Scott McPherson's Web Presence

Today, if you are a bird and you are alive in the capital of South Korea, consider yourself lucky.  That also means you are probably not a chicken, duck, pheasant, or turkey.  That is because the government of South Korea took the dramatic step to slaughter every single feathered food source within the confines of the capital of Seoul. 

Myriad newspapers are covering the story today, so I will simply point you toward this story, from the AP and located on  USA Today's Website:

SEOUL (AP) — South Korean officials say they have killed Seoul's entire poultry population to curb the spread of bird flu following a fresh outbreak of the disease in the capital.

Quarantine officials destroyed 15,000 chickens, ducks, pheasants and turkeys raised in farms, restaurants, schools and homes in the city, Kim Yoon-kyu, an official at the Seoul Metropolitan Government, said Monday.

The Seoul government said in a statement that the slaughter was necessary to contain the disease. It said it will now focus on preventing live poultry from being brought into Seoul.

The slaughter began Sunday night, hours after authorities recorded Seoul's second outbreak of bird flu in less than a week.

The slaughter did not affect parrots, parakeets and canaries because they have little chance of spreading the disease, Kim said.

On Monday night, government tests confirmed the latest outbreak in Seoul was caused by the deadly H5N1 virus, said Yoon Young-ku, a spokesman at the Agriculture Ministry.

The tests also confirmed two additional outbreaks of the virus in Busan, brining to 31 the total number of outbreaks in South Korea, he said.

Bird flu began sweeping southern parts of the country last month for the first time in more than a year, forcing the slaughter of about 6.8 million birds.

The virus remains hard for people to catch, but scientists worry it could mutate into a form that spreads more easily between humans, with the potential to kill millions worldwide.

At least 240 people have died from bird flu since 2003, according to the World Health Organization. Most human cases so far have been linked to contact with infected poultry.

http://www.usatoday.com/news/health/2008-05-12-skorea-poultry_N.htm?csp=34

South Korea is currently being ravaged by H5N1 avian influenza.  Perhaps the only other country that can lay claim to the words "currently besieged by bird flu" is India.  No less than 31 separate confirmed outbreaks of high-path H5N1 have been documented in poultry in the past few weeks.

The medicine Seoul is taking to try and halt the spread of H5N1 is drastic, but not unprecedented.  Hong Kong, as we all know, took similar measures in 1997 -- and probably stopped an H5N1 pandemic in its tracks.  It is sad yet comforting to see that another nation is taking the situation as seriously as Hong Kong's government did and decided to act decisively.

Stay tuned for more developments from South Korea. 

One of my favorite movies of all time is the cult classic Circle of Iron.  Also titled The Magic Flute, this inde gem was written by and for Bruce Lee (with the assistance of one James Coburn, by the way).  Upon Lee's tragic death, David Carradine assumed Lee's (multiple) role(s) and Jeffrey Cooper was cast as the male lead.  Cooper, whose only other film I can recall is the first Billy Jack movie Born Losers, did an acceptable job with the role.  I am told Cooper went on to do Dallas and soaps.

Carradine's recurring character the Blind Man talks in Zen riddles during much of the film, so Cooper's frustrated character Cord chimes in with a great line.  Here is the exchange:

“Tie two birds together, and even though they have four wings they cannot fly." – The Blind Man.

"And a horse has no udders and a cow can’t whinny and up is down and sideways is straight ahead." – Cord.

I was drawn to this exchange when I read this article:

Government asks court to block wider testing for mad cow

By SAM HANANEL – 3 hours ago

WASHINGTON (AP) — The Bush administration on Friday urged a federal appeals court to stop meatpackers from testing all their animals for mad cow disease, but a skeptical judge questioned whether the government has that authority. (bold mine)

The government seeks to reverse a lower court ruling that allowed Arkansas City, Kan.-based Creekstone Farms Premium Beef to conduct more comprehensive testing to satisfy demand from overseas customers in Japan and elsewhere. (bold mine)

Less than 1 percent of slaughtered cows are currently tested for the disease under Agriculture Department guidelines. The agency argues that more widespread testing does not guarantee food safety and could result in a false positive that scares consumers.

"They want to create false assurances," Justice Department attorney Eric Flesig-Greene told a three-judge panel of the U.S. Court of Appeals for the D.C. Circuit.

But Creekstone attorney Russell Frye contended the Agriculture Department's regulations covering the treatment of domestic animals contain no prohibition against an individual company testing for mad cow disease, since the test is conducted only after a cow is slaughtered. He said the agency has no authority to prevent companies from using the test to reassure customers.

"This is the government telling the consumers, `You're not entitled to this information,'" Frye said.

Chief Judge David B. Sentelle seemed to agree with Creekstone's contention that the additional testing would not interfere with agency regulations governing the treatment of animals.

"All they want to do is create information," Sentelle said, noting that it's up to consumers to decide how to interpret the information. (bold mine)

Larger meatpackers have opposed Creekstone's push to allow wider testing out of fear that consumer pressure would force them to begin testing all animals too. Increased testing would raise the price of meat by a few cents per pound.

Mad cow disease, or bovine spongiform encephalopathy, can be fatal to humans who eat tainted beef. Three cases of mad cow disease have been discovered in the U.S. since 2003.

The district court's ruling last year in favor of Creekstone was supposed to take effect June 1, 2007, but the Agriculture Department's appeal has delayed the testing so far.

http://ap.google.com/article/ALeqM5gLzqdHsMBuQV9h5k-kVnabJDsj1AD90I89K80

OK, so here we go:  We have a meat company (Creekstone) that wants to do the right thing for both its domestic and international customers.  They want to test all their slaughtered beef for Mad Cow.  Not just a random cow here and there.  ALL OF THEM.

Creekstone would use its own money to test and certify.  What could possibly be wrong with that?

Plenty, if you believe the Department of Agriculture.  Here we have the United States Government going to court to stop this self-imposed practice, because it allegedly gives the meat company an unfair competitive advantage?  Have we all gone MAD, so to speak?

The planet has been knocked off its axis.  Madmen run Washington.  Up is down and sideways is straight ahead.

Perhaps they should be tested for CJD, which may explain their bizarre behavior.

One of the things not generally talked about during pandemic discussions is the impact a severe flu pandemic will have on financial markets such as life insurance.  I mentioned this lack of discussion when I recently lectured to senior employees of the Florida Department of Financial Services, or DFS.  DFS is run by a very impressive woman, Alex Sink.  Ms. Sink has run a banking empire (Bank of America) and has also served on numerous private sector boards and commissions.  She is also the only elected statewide Democrat on Florida's elected Cabinet, so she is unique in her ability to get her message of fiscal discipline to voters of all persuasions.

Anyway, CFO Sink required all her senior staff to listen as I gave my then-new "First pandemic of the information age" presentation, giving new meaning to the axiom "Death by Powerpoint."   Her senior managers and policy experts came to terms with the sheer volume of human suffering and the resultant stress that a sudden spike in death claims would have upon the life insurance industry, not to mention a downturn in tax receipts.  The actuarials in the audience quickly performed their unique calculus and their faces went pale with concern about the solvency of some life insurance companies who would hypothetically be paying death claims on young lives whose premiums had not been given time to prosper within the Law of Large Numbers that is the industry's hallmark.

Add to that growing list of concerned organizations the venerable Lloyd's of London.  Lloyd's, whose very name is synonomous with global best practices in the insurance and reinsurance fields, recently conducted a seminar on pandemic planning. It is one thing to read bloggers' diatribes about pandemic preparedness, including my own.  It is another thing to hear our government's top leaders -- including the President himself -- speaking on the need for preparedness.  But for some, confirmation only comes whan a prestiege firm such as Lloyd's comes out and says, "Do this."

For those people, consider yourself warned.  Lloyd's is taking the approach that a pandemic is an event with a very close beginning date. An extract taken from the Lloyd's press release:

Prepared for a pandemic?

2 May 2008

A pandemic ‘flu that causes massive disruption to economies around the world is inevitable and all businesses must prepare for it now. That was the stark message to emerge from a recent high level seminar co-organised by Lloyd’s and XL.

In a series of sobering presentations, business continuity and risk management experts explained how insurers and their customers could be affected by a pandemic and what they can do to mitigate the fall-out from a nightmare scenario.

In risk management terms, a pandemic is unlike any other natural or manmade disaster that businesses routinely prepare for. A ‘flu pandemic is not a sudden, short lived event like a terrorist attack or industrial explosion that destroys infrastructure in a localised area. It could last for months.

“Nobody knows when this will happen, so it is a challenge to make it real to people,” Professor Lindsey Davies, national director of pandemic influenza preparedness at the Department of Health admitted. “But it will happen.”
When the UK’s Financial Services Authority simulated the effect of a pandemic ‘flu on the City it assumed an absence rate of 49%. Richard Maddison, deputy head of business continuity risks at the FSA, said that the exercise revealed that from the outset participants’ were not fully aware of the impact a pandemic would have on their suppliers and that there was uncertainty about how a pandemic will spread. “Plans and HR policies need amending,” he warned.

All the evidence points to a lack of preparedness among business. A YouGov survey last year found that over three quarters of companies have inadequate plans; around a third have no strategy at all.

Drawing a pandemic timeline, the FSA’s exercise showed how institutions will be challenged as a pandemic quickly develops momentum. Chillingly, by week five of the simulation, companies were extending HR policies to include emergency financial support, accommodation and death in service benefits to employees.

The insurance industry will potentially have to cope with an variety of claims , while it is still reeling from its own business continuity problems, Trevor Maynard, emerging risk manager at Lloyd’s, said. Life and health programmes will be directly impacted but less immediately obvious losses could pile up as businesses grind to a halt, from credit insurance to event cancellation.

When the UK’s Financial Services Authority simulated the effect of a pandemic ‘flu on the City it assumed an absence rate of 49%. Richard Maddison, deputy head of business continuity risks at the FSA, said that the exercise revealed that from the outset participants’ were not fully aware of the impact a pandemic would have on their suppliers and that there was uncertainty about how a pandemic will spread. “Plans and HR policies need amending,” he warned. All the evidence points to a lack of preparedness among business. A YouGov survey last year found that over three quarters of companies have inadequate plans; around a third have no strategy at all. Drawing a pandemic timeline, the FSA’s exercise showed how institutions will be challenged as a pandemic quickly develops momentum. Chillingly, by week five of the simulation, companies were extending HR policies to include emergency financial support, accommodation and death in service benefits to employees. The insurance industry will potentially have to cope with an variety of claims , while it is still reeling from its own business continuity problems, Trevor Maynard, emerging risk manager at Lloyd’s, said. Life and health programmes will be directly impacted but less immediately obvious losses could pile up as businesses grind to a halt, from credit insurance to event cancellation.

http://www.lloyds.com/News_Centre/Features_from_Lloyds/Prepared_for_a_pandemic_02052008.htm

There is more, but I will let you read the release.  I do want to post Lloyd's Top Ten things to remember in a pandemic:

Top 10 tips for businesses to cope with a pandemic

• Although the emergency services are taking pandemic preparedness very seriously continuity plans should consider the impact of a reduced level of service.

• Educate your staff in advance on the hygiene and quarantine procedures they may need to take.

• Identify who your key personnel are and explore cross training to help cope with absent staff.

• Check that your suppliers are as well prepared as you are for a pandemic.

• Decide on corporate priorities and the key services that must be maintained.

• Exercise contingency plans against the timeline of a pandemic.

• Fully understand how telecommuting can serve the business and where the weak points are.

• Evaluate your requirements for bandwidth at your gateway and consider buying extra now.

• Be prepared for subsequent waves and plan for the recovery phase.

• Expect a more fluid job market as employees react to how they were treated by employers during the pandemic.

This is among the best advice I have ever seen for pandemic preparedness.  Of course the Devil is always in the details, but these tips are simple, straightforward and can apply equally to the public and private sectors.  And note that final bullet:  If your business fails to properly consider the role that pandemic planning and response took in their own lives, do not expect to retain them.  If you care not a fig for your employees enough to prepare them for pandemic flu, they will repay your lack of care by leaving you.  Hey, that rhymes!

Hat-tip to Flutrackers poster Shiloh. 

Over the weekend, a news story broke that a federal task force had released recommendations for triage of victims of a future flu pandemic.  The task force comprised doctors and researchers from well-known universities, medical organizations, and government agencies including the Department of Homeland Security, the Centers for Disease Control and Prevention, and the Department of Health and Human Services.

The story was picked up by the Associated Press and other news organizations.  Here's the story:

Triage plan details whom to let die during a pandemic

Treatment blueprint gives severely hurt, elderly lower priority

Lindsey Tanner, Associated Press

Monday, May 5, 2008

Doctors know some patients needing lifesaving care won't get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding whom to let die.

Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention, and the Department of Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals "so that everybody will be thinking in the same way" when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux, a critical care specialist in San Diego and lead writer of the task force report.

The idea is to try to make sure that scarce resources - including ventilators, medicine and doctors and nurses - are used in a uniform, objective way, task force members said.

Their recommendations appear in a report published today in the May edition of Chest, the medical journal of the American College of Chest Physicians.

"If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing," the report states.

To prepare, hospitals should designate a triage team with the Godlike duty of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific and include:

-- People older than 85.

-- Those with severe trauma, which could include critical injuries from car crashes and shootings.

-- Severely burned patients older than 60.

-- Those with severe mental impairment, which could include advanced Alzheimer's disease.

-- Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

Dr. Kevin Yeskey, director of the preparedness and emergency operations office at the Department of Health and Human Services, was on the task force. He said the report will be among many the agency reviews as part of preparedness efforts.

Public health law expert Lawrence Gostin of Georgetown University called the report an important initiative but also "a political minefield and a legal minefield." The recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force.

If followed, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said. While health care rationing will be necessary in a mass disaster, "there are some real ethical concerns here."

James Bentley, a senior vice president at American Hospital Association, said the report will give guidance to hospitals in shaping their own preparedness plans, even if they don't follow all the suggestions. He said the proposals resemble a battlefield approach in which limited health care resources are reserved for those most likely to survive.

While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary, Bentley said.

Devereaux said compiling the list "was emotionally difficult for everyone." That's partly because members believe it's just a matter of time before such a health care disaster hits, she said.

"You never know," Devereaux said. "SARS took a lot of folks by surprise. We didn't even know it existed."

http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2008/05/05/MNM210GNVM.DTL

I have told the story before.  Back in late 2006, HHS floated a trial balloon:  Let the governors of the states decide how best to distribute vaccine and antivirals during a flu pandemic, once the first responders were taken care of.  I sent my friend, then-governor Jeb Bush, an email that included the balloon from HHS.  I concluded in the missive,

"Jeb, Who do you vaccinate in a pandemic?  Your future or your past?"  I also told Jeb that, blessedly, he would not have to make that decision -- but his successor very well might.

The answer to my rhetorical question is very, very clear to me:  It is whoever is at highest risk.  If it's 1918 all over again, I would not hesitate to treat and vaccinate the most vulnerable first, based on mortality:  Young adults 18 to 40.  That might rankle the ire of AARP, but that is just too bad.

Allow me to explain why.

Look at the results of the Spanish Flu pandemic of 1918-19.  Depending on whose book you read, the life expectancy of an American dropped by anywhere from ten to twelve years in the wake of that pandemic.  That is how many youthful Americans died, both from World War I and the Spanish Flu.  We know today that more American soldiers died from flu than from contact with the enemy. 

We know that the most likely person to die in 1918 in the United States was a pregnant woman aged 27.  Her chances of dying if she acquired the Spanish flu were 55 in 100. 

America was able to weather that pandemic storm and prosper because making babies and building families were still the preferred projects in the eyes of American youth.  Now let us look at the realities of today.  We cannot say that with any confidence whatsoever. Political leaders must look at a pandemic within that context, and not just within the context of administering care for people. 

Were it not for immigration (legal and otherwise), the United States would have lost population from 1990 to 2000.  That is because people are not having babies in sufficient quantities to replace the people who are dying.  This fact is borne out in every single projection regarding future imbalances in Social Security, Medicaid, Medicare and federal entitlements in general.  Medicare is already out of balance, according to a good friend of mine, a Federal economist with the Department of Labor.  That means recipients of Medicare are pulling money out of the system faster than wage-earners  are paying into it.  Soon, Social Security will be the same way.  And by 2042, according to the Comptroller of the Currency, 100% of the Federal budget will be taken up by these entitlements.  No defense.  No transportation.  All entitlements.  What a mess.

Again, this is because there are fewer people being born than there are people dying.  And if you think this is bad, you should look at the looming danger about to befall Europe.  At least we grew:  Europe did not, and as a result has to import its labor now, with consequences we can see on televisions nightly.  Of all the nations of the earth, only Australia grew the "old fashioned" way.

From the Website of the Population Reference Bureau:

The more developed countries in Europe and North America, as well as Japan, Australia, and New Zealand, are growing by less than 1 percent annually. Population growth rates are negative in many European countries, including Russia (-0.6%), Estonia (-0.5%), Hungary (-0.4%), and Ukraine (-0.4%). If the growth rates in these countries continue to fall below zero, population size would slowly decline. As the chart "World population growth, 1750–2150" shows, population increase in more developed countries is already low and is expected to stabilize.

http://www.prb.org/Educators/TeachersGuides/HumanPopulation/PopulationGrowth.aspx

Imagine a scenario that takes the 1918 pandemic and extrapolates that pandemic's societal impact across today's population and across today's social and economic realities.  Take the 675,000 who died in the US and assume half were 18 to 40, as we always say in our presentations.  Now imagine if we took the 2.5 million Americans who would die if 1918 broke out all over again.  Imagine if we took more than one million Americans between 18 and 40 and just erased them from the map.  We also erase their earnings potential across their lifetimes.  We erase their incomes, their contributions to society, their ability to buy homes, their ability to build businesses, their ability to help mold a new America.  And we erase their ability to pay the taxes that will be needed to keep the nation afloat. 

That is where pandemic flu also crosses the line into the illegal immigration debate.  It is simple economics.  If a million younger wage earners die, a million more must take their place.  The United States will have no choice.  It will have to import its labor from wherever it can take it, and it will reshape the nation's future permanently. 

Forget the IMF, World Bank, CBO and British government projections of a drop of nearly 6% in global GDP.  Imagine if that drop maintained itself for years, maybe even decades..

In short, were a flu pandemic to erupt today, and if we do not try to save our future wage earners, leaders and mothers and fathers, we will surely bankrupt the nation and plunge the world into economic depression.  Without a national pandemic triage strategy to debate in the sunshine, and without the proper national resolve, we may wind up dooming the United States to its darkest period since the Civil War.  And this is assuming only a 2.5% Case Fatality Rate.  What if it is worse?  Heck, the CFR from SARS was nearly 10%! 

If H5N1 "goes pandemic," we know the CFR -- and the death curve -- are potentially even more depressing.  Sure, elderly people die.  But 90% of the deaths due to H5N1 infection are people under 40, and younger children suffer disproportionately.  Elderly people do not die in the same percentages when infected by H5N1.

The United States, therefore, simply cannot afford to treat all its people equally in a pandemic.  It must have a national triage strategy, saying that based on the mortality of the disease, certain age groups must come first for Tamiflu, for ventilators, for vaccine.  It means others will have to take a back seat or, regrettably, not get a seat at all.  And I doubt if there will be any real legal consequences for these decisions, since any flu pandemic invoking this level of triage will certainly also invoke a national state of emergency, maybe even martial law.  Those declarations pretty much wipe out any legal standing for dying plaintiffs.

So in the next pandemic, who gets the ventilator?  The 29-year old woman, or the 69-year old man?  Who do you save, your future or your past?

Is it really that hard to decide? 

C.diff sickening half a million Americans a year.

Intrepid reader,

Florida's legislative session is winding down its final hours, and you will find me blogging again on a more regular basis. Until then, read this MSNBC article on C.diff, a bacteria that is quite nasty indeed.

A bad germ gets worse

‘C. diff’ rivals MRSA as the next deadly bacteria threat, experts say

By JoNel Aleccia

Health writer

MSNBC

updated 8:22 a.m. ET, Fri., May. 2, 2008

Amy Warren had never heard of the germ that made her so miserable.

In January 2005, weeks after giving birth to her daughter, the Ohio mother of two knew only that she was in pain, suffering cramping so severe she felt like she was still in labor. Then came the diarrhea, uncontrollable bouts up to 50 times a day, which left Warren weak and raw and stranded in her Maineville home.

"I was so sick; I thought I had colon cancer and was dying," Warren recalled.

Three tests failed to detect the source of her intestinal trouble. A fourth, however, confirmed Warren as part of a toxic trend: She was among growing numbers of people sickened by an especially virulent form of the bacterial infection Clostridium difficile, known as C. diff.

Doctors told Warren she’d contracted the NAP1 type of the bacteria, a mutated version that produces roughly 20 times the toxins responsible for illnesses ranging from simple diarrhea to blood poisoning — and death.

“It’s like a science fiction disease,” said Warren, who struggled for six months through three relapses before controlling the infection. “That’s what scared me. People die from this.”

C. diff has long been a common, usually benign bug associated with simple, easily treated diarrhea in older patients in hospitals and nursing homes. About 3 percent of healthy adults harbor the bacteria with no problem. But overuse of antibiotics has allowed the germ to develop resistance in recent years, doctors said, creating the toxic new type that stumps traditional treatment.

"This is the one we're scared of," said Dr. Brian Koll, chief of infection control at Beth Israel Medical Center in New York.

C. diff produces anaerobic spores transmitted through feces that are able to survive for months on most surfaces. People are infected when they ingest the bacteria, typically by touching contaminated surfaces and then touching their mouths, or by eating contaminated food.

Overall infections caused by C. diff more than doubled between 2000 and 2005, according to the latest government figures. In 2005, the year of Warren’s illness, 301,200 cases of C. difficile-associated disease (CDAD) were logged in discharge records kept by the nation’s hospitals. Some 28,600 people who had the infection died.

That's only hospitals, however. Counting nursing homes and other care centers, the number of cases nationally is likely closer to 500,000, experts estimate.

Contaminated health care settings remain the main source of C. diff infections, primarily because they treat so many people with serious diarrheal illness.  The NAP1 strain has been found in other sites and populations in recent years, infecting young adults and pregnant women with no history of antibiotic use, according to federal sources.

Despite the concern, scientists don't know how many people contract NAP1 infections, or how many die from them. C. diff infection is not a reportable condition in most states, although a rare pilot project that mandated reporting in Ohio in 2006 found more than 14,000 cases in hospitals and nursing homes that year, according to the state health department.

Mutant strain detected in 38 states
What is clear is that the most toxic strain is taking hold, according the federal Centers for Disease Control and Prevention.

In February 2007, 23 states told the CDC they'd seen cases of the NAP1 strain; by November, that number had grown to 38. Officials in the remaining states and territories contacted by msnbc.com said they hadn't detected the virulent bug, but most also said they don't look for it.

Better data about the scope of the C. diff problem may be available by this fall, when the Association for Professionals in Infection Control (APIC) presents the results of a prevalence study being conducted this month.

Last year, APIC was among the first agencies to note that rates of Methicillin-resistant Staphylococcus aureus, known as MRSA, were about 10 times previous estimates. The so-called superbug claimed headlines last year when researchers linked it to more than 94,000 infections and nearly 19,000 deaths in the U.S. in 2005.

Health officials now rank C. diff on par with MRSA as one of the top two infections acquired in hospitals.

“In light of how frequently it is already occurring as well as the trajectory of its recent increase, it is an infection that definitely deserves our respect and attention,” said Dr. L. Clifford McDonald, chief of prevention and response for a division of the CDC.

Attention must also be paid, scientists say, because the infection that mostly affects older, sicker people with long histories of antibiotic use now appears to be showing up in younger, healthier patients like Warren.

Warren’s not sure how she contracted the infection, which is caused when normal flora in the gut is disturbed, typically by antibiotics. About 90 percent of CDAD cases occur in patients who've used antibiotics recently, especially fluroquinolines such as the popular drug Cipro.

The resistance allows the C. diff bacteria to take over and flourish. Consequences can range from severe diarrhea to colitis and toxic megacolon, a condition that can lead to shock and death.

Warren, now 39, may have gotten the infection from her daughter, Celeste, who had a mild C. diff infection shortly after birth. Infants often harbor C. diff harmlessly in their intestines for about the first year of life, before more mature flora take over, experts said.

It's also possible Warren may have acquired the bacteria the previous fall, when she was briefly hospitalized and wound up sharing a room with a woman with severe diarrhea.

“I was sharing a bathroom with her,” Warren said.

‘Filthy’ hospitals perpetuate problem
There's no question that the rise of C. diff is tied to the cleanliness of the nation's hospitals, say researchers and health care advocates lobbying for better infection control.

"Outbreaks highlight the fact that standard infection control procedures in hospitals are not as good as they could be," said Dr. Curtis Donskey, director of infection control at the Louis Stokes Veterans Affairs Medical Center in Cleveland, Ohio.

Even after cleaning, studies show that C. diff spores linger on virtually every hospital surface, including bedrails, telephones, call buttons and toilets.

C. diff spores cling to patient skin, and not only in expected areas, such as the groin, according to a small-but-telling study published by Donskey and colleagues in the February issue of the journal Clinical Infectious Disease. Nearly 40 percent of patients diagnosed with CDAD infections tested positive for C. diff on their hands, and nearly 20 percent had the bacteria on their forearms, researchers found. About 60 percent had C. diff detected on their chest and abdomen.

 

Typical hospital germicides and alcohol hand sanitizers don’t kill C. diff, experts said. Instead, it takes bleach to eliminate it from surfaces and the friction of soap and water to remove it from hands.

But many hospitals have failed to make controlling C. diff a priority, critics contend.

“The biggest problem in our hospitals is that they are filthy dirty,” said Dr. Alfonso Torress-Cook, an epidemiologist who says he adopted practices that cut C. diff infections by 90 percent at his acute rehabilitation center in Orange County, Calif.

"If we start cleaning the environment, the infection will take care of itself," he added.

Interventions can range from ultra-violet light targeted to kill C. diff germs to silver-infused flooring and antimicrobial curtains aimed at resisting the bugs.

 

Making infection control a daily habit
The most important remedy is building infection control practices into the daily routine of organizations, said Koll, who is known for his work reducing potentially deadly central line-associated bloodstream infections.

Koll has spent the last two years improving prevention of C. diff in his hospitals, revamping protocols ranging from housekeeping techniques to quicker diagnosis.

"The minute somebody has diarrhea, you think 'C. diff'," he said.

Some changes have been obvious, Koll said. A switch from reusable rectal thermometers quickly contributed to C. diff rates that have fallen by 25 percent.

Key to a new collaboration with three dozen Northeast hospitals is a checklist of infection control steps and a “C. diff bundle,” a portable, prepacked kit of supplies that keeps health care workers from having to search for gowns, masks and necessary tools.

“People will do the right thing,” said Koll. “No one wants to give their patients an infection.” 

It's long past time hospitals began to pay attention to their infection control practices related to C. diff, MRSA and other organisms, said Lisa McGiffert, director of the Stop Hospital Infections project for Consumers Union, a patient advocacy group.

Hospital-associated infections affect nearly 2 million patients and are associated with nearly 100,000 deaths each year, according to the CDC.

“Here’s the problem with these bad bugs: They’re very hard to stop when they get inside the body,” McGiffert said. “The only defense we have is prevention.”

Medicare may not pay for C. diff infections
It may take proactive efforts like those proposed by Koll and others to implement hospital-wide control practices. Or it may take punitive efforts, such as the move by federal Medicare officials to cut payments to hospitals for certain avoidable conditions acquired after admission. Last month, Medicare proposed adding C. diff to the growing list of preventable problems after the agency recorded 96,000 cases of the infection in 2007 at an average cost of $59,000 apiece.

In the meantime, patients need to take care into their own hands, often literally, advocates said.

They need to become acutely aware of hand hygiene, making sure to wash their own hands frequently and remembering to ask visitors and health care workers to wash up as well, said Betsy McCaughey, who heads the advocacy group Committee to Reduce Infection Deaths, or RID.

“No matter how dirty the hospital is, if that spore does not go in your mouth, you won’t get C. diff,” she said.

 

Some patients and their family members have become even more vigilant, bringing their own bleach-infused hand wipes to wash down hospital door knobs and bed-rails, said McGiffert.

“People are cleaning the bathrooms themselves because they’re filthy,” she said. “People have lost faith that the hospitals are going to do those things. They’re taking it on themselves.”

Officials with the CDC and APIC decline to recommend such forceful interventions because clinical studies haven't proven their effectiveness.

But even Donskey, the Ohio scientist, said his research has given him personal pause.

"I might bring along a bottle of bleach to disinfect my room and ask every health care worker who examines me to wash their hands, but I don't think most patients are willing to do that," he said.

Anxiety lingers, three years later
Nearly three years after her last bout with C. diff, Amy Warren said she does everything she can to avoid sources of the infection, including hospitals and antibiotics. She’s acutely aware that it took three doses of vancomycin, the strongest antibiotic available, to get rid of the bacteria after six months.

“If I get sick, I get a panic attack,” she said. "What if the vancomycin doesn't work? I have no other medicine."

She tries to warn friends and family about the dangers of C. diff, urging them to limit their use of antibiotics and to be vigilant about hand hygiene. But, she said, it's clear they're not listening.

"They think, 'How can diarrhea be that bad?'" Warren said. "But this is more than diarrhea."

http://www.msnbc.msn.com/id/24407803/

A spore that can live and infect people for months!  A CFR of nearly ten percent!  Infections disgnosed and confirmed in 38 states (see map at left)!  The possibility that if you try to calculate the number of unreported or undiagnosed cases, the total number of infected could reach half a million!

I am reminded of a line from the recent and groundbreaking film "Cloverfield."  In the scene in question, youthful adults are fleeing from some incredible monster that is trashing Manhattan.  They run straight into an Army patrol in a department store that has been turned into a command post. 

One of the young adults blurts out, "What is that thing?"

The soldier replies, "Whatever it is, it's winning."

It should be apparent to anyone and everyone that in our war against bugs, the bugs are winning.  And our enemy, to paraphrase Pogo, is us.  It is lax hospital protocols that threaten nearly everyone who walks into one.  It is our inability to teach proper hygiene, even in our own homes.  It is ludicrous (not the rapper) decisions such as the one recently taken in Leon County, Florida (Tallahassee) schools, where alcoholic hand sanitizer was declared a fire hazard and ordered removed from classrooms. And it is not mandating the testing and reporting of these pathogens to local and state health authorities.

We don't need a bird flu pandemic to threaten our lives.  We are doing perfectly well threatening ourselves..