Wisconsin Points Way for Public Health Research as Ebola Breeds Fear

Wisconsin is regarded as the premier influenza virus surveillance public health program anywhere in the country.

Public research and public health investments our state made over the 20th century spurred on by liberal, secular types at UW-Madison that laid the scientific ground for the political will to establish a sophisticated public health system.

Wisconsin's public health commitment was built upon pioneering work in Madison by some extraordinary people like Pete Shult and Jeff Davis, according to health and research authorities.

The Unites States would benefit from the Wisconsin Idea.

The Wisconsin Idea is unlikely to replicated while Republicans run Congress. See NIH director: Budget cuts delayed Ebola vaccine, treatment.

For a dose of sanity regarding viruses and public health, see:
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Influenza: A Disease at the Interface of Animals and Human Beings
Christopher Olsen, Associate Dean for Academic Affairs and Professor of Public Health, School of Veterinary Medicine, University of Wisconsin - Madison
- Recorded April 17, 2009

Wisconsin's Top H1N1 Surveillance

Anecdotal news the last few weeks out of Milwaukee that the H1N1 virus is hitting professional families and today's report that the virus is now widespread in Milwaukee is cause for some alarm.

Below is an updated column on the Wisconsin influenza surveillance system that diagnoses such infections and is called the premier public health program of its kind in the nation, perhaps accounting for the large percentage of reported and confirmed cases here.

Wisconsin's H1N1 (Swine Flu) incidents reveal odd figures on the spread of the disease through the American population with 19 percent of all confirmed cases occurring in Wisconsin.

Of the 17,855 confirmed or probable cases in the United States (and the District of Columbia and Puerto Rico), 3,407 are reported in Wisconsin, equal to some 19 percent of the U.S. population, though Wisconsin comprises only one percent of Americans.

One is thankful for all those public research and public health investments our state made over the 20th century spurred on by liberal, secular types at UW-Madison that laid the scientific ground for the political will to establish a sophisticated public health system.

The public health commitment that has our A H1N1 (swine flu) numbers so high was built upon pioneering work in Madison by some extraordinary people like Pete Shult and Jeff Davis, according to health and research authorities.

Said Dr. Christopher Olsen, Associate Dean for Academic Affairs and Professor of Public Health at a lecture in Madison in April:

Pete (Shult), diagnostic virologist [Director, Wisconsin Communicable Disease Division & Emergency Lab Response] at the state lab of hygiene [Wisconsin State Laboratory of Hygiene(WSLH)] did his undergraduate and PhD studies here at UW and then joined the Wisconsin State Laboratory of Hygiene in 1988. Pete has created what I think is the premier influenza virus surveillance public health program anywhere in the country. Together with Jeff Davis, who is our chief medical officer for Wisconsin and our state epidemiologist, we are looked at as a state for having this wonderful model surveillance program.

UW Public Research

Scientists here discovered that "genetic mixing" of viruses causes Zoonotic Diseases - "diseases caused by infectious agents that can be transmitted between (or are shared by) animals and humans," (Dr. Christopher Olsen) - in pigs for example, and that pigs can act as an intermediate host of viruses that can be transmitted to human beings like A H1N1 (swine flu).

These virus-mixing hosts (like swine that are uniquely susceptible to bird viruses and human viruses) provide a "phenomenally powerful way of generating genetic diversity," mutations that sometimes can lead to the creation of viruses that are destructive to human beings, said Olsen.

Olsen and others had conducted a study with results that "strongly support the hypothesis that people associated with swine production are infected with swine influenza viruses more regularly than the small number of zoonotic infections in the literature would suggest," published in August 2002.

Thanks to the work of UW-Madison, our state and the world are more prepared for the outbreak of emerging influenza than at any point in human history.

The current World Health Organization (WHO) phase of pandemic alert is 6, the peak phase of the pandemic.

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Influenza: A Disease at the Interface of Animals and Human Beings
Christopher Olsen, Associate Dean for Academic Affairs and Professor of Public Health, School of Veterinary Medicine, University of Wisconsin - Madison
- Recorded April 17, 2009

H1N1 Virus Still Unpredictable

News that a Wisconsin adolescent died from H1N1 has health authorities on edge, though the virus strain is not as lethal as the normal seasonal flu bugs that hit the world every flu season.

But read between the lines of public health announcements and one perceives worry that the strain could become worse.

The world, with Wisconsin being a model state, has never been as prepared for the surveillance and treatment of a pandemic, but if H1N1 mutates into a more lethal virus, lots of unknowns follow.

On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6 in response to the ongoing global spread of the novel influenza A (H1N1) virus. A Phase 6 designation indicates that a global pandemic is underway. ...

WHO’s decision to raise the pandemic alert level to Phase 6 is a reflection of the spread of the virus, not the severity of illness caused by the virus.

This virus strain mutates of course and it evolves in unpredictable ways with unpredictable traits, and the fear is that it could mutate into a more deadly and aggressive strain that provokes the human immune system in a manner like the 1918 Spanish Flu.

Is this remotely possible? What are the odds? Reading the CDC and WHO sites, one won't find epidemiological odds makers on the capacity of a virus to become more lethal. Such is the nature of evolution.

No one serious is debating evolution now; instead watching how this strain evolves, and using science and rational public health messages to ward off a bad situation.

From the WHO - What You Can Do to Stay Healthy

Stay informed. This website will be updated regularly as information becomes available.
Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.

Take everyday actions to stay healthy.

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.

Avoid touching your eyes, nose or mouth. Germs spread that way.

Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.

Find healthy ways to deal with stress and anxiety.

Wisconsin's High H1N1 Cases Result of Top Surveillance

News last week of Wisconsin's first A H1N1 (Swine Flu) death reveals odd figures on the spread of the disease through the population.

Of the 11,054 confirmed cases in the United States (and the District of Columbia and Puerto Rico), 2,071 are reported in Wisconsin, equal to some 18 percent of all confirmed American cases, though Wisconsin has only 1 percent of the American population.

Health authorities point out the influenza surveillance system in Wisconsin that diagnoses such infections is the premier public health program of its kind in the nation, and this may account for the large percentage of reported and confirmed cases in Wisconsin.

One is thankful for all those public research and public health investments our state made over the 20th century spurred on by liberal, secular types at UW-Madison that laid the scientific ground for the political will to establish a sophisticated public health system.

The public health commitment that has our A H1N1 (swine flu) numbers so high was built upon pioneering work in Madison by some extraordinary people like Pete Shult and Jeff Davis.

Said Dr. Christopher Olsen, Associate Dean for Academic Affairs and Professor of Public Health at a lecture in Madison in April:

"Pete (Shult), diagnostic virologist [Director, Wisconsin Communicable Disease Division & Emergency Lab Response] at the state lab of hygiene [Wisconsin State Laboratory of Hygiene(WSLH)] did his undergraduate and PhD studies here at UW and then joined the Wisconsin State Laboratory of Hygiene in 1988. Pete has created what I think is the premier influenza virus surveillance public health program anywhere in the country. Together with Jeff Davis, who is our chief medical officer for Wisconsin and our state epidemiologist, we are looked at as a state for having this wonderful model surveillance program."

UW Public Research

Scientists here discovered that "genetic mixing" of viruses causes Zoonotic Diseases - "diseases caused by infectious agents that can be transmitted between (or are shared by) animals and humans," (Dr. Christopher Olsen) - in pigs for example, and that pigs can act as an intermediate host of viruses that can be transmitted to human beings like A H1N1 (swine flu).

These virus-mixing hosts (like swine that are uniquely susceptible to bird viruses and human viruses) provide a "phenomenally powerful way of generating genetic diversity," mutations that sometimes can lead to the creation of viruses that are destructive to human beings, said Olsen.

Olsen and others had conducted a study with results that "strongly support the hypothesis that people associated with swine production are infected with swine influenza viruses more regularly than the small number of zoonotic infections in the literature would suggest," published in August 2002.

Thanks to the work of UW-Madison, our state and the world are more prepared for the outbreak of emerging influenza than at any point in human history.

The current World Health Organization (WHO) phase of pandemic alert is 5.











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Influenza: A Disease at the Interface of Animals and Human Beings
Christopher Olsen, Associate Dean for Academic Affairs and Professor of Public Health, School of Veterinary Medicine, University of Wisconsin - Madison
- Time: 47:03
- Recorded April 17, 2009

UW Virologist Puts Swine Flu in Perspective

"Let's not lose track of the fact that the normal seasonal influenza is a huge public health problem that kills tens of thousands of people in the U.S. alone and hundreds of thousands around the world," said Dr. Christopher Olsen, a molecular virologist who studies swine flu at the University of Wisconsin School of Veterinary Medicine in Madison.

Karen Kaplan and Alan Zarembo of the LA Times offer a precise and less alarmist explanatory piece today, 'Genetic data indicate outbreak won't be as deadly as that of 1918, or even the average winter.'

U.W. Madison and Zoonotic Diseases

U.W. Madison has a tutorial website on Zoonotic Diseases, "diseases caused by infectious agents that can be transmitted between (or are shared by) animals and humans," copyrighted by Dr. Olsen, continuing its tradition as a leader in this research field, and a page on Swine Flu.

From University Place - Wisconsin Public Television, below (posted on YouTube) is a lecture by Olsen: "Influenza: A Disease at the Interface of Animals and Human Beings," delivered on April 17, 2009, shortly before the first cases of this strain of Influenza A, (H1N1) virus [Swine Flu] were confirmed by CDC laboratories as occurring in the United States.

Olsen talks about the pioneering research on Zoonotic Diseases (of which Swine flu is a "classic Zoonotic infection") done at UW-Madison the last six decades [noting for example UW scientist Dr. Robert Hanson's research group that first isolated an influenza virus in pigs in 1949 and predicted the emergence of new Zoonotic diseases as ecological and environmental conditions in human and animal "host populations" change, describing perfectly present-day circumstances leading to the emergence of Ebola virus and Swine Flu for instance], 'genetic mixing" and how pigs for example act as an intermediate host of viruses that can be transmitted to human beings.

A virus needs a host, like a human being or other animal, to successfully reproduce itself.

"Bob Hanson was way, way, way ahead of his time," said Olsen. Great stuff, and so is the Wisconsin Idea and University Place - Wisconsin Public Television!

Answers on the Pandemic

Here is some question and answer on influenza pandemics from the Toronto Public Health site and the CDC offering background on the Swine Influenza (swine flu), "a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs" that is now affecting human in an imminent pandemic.

On a mildly interesting note, the CDC question and answer references a case in Wisconsin from 1988.

Can humans catch swine flu?

Swine flu viruses do not normally infect humans. However, sporadic human infections with swine flu have occurred. Most commonly, these cases occur in persons with direct exposure to pigs (e.g. children near pigs at a fair or workers in the swine industry). In addition, there have been documented cases of one person spreading swine flu to others. For example, an outbreak of apparent swine flu infection in pigs in Wisconsin in 1988 resulted in multiple human infections, and, although no community outbreak resulted, there was antibody evidence of virus transmission from the patient to health care workers who had close contact with the patient.

And from the Toronto Public Health site:

What is Pandemic Influenza?

An influenza pandemic occurs when there is an abrupt and major change in the protein structure of the Influenza A virus resulting, in a new strain. Because people have little or no immunity to this new strain, it can spread quickly, causing outbreaks in one or more countries or worldwide. This is called a pandemic.

How often do flu pandemics occur?

Flu pandemics have historically occurred three or four times each century. There were three flu pandemics in the last century (1918, 1957 and 1968).

CDC: 'Rapidly Evolving Situation'; WHO Raises Alert

Update: The World Health Organization (WHO) Director-General has raised the level of influenza pandemic alert from phase 4 to phase 5, signaling a broader outbreak among world populations. [WHO graphic has phase 4 circled and has not been updated yet.]

The WHO defines a Phase 5 alert as: follows: "Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short."

The CDC site reads:

This is a rapidly evolving situation and CDC will provide updated guidance and new information as it becomes available.

The WHO Director-General's statement:

Ladies and gentlemen,

Based on assessment of all available information, and following several expert consultations, I have decided to raise the current level of influenza pandemic alert from phase 4 to phase 5.

Influenza pandemics must be taken seriously precisely because of their capacity to spread rapidly to every country in the world.

On the positive side, the world is better prepared for an influenza pandemic than at any time in history.

Preparedness measures undertaken because of the threat from H5N1 avian influenza were an investment, and we are now benefiting from this investment.

For the first time in history, we can track the evolution of a pandemic in real-time.

I thank countries who are making the results of their investigations publicly available. This helps us understand the disease.

I am impressed by the work being done by affected countries as they deal with the current outbreaks.

I also want to thank the governments of the USA and Canada for their support to WHO, and to Mexico.

Let me remind you. New diseases are, by definition, poorly understood. Influenza viruses are notorious for their rapid mutation and unpredictable behaviour.

WHO and health authorities in affected countries will not have all the answers immediately, but we will get them.

WHO will be tracking the pandemic at the epidemiological, clinical, and virological levels.

The results of these ongoing assessments will be issued as public health advice, and made publicly available.

All countries should immediately activate their pandemic preparedness plans. Countries should remain on high alert for unusual outbreaks of influenza-like illness and severe pneumonia.

At this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities.

This change to a higher phase of alert is a signal to governments, to ministries of health and other ministries, to the pharmaceutical industry and the business community that certain actions should now be undertaken with increased urgency, and at an accelerated pace.

I have reached out to donor countries, to UNITAID, to the GAVI Alliance, the World Bank and others to mobilize resources.

I have reached out to companies manufacturing antiviral drugs to assess capacity and all options for ramping up production.

I have also reached out to influenza vaccine manufacturers that can contribute to the production of a pandemic vaccine.

The biggest question, right now, is this: how severe will the pandemic be, especially now at the start?

It is possible that the full clinical spectrum of this disease goes from mild illness to severe disease. We need to continue to monitor the evolution of the situation to get the specific information and data we need to answer this question.

From past experience, we also know that influenza may cause mild disease in affluent countries, but more severe disease, with higher mortality, in developing countries.

No matter what the situation is, the international community should treat this as a window of opportunity to ramp up preparedness and response.

Above all, this is an opportunity for global solidarity as we look for responses and solutions that benefit all countries, all of humanity. After all, it really is all of humanity that is under threat during a pandemic.

As I have said, we do not have all the answers right now, but we will get them.

Pandemic Level Raised

The World Health Organization (WHO) Director-General has raised the level of influenza pandemic alert from phase 3 to phase 4, the first stage of "response and mitigation efforts".

A pandemic is broadly defined as an epidemic (a sudden outbreak) affecting a whole region, a continent, or the world.

Just the flu so far and raising the level does not imply anything about how bad the Swine Flu bug will make you feel if you catch it.

Besides washing your hands often and not going to Mexico unless you have to, another good idea is not reading Richard Preston or Daniel Kalla for a while.

From the WHO:

In the 2009 revision of the phase descriptions, WHO has retained the use of a six-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans.

Phases 1–3 correlate with preparedness, including capacity development and response planning activities, while Phases 4–6 clearly signal the need for response and mitigation efforts. Furthermore, periods after the first pandemic wave are elaborated to facilitate post pandemic recovery activities.

Nichols: GOP Fought Pandemic Preparedness

As the world health authorities contend with halting the Swine flu, John Nichols points to the almost pathological disdain that Republicans have for the government's promoting public health, and specifically stopping pandemics in his GOP Know-Nothings Fought Pandemic Preparedness (The Nation).

When House Appropriations Committee chairman David Obey, the Wisconsin Democrat who has long championed investment in pandemic preparation, included roughly $900 million for that purpose in this year's emergency stimulus bill, he was ridiculed by conservative operatives and congressional Republicans.

With a major political party actually hostile to the idea of public health, not a good idea to be reading Daniel Kalla bio-terror novels like Pandemic, in case anyone brought some of this genre of books for their girlfriend last Valentines Day.