Scott McPherson's Web Presence

The virulent strain of mutant bacteria known as Clostridium difficile, or C.diff for short, has hit Scotland again.  This time, at hospitals in Glascow and Aberdeen, a total of nine patients have been hit with the pathogen, and two are dead.

According to ProMED, the toxic 027 strain is the culprit.  Until recently very rare, apparently 027 is becoming not quite commonplace, but not rare anymore, either.  Again, according to ProMED, C.diff 027 killed some 65 Scottish patients at Stoke Mandeville Hospital in Aylesbury, Buckinghamshire, England, between 2003 and 2005.  Stubborn little pest, that C.diff.

Hospitals are pretty dangerous places these days.  In my opinion, that is because there is little functional difference between a hospital and a bus terminal.  We let a virtual stampede of people through our corridors, wings and even rooms.  I have personally visited patients with twelve visitors in a room at one time.  the lax "enforcement" of visitor maximums has to be part of the problem.

So is the laziness of modern healthcare practitioners.  How many surveys have we seen recently that show not even doctors bother to wash their hands between patients?  Here's a 2004 story from WebMD.com:

July 6, 2004 -- Upwards of one-half of doctors don't wash their hands between visits with hospital patients, a new study shows. It's a big infection control concern in hospitals because dirty hands transmit germs to other patients.

Why don't doctors wash their hands -- a seemingly simple procedure? Hospitals routinely promote good hygiene to doctors and other health-care workers, alerting them of the risks of dirty hands after examining different patients or after examining various infected and uninfected sites on a single patient. Yet doctors are frequently observed breaking the rules.

In this study, researchers sought to better understand doctors' attitudes. They secretly tracked 163 doctors to monitor their hand washing during the day. Each doctor also completed a survey about their attitudes on hand hygiene.

They observed just 57% of doctors washing their hands between patients, writes lead researcher Didier Pittet, MD, MS, an infection control expert with the University of Geneva Hospitals. Pittet's report appears in the latest Annals of Internal Medicine.

http://women.webmd.com/news/20040706/study-doctors-dont-wash-hands-enough   

The problem does not rest exclusively with physicians and nurses.  We have become slobs ourselves. 

Restroom Study Finds Hand Washing on the Decline

FRIDAY, Sept. 21 (HealthDay News) -- Americans aren't washing their hands like they used to.

That's the conclusion of a new observational study that found fewer users of public restrooms stopping by the sink on their way out, compared to years past.

The study was released to coincide with National Clean Hands Week by the American Society for Microbiology and The Soap and Detergent Association.

For the study, researchers observed the behavior of almost 6,100 adults at six locations in four cities -- Atlanta, Chicago. New York and San Francisco.

They found that 77 percent of people washed their hands in public restrooms, a 6 percent decline from the 83 percent noted in 2005.

This latest study found that women were still more likely (88 percent) to wash their hands than men (66 percent). In 2005, 90 percent of women and 75 percent of men washed their hands.

In both the 2005 and 2007 studies, researchers observed the hand washing behavior of people at: Turner Field in Atlanta; the Museum of Science and Industry and the Shedd Aquarium in Chicago; Grand Central Station and Penn Station in New York City; and the Ferry Terminal Farmers Market in San Francisco.

In 2007, Chicago had the most conscientious hand washers (81 percent), followed by New York City (79 percent), Atlanta (75 percent) and San Francisco (73 percent).

"According to the Centers for Disease Control and Prevention, the single most important thing we can all do to keep from getting infectious diseases and spreading them to others is to clean our hands," ASM spokesperson Dr. Judy Daly, director of the microbiology laboratories at the Primary Children's Medical Center in Salt Lake City, said in a prepared statement.

"Many cases of colds, flu and foodborne illness are spread by unclean hands, and these diseases are responsible for billions of dollars each year in health-care expenditures and productivity losses in the United States," Daly noted. "Worldwide, infectious diseases remain the leading cause of illness and death."

-- Robert Preidt

SOURCE: American Society for Microbiology, news release, Sept. 17. 2007

http://www.medicinenet.com/script/main/art.asp?articlekey=84055

Two weeks ago, a brother of a very close family friend died.  His autopsy reads, Cause of Death: MRSA.  He had been in hospital for a minor surgical procedure a few weeks prior. Did he contract MRSA from the hospital?  That remains to be seen.  One thing is for sure:  Hospitals are losing the battle against superbugs.  Their own policies regarding visitation, coupled with their inability to enforce common sanitary protocols, may be counteracting any feel-good, window-dressing initiatives their PR departments and legal counsel can conjure up to lull patients into a false sense of security.

Let me close with the last three paragraphs of the ProMED report:

_C. difficile_ is a potentially fatal bug, which mainly affects the elderly, and usually grows in the large intestine. Spores can survive for a long time in the environment, with areas around hospital beds and toilet areas common. Health officials have been concerned that the "hypervirulent" 027 strain could become more common in Scotland as it spreads from England, and a _C. difficile_ "reference laboratory" has been established in Scotland to help identify more virulent strains including 027, which might not be picked up otherwise, and help understand the bug's characteristics.

The 027 strain produces more toxins than other types, has caused large outbreaks of severe disease in hospitals in Canada and the US since the beginning of the decade, and has now been detected in more than 80 hospitals in England and Wales. The 1st Scottish case of 027 was diagnosed in October 2006. Then, in November last year [2007], an unnamed female patient died in the West of Scotland due to a "combination of factors" after being infected with the 027 strain.

Figures show all strains of _C. difficile_ caused 100 deaths in Scotland in 2005 against 57 in 2001. Cases increased by 10 per cent in 3 months.(bold mine)

With the exception of Indonesia and South Korea (and India too, I suppose), the bird flu front has been relatively quiet.  This has given me the opportunity to catch up on my posting on my "other" blogsite, the Web home of the computer publication Computerworld Magazine blogs.computerworld.com/mcpherson. That site, as you can imagine, deals with my profession, which is information technology.  But I serve up my observations with the same wit, or lack thereof, so feel free to drop by over there and read those blogs when you can.  they can occasionally overlap, and are a great resource for people used to dealing with calamity and catastrophe.  Emergency managers, DR/COOP/BCP planners, Republican Congressional political consultants, that sort of thing.

My Outlook task list is overflowing with blog ideas for these slow periods.  Of course, impatient one, you can also go to the Websites and blogsites that deal with avian flu on a much more dependable, daily basis.  They are all posted on the left frame of this Website, and they are all worthy of your time.

One item that I am looking forward to writing is a critique of the pandemic guide of the American Civil Liberties Union.  I suppose they will sue bird flu to death, yuk yuk.  Seriously, this topic needs to be debated.  That there will be some sort of temporary cessation, or suspension of some subset of civil liberties is all-but-assured.  The scope of that suspension cannot be determined in advance.  It has to be planned for, exercised, and chronicled.  We also need to define, legally, when that cessation of that subset of civil liberties itself ceases.  Is it when cases drop back below the epidemic threshold?  Is it when the Congress says so?  The governors?  The military?  Homeland?

I will also be turning toward the plague of Dengue Fever and DHF that is becoming endemic in the Caribbean, and how we may be only a blow away from Dengue on our own doorstep.  Hurricanes can bring the United States more than just a lot of rain, wind and property damage.  It can bring misery on a scale not seen since the late 1800s. 

I want to comment on something I read in Mike Coston's blog, Avian Flu Diary.  Dr. Mike Osterholm is a genuinely good person and, I am happy to say, a friend of mine.  Mike's stamina as regards pandemic fatigue is remarkable.  I have found that I need to "charge my batteries" from time to time, leaving the topic of bird flu for days to weeks in order to energize.  Mike Coston has the luxury of a Florida beach apartment to lounge in and recharge, curse him.  Me? I have a backyard with a pool that is forming its own ecosystem.  But thank God that Mike Osterholm is the Energizer Bunny of pandemic planning. 

Dr. Mike has given a seminal speech in his native Minnesota, speaking in front of hundreds who were treated to Vintage Osterholm.  the story is at: http://www.postbulletin.com/newsmanager/templates/localnews_story.asp?z=2&a=342839

Osterholm back on the speaking circuit and getting picked up by the media is a good thing: There is no one else in the world today with the gravitas to match Dr. Mike when he speaks about supply chain disruptions, along with the upcoming potential failure of essential services such as municipal fresh water systems and electric utilities.  And Mike consistently gets it right.  He is Cassandra, but so am I.  So are we all.  And we are right and correct in our beliefs. 

I am barely qualified to carry his water when it comes to these topics.  In fact, he is where I draw much of my inspiration from when I blog about IT and the incredible vulnerability our society has if the technology fails.  Yet that is what I am expert in -- IT -- and I mean IT like IT that means the difference between life and death, good and bad, success and failure on an enterprise scale.  So when I see the train wreck that is the failure of multiple essential services like coal mining, petroleum refining and data center failures, I have been there and done that.

One of the countless things I learned while preparing the entire state of Florida for Y2K was that it is not the loss of fresh water that worries me as much as the inability to move waste.  You see, waste flows downhill as they say, and in most areas of Florida (and probably in your area too), that downhill flow has to be power-assisted.  If there are serious disruptions to the electric grid (and you can count on those in a moderate-to-severe pandemic), human waste will back up and become quite a public health problem.  Sure, there are generators that are responsible for doing their thing at transfer stations, but they, too, require energy -- in the form of petroleum products.  When that flow is disrupted, the other flow will be, too.

So add to that cascading series of probable failures, the failure to move human waste from Point A to Point B.  And that means a very real possibility of diseases such as cholera to suddenly appear as a secondary infection during a severe pandemic with accompanying disruptions to the electrical grid.

When I did the Sandy Springs radio show last week, I mentioned that a pandemic is like Y2K where the people fail, not the machines -- at least not in the beginning.  Eventually, however, machines will fail too.  Not all of them at once, but enough of them to make life pretty miserable for an extended period of time.  Machines break.  Computers break, too, because computers are machines at their core. they all require maintenance.  No maintenance, or reduced maintenance, equates to disruptions and failures.

Now factor in Nature.  Nature does not schedule its rage sequentially, in a linear timeline.  Mother Nature likes to "pile on," like some football coach running up the score on Hapless U. to get a few extra poll votes or points in a computer ranking.  So it is that over half of the influenza pandemics of the past 300 years had waves in what is known as Hurricane Season, June 1 to November 30.  Imagine the problems if a major hurricane hit the United States while a flu pandemic raged?  Can we even begin to imagine what happens when the entire veneer of a modern lifestyle is peeled back by a killer virus and then a natural cataclysm?  Anyone who thinks the infrastructure could withstand that is buying illegal substances from Mexican cartels.

Last Sunday, my wife and I were en route to our church when we noticed all the traffic signals were dormant in the mile leading to the church.  We performed the quick calculus and concluded the power would be off in the church and we thanked our God that He gave us the wisdom to dress very Summery.

Sure enough, when we entered the church, it was beginning to get pretty sticky in there.  We became grateful for the incense!  The point is that within about forty-five minutes, the church began to swelter.  That is how long it took for people to become really uncomfortable with the conditions.  Now transpose that to hours or even days.  It is not so unlikely a scenario:  A few months ago, our City of Tallahassee power was off for just shy of eight hours, caused by a mild thunderstorm.  What was maddening was that our power stayed out while the next street over had electricity within three hours.  Why our block was subjected to torture while another was quickly restored is still a mystery.

An increasingly thin veneer separates us from chaos.  That veneer is abraded today by absurdly high gas prices, unemployment, foreclosures and malaise.  It can be stripped bare by natural disasters such as tornadoes, earthquakes or hurricanes.  It can be blown to smithereens by a severe flu pandemic.  Every single thing we can do to ensure the success of the supply chain and the delivery of infrastructure, utilities, food and energy during a pandemic is important, welcomed and is absolutely essential.

My good friend Craig Fugate is the emergency manager for Florida.  He spoke yesterday at the Governor's Hurricane Conference in Ft. Lauderdale ("Ft. Liquordale" to the oldies there).   The topic was hurricane preparedness, but he also spoke indirectly to this culture of victimization and how it is a cancer upon our society.  People are not taking responsibility for their actions.  Read on::

(Florida Governor Charlie) Crist and Craig Fugate, director of the Florida Division of Emergency Management, urged people to stock up on food, water, gasoline and other provisions. Fugate said residents should adopt a proactive approach, instead of relying on government to ride to their rescue.

"You don't have to get ready: Somebody's going to take care of you. Your house got tore up? Blame somebody else," Fugate quipped. "Ice didn't get there today, 12 hours after a hurricane? Blame the government.

"So when did we suddenly decide that we were going to play the role of victim?" he asked.

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.

It was not surprising to receive the Google alert on this news story.  As I have said before, in public health, there are few coincidences.  I had predicted as much in several earlier blogs.  Let us hope he can succeed and persuade the Indonesian government to rejoin the rest of the world.

Bill Gates to explore bird flu vaccine development in Indonesia

Jakarta (ANTARA News) - Owner and founder of the giant company Microsoft Corporation, Bill Gates, will discuss the development of bird flu vaccine with the Indonesian government during his visit here on May 8 and 9, 2008.

"The Indonesian government and Bill Gates will talk about cooperation in developing bird flu vaccine," Coordinating Minister for People`s Welfare Aburizal Bakrie said here on Tuesday.

Indonesia, Bakrie said, had advance talks on the development of bird flu vaccine with Gates but no conclusion had been reached.(*)