), which is a disease associated with fever and signs and symptoms of pneumonia or other respiratory illness, is transmitted from person to person predominantly by the aerosolized or droplet route, and, if spread in the population, would have severe public health consequences.

(c) Influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic.

    Even though CDC is constrained with what it can require states to report and is limited to this list, they have created a great "work around" that does not violate the federalism principle or the law, giving states jurisdiction over public health matters. CDC developed a relationship with a non-government organization, the Council of State and Territorial Epidemiologists (CSTE) to develop common case definitions to allow reporting through this channel. Some strict-federalists may see this as having the effect of taking power from the states in public health matters, but no one has ever challenged this relationship or process.  It is often the best source of data of illnesses and surveillance of illnesses in the U.S. and makes up the backbone of the National Notifiable Diseases Surveillance System (NNDSS).

    Now, since it is now clear why the data reported by CDC is not from CDC --- take a look at the map CDC published on Aug. 19th. The map created below is based on ARBOnet data, used by CDC to report as of Aug 19, 2014, the number of people infected with Chikingunya.  The states with these reports are in medium blue on the map. These were cases acquired by travelers coming back from traveling to infected areas. Florida is the only state with cases of transmission WITHIN the state, and is particularly of concern since it is spreading so rapidly. We may yet see more states with local transmission.
 

When Ebola Met Hollywood

Craig Schneider at the Atlanta Journal-Constitution contacted me last week regarding his story about how culture had been impacted by ebola and other biological scares. This, of course, was in response to bringing two victims of ebola to Atlanta for treatment. The concern among residents in Atlanta was evidenced in many comments to the articles, Craig told me. I had the opportunity to talk about my new book, The Things That Keep Us Up At Night, the human fear response and the movies that use that fear as a plot device.  Here's the article When Ebola Met Hollywood.  They used quite a bit from my book including the reference to The Satan Bug, a 1965 movie about a laboratory accident with a bioweapon.  (I asked him why they used the movie since it wasn't about ebola and he said they liked the title!) That said, I also told him which movies used ebola (see Chap 8) as the bioweapon or disease, and since he didn't use it, I will list them here, as described in the movie, for my blog readers:

Contagion (US, 2002) "Level Four Ebola Virus"
Global Effect (US, 2002) particularly virulent ebola virus
Azaan (Bollywood, 2011) Ebola variant, bioweapon

Mosquito repellant nanotechnology clothing against Chikangunya

     As I wrote on a previous post, Chikangunya virus is spreading quickly in the Caribbean and has been transmitted in the U.S. in Florida, now.  I am currently visiting Dominica in the Eastern Caribbean, a region particularly hit by the virus.  In addition to the old standby, #SkinSoSoft by Avon, I discovered new insect repellant nanotechnology for clothing sold at #Cabela's and made by #BurlingtonLabs. Reasonably priced, I have attached a photo of the labels showing the fabric contains 0.52% permethrin, an insecticide, on one of the shirts. 

    We ventured into the Central Rain Forest, a national park and encountered no problems. I think it really repelled mosquitoes and other insects. Only after I removed the clothing after returning to the hotel (albeit with the windows open) did I get a mosquito bite in #Dominica.  Now I will wait and see what happens.

China Provinces Implement Broad Quarantine

            One person, Wang, of unknown gender, died in Yumen of pneumonic plague on Wednesday, July 16, 2014 and 151 people had close contact with him have been contacted and isolated. Conflicting reports say he was in close contact with a marmot or with rats.
            The National Health and Family Planning Commission has gone to Yumen to implement control measures.  It is not clear on whose authority quarantines were issued, but reports say that authorities in the city of Juiquan, Gansu Province, implemented quarantine in four areas on Thursday, July 17, 2014: Yuman City, Chijin Tow, Xihu Village and an unnamed rural area.  In addition, roads have been closed into and out of Jiuquan, including Lianhuo Expressway that lings east Jiangsu Province with the Xinjiang Uygur Autonomous Region and it is being enforced by local police officers.

According to reports, the third-highest in a four-tier quarantine law was implemented in these areas and roads going in and out of the area.

           “As a result of the emergency alert -- the third-highest in a four-tier system - four quarantine areas have been set up: in Yumen City, Chijin Town, Xihu Village and an unnamed rural area, the government said. Several roads into and out of Jiuquan have also been closed, including the Lianhuo Expressway that links east Jiangsu Province and the Xinjiang Uygur Autonomous Region, local traffic police said. "We don't know when the road will reopen," said Meng Guanghui, a police officer who patrols the expressway, adding that drivers have been told to find alternative routes.”
            China’s Law on the Prevention and Treatment of Infectious Diseases categorizes plague as a Class A infectious disease, the highest level.
            During the SARS outbreak, China’s quarantine laws included individual and area quarantines such as the one described in these recent news accounts.  Area quarantines are unusual in the United States and are typically reserved for agriculture quarantines, not people.  Quarantining a region or town for a human disease would be a highly unusual action and is not a measure provided for in most state public health emergency laws, although it has been recommended in model legislation as an important tool for managing infectious disease outbreaks.

First thing we do, let's purge all the advisors!

    My title is a play on the Shakespearean quote from his work, “Henry VI”, “First thing we do, let’s kill all the lawyers!” uttered by Dick the Butcher in hopes that if he could do away with law and order, he could become king. This title seems apropos for the purging of the institutional memory of the NSABB yesterday with the wave of dismissals of 11 of the 23 member FACA (Federal Advisory Committee). Yesterday’s news of the purge of the NSABB in the wake of the CDC and NIH incidents with anthrax and smallpox, raises questions about the reason for making an exception to the charter’s length of service of membership appointments and the very purpose of the NSABB. The NSABB Charter provides that members will be appointed “for overlapping terms of up to four years; . . .”

               The purpose of the NSABB is explained in the charter “. . . is to provide, as requested, advice, guidance, and leadership regarding biosecurity oversight of dual use research, defined as biological research with legitimate scientific purpose that may be misues to pose a biologic threat to public health and national security. The NSABB will provide advice on and recommend specific strategies for the efficient and effective oversight of federally conducted or supported dual use biological research. . .”  This is a very narrow charge, and the NSABB has historically worked in this narrow area.  The scope of authority for the NSABB does not include advice on the proper regulation of federal conducted research --- only that research in the context of its “dual use” implications.  Even a new array of advisors will have no further authority than the existing and purged membership, so it is unclear what the expectations are for this exceptional overturn of membership.

      The Pandemic and All-Hazards and Preparedness Act, 42 U.S.C. 217a, sec. 222, is the authority for the NSABB.  The NSABB is a Federal Advisory Committee which means it is made up of non-government members with government members and is advisory, only.  The NSABB advises the Secretary of Health and Human Services.

CDC's anthrax accident and the problems of self-regulation

The CDC’s most recent incident with the discovery of a strain of anthrax that was not what they thought it to be, that is, an attenuated or weakened strain, raises the same red flag that has been raised in previous incidents.  CDC is regulating itself, and it is apparent from their own internal investigation of the incident that they were not complying with their own requirements for experiment plans and specific protocols for each experiment, for response protocols or for biosafety standard operating procedures (SOPs) required for each experiment, point of contact (Responsible Official), etc.

But some of the more obvious problems with the regulatory structure in which biosafety and biosecurity should be achieved are evident in their own investigative report.  The CDC reported that it had “ceased operations” which is not what the regulating body should have done in this case.  The CDC should have at a minimum “suspended” its registration (42 CFR §73.8) which would not allow them to resume operations until a complete review of their biosafety and biosecurity plans and procedures and compliance had been verified by --- well, by them.  But there is more.  An incident such as this, resulting in a potential occupational exposure requires a reporting protocol, and a form completion within seven days of the incident (the incident was June 13):

 42 CFR §73.11(b) Upon discovery of a release of an agent or toxin causing occupational exposure or release of a select agent or toxin outside of the primary barriers of the biocontainment area, an individual or entity must immediately notify CDC or APHIS.

 (1) The release of a select agent or toxin must be reported by telephone, facsimile, or e-mail. The following information must be provided:

(i) The name of the select agent or toxin and any identifying information (e.g., strain or other characterization information),

                          (ii) An estimate of the quantity released,
                          (iii) The time and duration of the release,
                          (iv) The environment into which the release occurred (e.g., in building or outside
                          of building, waste system),
                          (v) The location (building, room) from which the release occurred,
                         (vi) The number of individuals potentially exposed at the entity,
                         (vii) Actions taken to respond to the release, and
                         (viii) Hazards posed by the release.

(2) A completed APHIS/CDC Form 3 must be submitted within seven calendar days. 

   The Freedom of Information Act should allow anyone to see how well they complied with this provision, but my experience with CDC was three years before a response to our FOIA request – another problem for another post.

   The CDC’s investigation report dated July 11, 2014 makes little attempt to cite any regulation that is violated and only references to needed improvements that are actually regulatory requirements are made without citing to any regulation.  It suggests that CDC’s investigation had little to do with the regulation or being regulated.  “Arrogance” is the word I am trying to avoid using too quickly, but it is becoming the elephant word in the room as I read the report. 

   The self-regulation in this case, bears review, and perhaps another department, like the Dept of Homeland Security, would be best suited to review the biosecurity compliance aspect, at least.  NIH, the sister agency of CDC within DHHS has more knowledge of biosafety than any other agency, even CDC, because they do more of the biodefense research than any other agency, and they would be well suited to be an advisory source for compliance.  But because NIH is regulated by CDC, this also sets up a conflict of interest where “mutual regulation” would be created. An external body could review the biosafety compliance if it was made up of conflict-free members who were not on the CDC payroll as consultants, but again, it is hard to find an expert who is not contracted with CDC to do inspections of laboratories.  Regulating CDC is not an easy problem to solve, but perhaps when a private accrediting association eventually emerges to accredit laboratories independent of CDC, they would be the place to seek a regulator of CDC’s own BSL facilities. 

    But my final word is that the real hero in this story is the scientist who discovered the unexpected growth of the anthrax on the discarded plates, and averted what could have been a biodisaster. 

    Congratulations and thanks to the individual scientists at CDC who are working to protect public health and safety, every day.  They are not the problem, it is the regulatory framework in which they work.

Chicken Pox Parties Gone Global

    In 2011, Reuters reported a Nashville U.S. District Attorney was warning parents not to mail chicken pox infected lollipops or other materials through the mail.  The mailing of infectious diseases through the U.S. mail is a federal crime.  They also caution that tampering with consumer products such as a lollipop is also a federal crime.  These warnings came after news of a multi-state ring of anti-vaccination parents were sharing lollipops licked by their infected children and mailing them to parents who wanted to intentionally infect their child with chicken pox to give them what they hoped was a mild case of it.
    The test for whether you have committed a federal crime is not whether the lollipop was mailed across state lines, but whether it had "a substantial effect on interstate commerce," which could be potentially achieved by having investigators travel to the area to investigate and spend money on a hotel and food.
    The parents were also hosting chicken pox parties.  Information for parents hunting for infected children was shared on Facebook at one page called "Find a Pox Party in Your Area".  I since located other Facebook pages, "Pox Party-USA", Pox Party in the Gulf South, Chicken Pox -- Greater New York Area".
     Not only is this illegal, it is dangerous.  CDC reports more than 100 children a year were killed by chicken pox before the childhood vaccine became available about a decade ago.  Shingles is also caused by the presence of the chicken pox virus, so once you have the disease you may be looking forward to shingles in the future.  The chicken pox vaccine allows your child to miss that opportunity.
     Troubling is the evidence that this is become a global phenomena, not just an American one.  The United Kingdom as well as New Zealand have had reports of chicken pox parties.
     The First Amendment provides for Americans to gather in their homes without government interference, but when those gatherings have a serious impact on public health, state governments should consider making these contamination rituals at parties, illegal.

The New York Times Review by Gopnik recognizes a new genre of biohorror/biothriller

Adam Gopnik, fantasy author in his own right, reviewed Chris Weitz's new children's book, "A Young World," in this Sunday's New York Times Book Review section.  The book is about a pandemic that leaves the teens in charge of the world.  But of most interest is that Gopnik begins to see an emerging genre when he writes,

"What is the deep appeal of this kind of fantasy right now? That it is a well-developed — even an overdeveloped — genre is disarmingly acknowledged by Donna: “Even when it was happening, all I could think was, this is just like ‘Contagion.’"

I recommend The Things That Keep Us Up At Night --Reel Biohorror --the first book to identify and explore biohorror and biothriller as a new subgenre.   

Anti-Vaccine Believers and Scientific Studies

When The Economist, Hollywood, Jon Stewart, Scientists, Children and Scientific Fraud Collide

In 1989, Meryl Streep warned us away from apple juice because it contained a “pesticide” called alar.  It has since been shown first, that it is not a “pesticide” and second, that the upshot to omitting alar from apple growing – which causes the apple to stay on the tree longer, thus less need for pesticides – was that more pesticides will have to be used. (All of this happened as I was graduating with a Ph.D. in Environmental Sciences with a focus on risk communication, so it was indeed a memorable event that told me I had a lot of work ahead of me.) This is the way not to do science, and did we learn a lesson from taking scientific advice from Hollywood stars? No.  Apparently, the California hipsters in Napa, Sonoma, etc. have heeded the warning of another Hollywood “star” with no expertise.

On June 28, 2014, The Economist wrote a scathing commentary on the connection between Hollywood stars and the affluent areas of California which have seen a rise in childhood diseases correlated with resistance and refusal to get vaccinations. .

Jon Stewart, in June, did his usual comedic-style treatment of the subject. Samantha Bee did a nice job of hitting some key points, despite her abrasive biases against conservatives.

But none of these high profile, attention-grabbing presentations pointed the finger where it really deserved pointing – to the researcher who was cloaked with scientific credibility when he misrepresented his studies and claimed there was correlation between autism and the MMR vaccine for children. Scientists who falsify data are more to blame than Hollywood. A credible scientist, Wakefield, published in a prestigious medical journal the findings that correlated autism with vaccines, but on closer examination the funding for the study was in anticipation of litigation against vaccine manufacturers and came from lawyers involved in the case according to a report in CNN in 2011.  Reporter, Brian Deer, said Wakefield "chiseled" the data before him, "falsifying medical histories of children and essentially concocting a picture, which was the picture he was contracted to find by lawyers hoping to sue vaccine manufacturers and to create a vaccine scare." According to BMJ, Wakefield received more than 435,000 pounds ($674,000) from the lawyers. Godlee said the study shows that of the 12 cases Wakefield examined in his paper, five showed developmental problems before receiving the MMR vaccine and three never had autism.

Did the retracted article make it clear that the science was falsified and there is no correlation between autism and the MMR vaccine? Unfortunately, Dr. Andrew Wakefield (a British scientist) has played on the sensitivities of parents with children with autism who would like to find a reason. Undeterred, he has found safe haven for his anti-vaccine message in Austin, Texas where he is founder of an autism research center, Strategic Autism Initiative (SAI), and Director of the Autism Media Channel. With that in mind, it may be very relevant here to mention that one of the most frequently seen bumper stickers for Austin is “Keep Austin Weird.”

If a poll could be taken of parents asking them whether it was true that autism is caused by childhood vaccines, would they still remember the hype around the now discredited study or would they remember the retraction of that article? My hypothesis is that the parents who heard the scientifically reported article would number at least 3 to 1 the parents who knew  about (and understood) the retraction.  

Both FDA and CDC should join forces to develop an information campaign to tell parents the truth and help guide them through the collision of information bombarding them from every corner of the social media milieu to protect children and to protect public health in America.  The effect of this leadership could have a global impact as well, and the world's leader in science, education and discovery could save millions of lives by that one, simple campaign. 
 

 

 

Black Death "bio-archaeology" shows infection pathway

       The ability to map and discover the evolution of bacteria has enabled researchers to trace the movement of historic pandemics since 2000, and in several studies on the Black Death, a new field of "bio-archaeology" has emerged.  Perhaps using "Legal Biohistory", more can be learned about the human-bacteria interaction by correlating the legal record as well.
       A recent archaeological dig of Black Death victims from 14th Century Europe describe two new strains of bubonic plague. Further, the genomics of the evolution of the bacteria from each of the five dig sites, revealed a pathway of development of the bacteria, tracing a possible route of infection through Europe.  Bubonic plague was confirmed as the cause of the Black Death in each of these digs.  The massive pandemic of 1341-45 was just one of hundreds of lesser outbreaks of plague for hundreds of years.
       In a study led by Paul Kiem, Northern Arizona University, the evolution of the Black Death could be traced as well.  More recently, as reported May 18, 2014 in USA Today, Dr. Kiem led another investigation into the genomics of the Justinian Plague in the 6th Century, and discovered that the strain responsible for that death depicted in horrendous drawings and paintings reached an evolutionary end -- it doesn't exist anymore.
http://www.usatoday.com/story/news/nation/2014/05/18/on-the-trail-of-the-dreaded-plague/9232883/
       I would also suggest that further research, correlating the quarantine actions taken at ports and cities which are well documented during this period might reveal an impact on the evolution of the plague bacteria. If that were true, then I would suggest that it would be the first documented evidence of legal action affecting the evolution of a bacteria.
 The study by S. Haensch et al., is available from the open access journal, http://www.uni-mainz.de/eng/13883.php .

Proposed route of the Black Death from S. Haensch, et. al.