Monday, September 01, 2014

NPM 2014: Be Disaster Aware, Take Action to Prepare.



# 9023


After getting smacked repeatedly by hurricanes in the middle of the last decade (Katrina, Wilma, Rita, etc. . .), and pummeled by huge tornado outbreaks in 2010 and 2011 (see Weathering Heights: A Year For The Record Books), the United States has – comparatively speaking – enjoyed a welcome lull in major disasters.


Disasters still occur, of course.  Last months California quake caused billions of dollars in damage and major disruptions in the lives it affected, as did Hurricane Sandy in 2012.  But so far this year FEMA has only declared 33 major disasters nationwide – well behind the pace of 2011 (which saw 99 total).


While good news, this lull can’t be counted on to last. 2009 was a relatively mild year for disasters, but it was followed by the disaster ridden years of 2010 and 2011.  While no one can predict when the tide will turn, emergency managers know it is just a matter of time.


Unfortunately, individual, family, business and community preparedness remains less than FEMA, and local Emergency Management agencies would like to see. Only about half of the adults recently polled say they have a disaster plan, and of those, some of their preparations may be less than adequate.



Today marks the first day of National Preparedness Month, with the goal of getting Americans better prepared to deal with local, or national, disasters. 


The campaign really takes off tomorrow with a 2pm EDT Twitter Thunderclap, which where hundreds of twitter users (including @Fla_Medic) will simultaneously tweet the following message to over 6 million followers (details on how you can participate here).



All this month, as I do every September,  I’ll be featuring preparedness articles in this blog.  Some will be updates of earlier blogs, while others will be new content.  


Coincidentally, today (Sept 1st) is also Disaster Prevention Day in Japan,  which is the anniversary of the disastrous 1923 M7.9  quake that left Tokyo in ruins and killed – by some estimates – more than 140,000 residents.  Since 1960, that date has been used to conduct some of the most impressive disaster drills on the planet.

This year, one of the things the Japanese government is asking its citizens to add to their emergency stockpile is toilet paper.


Seriously, although some of the reasons behind this campaign may be more economic than practical.  Still, Japan saw a `toilet paper shortage’ after the Great 2011 Earthquake, and fears another natural disaster could see the supplies on the shelves bottom out (head down in shame, but moving on . . . ). 

It isn’t such a crazy idea, since there are often shortages of `necessities’ following a disaster.  And the use of `substitutes’ for toilet paper can clog sewer pipes and septic tanks, adding to the misery and health hazards following a disaster. 


Lest anyone think shortages like that can’t happen here, I would remind you of America’s Toilet Paper Panic of 1973 – one caused not by a natural disaster, but by a late night TV joke.


In December of 1973, the United States was suffering through the first of the OPEC oil shocks, and gas prices had tripled. Americans were understandably shaken by gas shortages and long lines at the pump.

Enter Wisconsin congressman Harold Froehlich who made the papers when he expressed concerns over a wood pulp shortage that could portend a paper shortage in 1974.  He quote an unnamed GAO source as saying they’d recently had trouble acquiring a full allotment of toilet paper.

Picking up on this obscure news item, staff writers for Johnny Carson’s Tonight Show wrote a joke for his monologue, saying that the next shortage congress was worried about was of toilet paper.

It got a modest laugh.

The next morning, however, millions of Tonight Show fans ran out and cleaned the shelves of all of the available toilet paper. Some people bought shopping cart's full. By noon, there wasn't a roll to be had in most major cities.

The supplies were, err, wiped out, so to speak.

That night, Johnny Carson went on the air to explain, and apologize. There was no shortage, folks.  It was all just  a joke  . . .  

Only one problem: Now there was a shortage.

As soon as new supplies were delivered and put on the shelves, they were snapped up by worried customers who hadn’t seen a roll on the shelf for days. People were hoarding toilet paper out of fear, and so the shortage continued.

Even though the supply chain was unbroken, it took 3 weeks before normalcy returned. And all of this took place back when stores actually had stockrooms, and didn't rely on just-in-time inventory restocking.

Now, consider what would happen if there were an actual break in the supply chain.  If production were reduced, or even halted, or if trucks couldn’t deliver goods to regions of the country.   Shortages could last not days, but weeks or longer. 

Granted, toilet paper isn’t exactly the highest priority item to have on hand in a disaster.  Food, water, required prescription meds, emergency lights, and a NWS weather radio all rank considerably higher on the list of `must haves’.  

Still, keeping a couple of extra rolls in the preps closet isn’t such a bad idea. 


This month FEMA and READY.GOV are both urging everyone to BUILD A KIT, MAKE A PLAN, and to BE INFORMED.


Basic kit : NWS radio, First Aid Kit, Lanterns, Water & Food & cash  for 3 Days minimum


Because during any disaster, the advantage goes to those who were already prepared.

Sunday, August 31, 2014

Modest Fissure Eruption Near Bárðarbunga


Source Icelandic Met Office 


UPDATED:  See update at bottom.


# 9022


The on again, off again RED aviation alert for the Bárðarbunga volcano is on again after a 1.5 km long fissure eruption overnight, but right now it is impossible to know just how disruptive this event is likely to become.  That said, this  eruption appears to be much larger than the small fissure eruption on Friday.


For now, a long dyke of sub-surface magma stretches north from the volcano to Askja to the north, which is now on Yellow Alert.



A tweet from a team on site from the University of Iceland describes the event:



An Olympic-sized pool contains about 2500 cubic meters of water, so the estimated lava flow at this time would fill about 24 pools a minute, or 1440 pools an hour.  Impressive, but at this time, this eruption appears to be smooth, non-explosive, and producing little or no ash.

The Icelandic Met Office – which warned yesterday that an eruption appeared more likely – describes the overnight event as:


31st August 2014 08:40 - Eruption in Holuhraun observed 05:15

Observation from scientists in the field (05:15): It appears that the eruptive fissure is longer than in the last eruption. It is extending north and south on the same fissure. The eruption is a very calm lava eruption and can hardly be seen on seismometers (almost no gosórói). Visual observation confirm it is calm, but continuous.


Several of the webcams monitoring the event I’ve mentioned in the past appear to be offline right now, but you can watch live (from a distance) on this webcam.


Seismic activity in and around  Bárðarbunga continues, with a M5.1 reported within the past hour.


We should see an update from the

Scientific Advisory Board of the Icelandic Civil Protection later today.  Yesterday a fissure eruption was deemed one of the more likely scenarios, although an explosive eruption of Bárðarbunga could not be discounted.

Stay tuned.

UPDATE:  1100 hrs EDT

Although weather conditions are hindering observations, the Scientific Advisory board has released the following update:


31st August 2014 12:07 - from the Scientific Advisory Board

Scientists from the Icelandic Met Office and the Institute of Earth Sciences and representatives of the Civil Protection in Iceland attend the meetings of the Scientific Advisory Board of the Icelandic Civil Protection.

Conclusions of the Scientific Advisory Board of the Icelandic Civil Protection:
  • A lava eruption started in Holuhraun shortly after 04 AM, on the same volcanic fissure, which erupted earlier this week. The fissure is estimated to be 1,5 km long. It was detected on Míla´s web-camera at 05:51 AM. Fewer earthquakes seem to follow the event than in the previous eruption, but more lava is being extruded.
  • At 07 AM the lava flow was around 1 km wide and 3 km long towards northeast. The thickness was estimated a few meters, the flow about 1000 m3 pr second.
  • Approximately 500 earthquakes were detected in the area and smaller than before. The strongest earthquake, M3.8 was in the Bárðarbunga caldera. Poor weather conditions prevail in the area, which makes detection of smaller earthquakes difficult.
  • GPS measurements show continued movements north of Dyngjujökull.
  • Gas emissions rise to a few hundred meters above the fissure.
  • Weather conditions make it difficult to follow the progression of the eruption, but scientists are in the area, using every opportunity to acquire information on gas and lava outflow.
  • Weather conditions do not allow overflight at this time. The opportunity to fly over the area will be assessed later today.
From the Icelandic Met Office:
The Aviation Colour Code for Bárðarbunga is at ‘red' and the code for Askja at ‘yellow'.

I would note that the latest Aviation Color code map has just recently been changed back to Orange.


Mackay On Ebola: Blood, Sweat & Tears




# 9022



Ian Mackay, in a follow up to his seminal post on Ebola ten days ago, writes today on the level of EBOV detection (often via RNA, or Antigens) in various human body fluids. 


While the blood of  viremic patients is infamously teeming with the virus, Ian describes the (somewhat limited) research to date on the level of EBOV detection in other body fluids – like tears, sweat and saliva.


Although the level of EBOV detection in these fluids have been far lower –and  often even undetectable -  given the believed low infectious dose for contracting viral hemorrhagic fevers and the likely variability of virus shedding across numerous cases, any hint of the virus in these body fluids is deserving of our attention and respect.


Follow the link to read.


Sunday, 31 August 2014

Ebola: Blood, sweat and tears...

This post follows up the recent one on convalescent semen being able to harbour infectious Ebola virus (EBOV; although I am not aware of any infection resulting from this route of transmission there has been at least one report for Marburg virus [4]).

I thought I'd give the same treatment to tears and sweat which are also fluids intermittently listed as possible sources of EBOV infection for humans. Some examples of the scientific literature which support the risk messaging, follow.

(Continue . . .)

WHO Update & Timeline On Senegal’s 1st Ebola Case




# 9022


On Friday we learned that a fifth African nation had been touched by the Ebola outbreak in Senegal Reports 1st Imported Case Of Ebola.  Initial details were sketchy, particularly concerning the timing of the index cases' arrival and diagnosis.


Today the World Health Organization has released an update that, unfortunately, shows this patient was symptomatic, and living with relatives in Dakar for several days before being admitted to the hospital.


All of which makes the identification and observation of all of this patient’s contacts during that period of paramount importance. It also appears that this person entered the country prior to last week’s (Aug. 21st) border closing with Guinea.


WHO Ebola Disease Outbreak News: Senegal


Epidemiology and surveillance

On 30 August 2014, Senegal’s Ministry of Public Health and Social Affairs provided WHO with details about a case of Ebola virus disease (EVD) announced in that country on 29 August.

WHO has also received details of the emergency investigation immediately launched by the Government. Testing and confirmation of Ebola were undertaken by a laboratory at the Institut Pasteur in Dakar.

The case is a 21-year-old male native of Guinea, who arrived in Dakar, by road, on 20 August and stayed with relatives at a home in the outskirts of the city.

On 23 August, he sought medical care for symptoms that included fever, diarrhoea, and vomiting. He received treatment for malaria, but did not improve and left the facility.

After leaving the facility, he continued to reside with his relatives. Though the investigation is in its early stages, he is not presently known to have travelled elsewhere.

On 26 August, he was referred to a specialized facility for infectious diseases, still showing the same symptoms, and was hospitalized.

On 27 August, authorities in Conakry, Guinea, issued an alert, informing medical services in Guinea and neighbouring countries, that a person, who was a close contact of a confirmed EVD patient, had escaped the surveillance system.

That alert prompted testing at the Dakar laboratory, launched an investigation, and triggered urgent contact tracing.

Health sector response

WHO is treating this first case in Senegal as a top priority emergency. Key operational personnel were dispatched to Dakar today; others will follow.

The Government of Senegal has informed WHO of the urgent need for epidemiological support, personal protective equipment, and hygiene kits. These needs will be met with the fastest possible speed.

Saturday, August 30, 2014

PAHO/WHO: Epidemiological Alert On Chikungunya & Dengue In the Americas




# 9020


While Ebola garners the bulk of the headlines, other serious disease threats like Chikungunya and Dengue continue their inexorable spread across the globe, infecting hundreds of times more people than does Ebola, albeit with a far lower morality rate.   


For 2013, PAHO provides the following assessment for Dengue in the Americas:


In 2013, dengue behaved like a classic epidemic for the Americas region, with the largest historical cases reported. In total, countries in the Americas reported more than 2.3 million cases of dengue, with 37,692 cases of severe dengue and 1,280 deaths, for a mortality rate of about 0.05%.


This year, for the first time, the Americas are also dealing with Chikungunya – which arrived late last fall in the Caribbean, and has spread rapidly since then.  PAHO’s most recent report (Week 34) indicates just over 650,000 CHKV infections in the Americas, and 37 deaths.



The arrival of Chikungunya to the Americas has been anticipated for some time, and the CDC & PAHO produced a 161 page guide on preparing for its arrival 3 years ago (see Preparedness and Response for Chikungunya Virus Introduction in the Americas).


Last May, in Florida Prepares For Chikungunya we looked at local preparations for its arrival.  Given its climate, its position as the gateway to the Caribbean, and that it receives millions of tourists every year -  Florida was considered a likely first US battleground against any CHKV invasion.  


And indeed, the first first locally acquired case in Florida was reported in July.


For now, the major concern is in the Caribbean, Central & South America where both Dengue and CHKV co-circulate, and where the burden of these diseases is infinitely higher than it is in the United States. As the height of the Dengue season generally occurs in the second half the year, the next few months are considered a critical time for mosquito control programs.


Yesterday PAHO and the World Health Organization released an 8-page PDF Epidemiological Alert for the Americas on these co-circulating mosquito-borne diseases.  Follow the link to read the entire document:


Epidemiological Alert

Chikungunya & Dengue Fever In the Americas

29 August 2014

Situation summary

The first evidence of autochthonous chikungunya transmission in the Americas was recorded in December 2013, since then, autochthonous transmission has been detected in 33 countries and territories of the Americas (27 countries and territories in the Caribbean, 3 countries in Central America, 1 country and 1 territory in South America and 1 country in North America).1,2 As of epidemiological week (EW) 35 of 2014, the Pan American Health Organization / World Health Organization (PAHO/WHO) has been informed of a total of 659,367 cases, including 37 deaths, in the Americas.

Usually during the second semester of the year, Central America, Mexico and the Caribbean experience a seasonal increase in dengue fever transmission. Currently, the Dominican Republic, El Salvador, Guatemala, and Honduras, are recording increases in cases coinciding with this period of greater transmission.

The threats posed by the seasonal increase of dengue transmission and the introduction, or risks of introduction of the chikungunya virus in the Region require an integrated approach of prevention and vector control activities of both diseases. With the rapid spread of the chikungunya virus observed in some countries of the Americas, simultaneous dengue and chikungunya outbreaks may occur, which would result in increased health care demand. Accordingly, health care services must be prepared to meet expected increased demand without compromising quality of care; preparations should be guided by the PAHO/WHO recommendations for clinical management of patients with dengue or chikungunya.

(Continue . . . . .)



With the rapid expansion of both Dengue and Chikungunya around the globe, Europe and the United States are seeing signifcant increases in the number of imported cases every year – each with at least the potential to seed local mosquito populations with the virus. So far locally acquired infections in both regions remain relatively rare.


The lack of an abundant non-human animal reservoir for the virus is likely partly responsible. But in 2003, a CDC EID study also found that economics and lifestyle may have a lot to do to with our lack of locally transmitted Dengue (see Texas Lifestyle Limits Transmission of Dengue Virus).


But given the availability of two competent mosquito vectors (Aedes Aegypti & Aedes Albopictus), and repeated introductions of the virus from travelers coming from regions where the virus is endemic, our luck in this matter may not last forever.


The good news is that these mosquito-borne illnesses (and others, including WNV, SLEV, EEE, etc.) are largely preventable.


Florida’s Health department reminds people to always follow the `5 D’s’:


Referral: Mackay On The Expansion Of Ebola Into Senegal


Credit Dr. Ian Mackay VDU Blog


# 9019


In his blog overnight, Dr. Ian Mackay adds Senegal to his Ebola outbreak map, and makes an important point about the uniqueness of each disease outbreak, the human variables that drive them, and the danger of assuming that the public health responses of the past will always suffice in the future.


First a link to Ian’s blog, then I’ll be back with a comment.


The fifth I give you...


According to it's Minister of Health, Awa Marie Coll Seck [1,2], a case of Ebola virus disease (EVD) has been imported from Guinea and it is confirmed by testing at the World Health Organization's collaboration Centre, the Pasteur Institute in Dakar.

Interesting that this occurred one week after Senegal closed its borders (again) with Guinea.[3,4] The infected Guinean student travelled on 29-August to Dakar where he presented to a hospital but did not admit to being in contact with known EVD cases. Senegal had closed its borders around 22-August.[5,6].


(Continue . . . )



After forty years of outbreaks – all of which were geographically limited and comparatively small – Ebola had gained the reputation of being a horrific killer – but basically only of `local concern’


Conventional wisdom said that it killed too quickly to allow those infected to spread the disease far. The virus simply didn’t have the `legs’ to spark a major outbreak.


Fast forward to 2014, and those assumptions are taking it on the chin.  Not because the virus has changed, but because Africa has changed (a major point made in Michael Osterholm’s WaPo Article  Aug. 1st).  


Remote villages aren’t nearly as remote as they once were. Cars, busses, trains, even airplanes are far more common today in Africa than they were in 1976 when the virus was first detected.  Society is more mobile today than ever before, and that applies to just about everywhere on this planet.


The world was caught flat-footed in its initial response to this Ebola outbreak – no doubt lulled by earlier successes in containing the virus -  and that has allowed it to spread unchecked. Given its lack of `airborne’ transmission, I fully expect it will eventually be brought under control, albeit at a terrible cost. 


The takeaway lesson here goes beyond Ebola, and well beyond the continent of Africa.


As the world changes, so do the capabilities of its pathogens. A side effect of modern society is that it has become the great enabler of infectious disease.  A novel virus or resistant bacteria can hitch a ride in New Delhi or Shanghai this morning and can be in London, or New York by tonight.


Which means that we no longer have the luxury of ignoring `small disease outbreaks’  anywhere in the world, no matter how remote. 


Because the next pathogen to crawl out of the woodwork may be far more `pandemic-ready’  than Ebola could ever be.