Wednesday, October 09, 2024

NHC 5am Milton Update - Key Messages - Bugging Out

 


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Hurricane Milton continues to exceed expectations and is still a CAT 5 storm roughly 20 hours before its expected landfall on Florida's West coast.   It is still expected to lose some strength, although possibly only down to CAT 4.  

While landfall is currently south of the mouth of Tampa Bay, the eye continues to wobble, and some track changes are inevitable before landfall. The latest advisory moved north a few miles, after dropping south last night. 

The worst surge will be immediately to the right of where the eye makes landfall.  The latest projections indicate 10-15 feet above ground level in some places. 

The latest Key Messages from the National Hurricane Center follow:


As for me and my cat (Jin-Jin), our bags are packed and staged near the front door. During the next break in the rain, I'll load my car, and hopefully in the next couple of hours we'll set off to my bug out location.  Plans are to be there before noon. 

I expect we'll lose both power and internet later tonight - possibly lasting for several days - and I doubt I'll be able to post again until after those services return.

Until then, you can get the latest infectious disease information from FluTrackers, Crof, CIDRAP, Dr. Ian Mackay, and our newcomer Hogvet54  - all excellent sources of information and analysis. 

Stay safe, everybody.

Tuesday, October 08, 2024

MMWR: Interim Effectiveness Estimates of 2024 Southern Hemisphere Influenza Vaccines




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Although Florida is now less than 48 hours from the expected arrival of Hurricane Milton, one of my pre-evacuation preps yesterday was to get my seasonal flu shot.  Two weeks ago, in preparation for our close encounter with Helene, I got my fall COVID vaccine.  

Last year, I also updated my Tetanus shot (Tdap).  

As I've explained previously (see #NatlPrep: Giving Your Preparedness Plan A Shot In The Arm), the last thing you want to have to deal with during an emergency is being sick.  And when you are stressed, and fatigued - and maybe cooped up with a lot of other people - your chances of catching something go up. 

Admittedly, Flu and COVID vaccines only provide modest protection against infection, but they usually do a better job at reducing severe illness and hospitalization. And since severe influenza infection is linked to strokes and heart attacks, even a modest amount protection can be lifesaving. 



Yesterday the CDC's MMWR published the results of a study of this year's flu vaccine effectiveness (VE) in 5 South American countries (Argentina, Brazil, Chile, Paraguay, and Uruguay) - which has the same components as the Northern Hemisphere's fall vaccine - and reports that it reduced the risk of hospitalization in high-risk patients by 35%.

While far from a stellar result, it is a significant reduction of risk. One that I'm more than happy to have on board, given the challenges ahead. 

I've only reproduced the Abstract and summary.  Follow the link to read the report in its entirety.  I

Interim Effectiveness Estimates of 2024 Southern Hemisphere Influenza Vaccines in Preventing Influenza-Associated Hospitalization — REVELAC-i Network, Five South American Countries, March–July 2024


Weekly / October 3, 2024 / 73(39);861–868

Erica E. Zeno, PhD1,2,*; Francisco Nogareda, MPH3,*; Annette Regan, PhD3,4; Paula Couto, MD3; Marc Rondy, PhD3; Jorge Jara, MD3; Carla Voto, MD5; Maria Paz Rojas Mena, MD5; Nathalia Katz, MD6; Maria del Valle Juarez, MPH6; Estefanía Benedetti, MPH7; Francisco José de Paula Júnior, MD8; Walquiria Aparecida Ferreira da Almeida, PhD8; Carlos Edson Hott, MBA8; Paula Rodríguez Ferrari, MSN9; Natalia Vergara Mallegas, MPH9; Marcela Avendaño Vigueras9; Chavely Domínguez, MD10; Marta von Horoch, MD11; Cynthia Vazquez, Phd12; Eduardo Silvera13; Hector Chiparelli, MD14; Natalia Goni, PhD14; Laura Castro, DrPH1; Perrine Marcenac, PhD1; Rebecca J. Kondor, PhD1; Juliana Leite, PhD3; Martha Velandia, MD3; Eduardo Azziz-Baumgartner1; Ashley L. Fowlkes, ScD1; Daniel Salas, MD3; REVELAC-i Network 

Summary

What is already known about this topic?

Influenza vaccine effectiveness (VE) varies by season.

What is added by this report?

In five South American countries (Argentina, Brazil, Chile, Paraguay, and Uruguay) the 2024 Southern Hemisphere seasonal influenza vaccine reduced the risk for influenza-associated hospitalization among high-risk groups by 35%. VE might be similar in the Northern Hemisphere if similar A(H3N2) viruses predominate during the 2024–25 influenza season.

What are the implications for public health practice?

CDC recommends that all eligible persons aged ≥6 months receive seasonal influenza vaccine. Early antiviral treatment can complement vaccination to protect against severe influenza-related morbidity.

Full Issue PDF

Abstract

To reduce influenza-associated morbidity and mortality, countries in South America recommend annual influenza vaccination for persons at high risk for severe influenza illness, including young children, persons with preexisting health conditions, and older adults. Interim estimates of influenza vaccine effectiveness (VE) from Southern Hemisphere countries can provide early information about the protective effects of vaccination and help guide Northern Hemisphere countries in advance of their season.
Using data from a multicountry network, investigators estimated interim VE against influenza-associated severe acute respiratory illness (SARI) hospitalization using a test-negative case-control design. During March 13–July 19, 2024, Argentina, Brazil, Chile, Paraguay, and Uruguay identified 11,751 influenza-associated SARI cases; on average, 21.3% of patients were vaccinated against influenza, and the adjusted VE against hospitalization was 34.5%. The adjusted VE against the predominating subtype A(H3N2) was 36.5% and against A(H1N1)pdm09 was 37.1%.
These interim VE estimates suggest that although the proportion of hospitalized patients who were vaccinated was modest, vaccination with the Southern Hemisphere influenza vaccine significantly lowered the risk for hospitalization. Northern Hemisphere countries should, therefore, anticipate the need for robust influenza vaccination campaigns and early antiviral treatment to achieve optimal protection against influenza-associated complications.

         (Continue . . . )
 

There is still time for Floridians in the path of Milton to get the flu/COVID vaccines, as well as those struggling to deal with the aftermath of Helene. I know it may seem pretty far down your list of things to do.

But during an extended disaster, you need every edge you can get. 


Monday, October 07, 2024

Hurricane Watches Raised For Most of Florida's West Coast

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In their 5 am advisory, the NHC posted Hurricane & Tropical storm watches for the entire west coast of Florida in anticipation of the arrival of Hurricane Milton late Wednesday afternoon.  As the graphic above shows, Hurricane conditions are expected well inland. 

Milton, currently a CAT 3 storm still in the far western Gulf of Mexico, is expected to grow to a CAT 4 or 5 storm over the next 36 hours, but is forecast to weaken somewhat before landfall. Probably to a CAT 3 or (hopefully) lower. 

But even if that happens, it will be pushing a massive wall of water ahead of it towards the coast. Record surge tides are expected to the right of where the eye makes landfall, but exactly where that will be is still unknown.  

Because of this uncertainty, a lot of people are going to be forced to evacuate low-lying coastal areas, even though some may be spared the worst.  While surge is the biggest risk to life and property, the effects of Milton are likely to be widespread and long-lasting. 

Extended power outages are inevitable. Millions are likely to find themselves without power, water, internet, or sewer for days or even weeks. Others may find their homes flooded, or damaged from high winds, and unlivable without extensive repairs. 

As far as what people can expect inland, away from the coast the National Weather Service has released this local product:


 For the purple colored regions they forecast:

Threat Level - Potential for wind greater than 110 mph

Potential Impacts Include:

*Structural damage to sturdy buildings, some with complete roof and wall failures. Complete destruction of mobile homes. Damage greatly accentuated by large airborne projectiles. Locations may be uninhabitable for weeks or months.

*Numerous large trees snapped or uprooted along with fences and roadway signs blown over.

*Many roads impassable from large debris, and more within urban or heavily wooded places. Many bridges, causeways, and access routes impassable.

*Widespread power and communications outages.

For the red colored area:

Threat Level - Potential for wind 74 to 110 mph

Potential Impacts Include:

*Considerable roof damage to sturdy buildings, with some having window, door, and garage door failures leading to structural damage. Mobile homes severely damaged, with some destroyed. Damage accentuated by airborne projectiles. Locations may be uninhabitable for weeks.

*Many large trees snapped or uprooted along with fences and roadway signs blown over. 

*Some roads impassable from large debris, and more within urban or heavily wooded places. Several bridges, causeways, and access routes impassable.

*Large areas with power and communications outages.

While not everyone in these warned areas will see these extreme conditions, everyone in Milton's path needs to prepare as if they could.  

Since I live in a mobile home in the red area, I'll be evacuating to a friend's house (also in the red area).  Luckily, I'm well inland and don't have to worry about flood damage to my home, but the wind is another matter.

As I've written often, most disasters boil down to unscheduled camping.  Living without power, internet, heat or A/C, running water (and sometimes even flushing toilets) . . . sometimes for weeks.  Most of my preps are built upon that premise

While the 12 hours or so that Milton pounds Florida will be traumatic and damaging, the biggest dangers from a hurricane often come in the days and weeks after the storm has passed, due to injuries or illness that occur during the `recovery' period.

Some of the many dangers include:

One of the most common, and dangerous threats comes from floodwaters which may linger for days, or even weeks following the storm. Waters that may contain toxic chemicals, dangerous viruses and bacteria, and hidden hazards like snakes, rats, and broken glass, sharp metal, or even live electrical wires.

The CDC maintains a web page on the dangers of Flood Waters or Standing Waters and in 2022 we looked at Florida: Uptick Of Vibrio Infections Following Hurricane Ian.

And lastly, the physical and mental impact of a major disaster should not be underestimated.  Many people are going to lose their homes, businesses, and their savings due to this storm. 

In March of 2009, in a study led by Dr. Anand Irimpen (Associate Professor of clinical medicine at Tulane), it was disclosed that residents of New Orleans saw a 300% increase in heart attacks in the first 2 years after hurricane Katrina.

A follow up, published in 2014 (see Tulane University: Post-Katrina Heart Attack Rates - Revisited), once again found the impact of Katrina on cardiac health remained pronounced.

In the wake of Hurricane Katrina, a study funded by the National Institute of Mental Health, which surveyed 1,043 survivors,  found:

  • More than 11% were diagnosed with a serious mental illness following the storm. This compares to just over 6% before the hurricane.
  • 9.9% had mild-moderate mental illness, compared to 9.7% before Katrina.
  • They estimated  200,000 people facing serious mental problems, such as PTSS (Post Traumatic Stress Syndrome) and depression, in the three states most affected.

In 2014, in Post-Disaster Stress Cardiomyopathy: A Broken-Hearted Malady, we looked at a rare condition known as Takotsubo cardiomyopathy – or stress induced cardiomyopathy which is often linked to extreme grief or stress, as might be experienced following a disaster.

Also known as broken heart syndrome, this acute ballooning of the heart ventricles is a well-recognized cause of acute heart failure and dangerous cardiac arrhythmia's. 

While often hidden from view, the psychological impact of a disaster can be enormous and ongoing. In 2011, in Post Disaster Stress & Suicide Rates, we looked at the impacts of disaster-related PTSD (Post Traumatic Stress Disorder). 

A small reminder that in the wake of a disaster not all wounds bleed, not all fractures show up on an X-ray, and that the best treatment can't always be found inside your first aid kit.

Sunday, October 06, 2024

With Milton, Evacuation Is The Better Part Of Valor



NOTE: As of this posting, there are no Hurricane watches or warnings for Florida, and no evacuation orders.  But both are coming (either later today or early Monday)

#18,342

With the dual caveats that soon-to-be Hurricane Milton is still 80 hours away, and both its forecast track and intensity (CAT 3) at landfall are subject to change, it is difficult as someone born and raised in St. Petersburg not to shudder at the implications of the NHC graphic above.

For Tampa Bay - home to more than 3 million people - this is pretty close to the worst-case scenario, as it would drive a huge storm surge up into the bay.   

A CAT 4 or 5 storm, or a track another 15-20 miles further up the coast would be worse, of course. While a landfall even 30 to 40 miles further south would greatly reduce the storm surge in Tampa bay. 

But that would only shift the disaster to other coastal communities who are still reeling from last week's devastation from Hurricane Helene. 

Even tiny shifts in the track can have huge impacts on storm surge and who needs to evacuate. The flood zones for the Tampa Bay area (below) illustrates just how vulnerable this region is. 

But the broader threat from Milton extends across much of the state.  Because of the enormity of this threat, last night the Governor issued a State of Emergency for 35 counties.  

This will, among other things, allow people to get a 30-day emergency supply of Rx meds. 


Regardless of where Milton makes landfall, power outages are likely to be extensive and prolonged.  Water and sewer services may be offline, roads and bridges may be blocked, flooded, or damaged, and emergency services (EMS, fire, police) may be severely degraded. 

Banks, gas stations, grocery stores, pharmacies, doctors, and other essential services may be shuttered for days or weeks. Stores that are able to reopen may not be able to process Credit or Debit cards. And for thousands of families, there may be no home to return to after the storm.  

Barring some major shift in the path, I'll be among the millions who will be forced to evacuate on Tuesday, taking only what I can fit in my car.  Thankfully, I have a `Disaster Buddy', who will take me and the cat in.  

Not everyone is that lucky, and many may end up in emergency shelters for days. Those who live on the barrier islands may not be able to return for weeks.  

The last time a major hurricane made a direct hit on Tampa Bay (1921), its population was 1/10th what it is today, and practically no one lived on the beaches, or the barrier islands. The damage from Helene just last week is the worst we've taken since then.

We've had close calls, of course.  

Hurricane `Easy' in 1950. Hurricane Donna in 1960Agnes in 1972, and the no name `storm of the century' in March 1993.  In 2004 Cat 4 Hurricane Charley was headed directly for Tampa when it unexpectedly veered east into Ft. Myers. 

While I'm hoping for a reprieve, I'll be spending the next 2 days preparing to bug-out.  I've got my flu shot scheduled for tomorrow morning (they may be hard to get post-Milton), just like I got my COVID shot before Helene.  

I'm going to try to get an emergency 30-day supply of my Rx meds (allowed under the State of Emergency), and I'll be staging what I am able take with me (clothes, Rx meds, important papers, Emergency gear, etc.), so I can quickly pack the car on Tuesday. 

Evacuation could be a nightmare, since millions may be ordered to leave, there are limited roads and bridges out of the affected areas, and the weather is expected to deteriorate on Monday (heavy rains).  I expect it will take hours to drive the 40 miles to my bug-out location. 

I'll take my laptop, but I fully expect to be incommunicado for some time.  I'll try to get word to Sharon at FluTrackers (who is also in the path), after the storm. 

I'll be taking my solar panels, batteries, and accessories (see How Not To Swelter In Place).  The one (minor) consolation is that it isn't August, and excessive heat should be less of a problem.


These preps should give us a few basic creature comforts like lights, radios, fans, MP3 players, and charged cell phones. We've got a camp stove, plenty of canned food, and enough propane for several weeks of cooking. 

In the end, you can only do what you can do, and hope it turns out to be enough. 

So, if you live anywhere near the west coast of Florida, in a flood-prone region, or live (as I do) in a mobile home away from the coast, now is the time to start planning what you will do tomorrow, and Tuesday, as the storm approaches. 

The danger is that too many people will wait too long before deciding whether they will evacuate. Some may be lulled by a forecast track that seems to spare them - but forecasts can change - leaving little time to act.

While I'll be doing usual hurricane preparedness blogs - and I follow (and highly recommendMark Sudduth's Hurricane Track, and Mike's Weather page - your primary source of forecast information should always be the National Hurricane Center in Miami, Florida.

These are the real experts, and the only ones you should rely on to track and forecast the storm.

If you are on Twitter, you should also follow @FEMA, @NHC_Atlantic, @NHC_Pacific and @ReadyGov, and of course take direction from your local Emergency Management Office.

For more Hurricane resources from NOAA, you'll want to follow these links.

HURRICANE SAFETY

ADDITIONAL RESOURCES

 

Saturday, October 05, 2024

California: CDPH Investigating 3rd Suspected Case Of H5 Avian Flu

 


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California's Department of Public Health released an emailed statement shortly after noon (EDT) announcing a 3rd suspected human H5 infection linked to dairy cattle.  This case is a `presumptive positive' based on local testing, and will need to be confirmed by the CDC.

Third Possible Human Case of Bird Flu Detected in California
October​​ 5, 2024
NR24-030

Individual had contact with infected dairy cattle; risk to general public remains low

What You Need To Know: A third possible human case of bird flu has been identified in California and is awaiting confirmatory testing from the Centers for Disease Control and Prevention (CDC). The individual was in contact with infected dairy cattle in the Central Valley. The risk to the general public remains low, although people who interact with infected animals are at higher risk of getting bird flu.


Sacramento – The California Department of Public Health (CDPH) reports that a third possible human case of bird flu has been identified in California. The case was identified in a Central Valley individual who had contact with infected dairy cattle. Specimens are being sent to the CDC to undergo confirmatory testing.

There is no known link or contact between this and the first two cases reported yesterday, suggesting only animal-to-human spread of the virus in California. All three individuals had contact with animals at three different farms. Like the first two cases, this individual also experienced mild symptoms, including eye redness or discharge (conjunctivitis). None of the individuals have been hospitalized.

Additional Information on Bird Flu​

Risk Remains Low: The risk to the general public remains low, but people who interact with infected animals, like dairy or poultry farm workers, are at higher risk of getting bird flu. CDPH recommends that personal protective equipment, or PPE, such as respirators (N95 masks), eye protection (face shields or safety goggles), and gloves be worn by anyone working with animals or materials that are infected or potentially infected with the bird flu virus. Wearing PPE helps prevent infection. Please see CDPH’s Worker Protection from Bird Flu (PDF) for full PPE guidance.

Pasteurized milk and dairy products continue to be safe to consume, as pasteurization is fully effective at inactivating the bird flu virus. As an added precaution, and according to longstanding state and federal requirements, milk from sick cows is not permitted in the public milk supply.
          (Continue . . . )


While there have been calls for the wearing of PPEs by farm workers since April, anecdotal reports suggest their use has been less than optimal. 


With at least 56 dairy herds infected with HPAI H5 (see below) in California alone, and more detections likely, it isn't surprising that a 3rd human infection has been reported. Nor would it be surprising to see that number rise in the days ahead. 


While people may be reassured by the mild symptoms reported in American farm workers, each human infection - and each spillover into other mammals - is another opportunity for the virus to better adapt to non-avian hosts. 

And, as we've seen in hard-hit felines, rodents, foxes, and and marine mammals, there are no guarantees it will remain mild for humans. 

NHC Now Issuing Advisories On T.D. #14 - Hurricane Threat To Florida Mid-Week


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With the very strong caveat that the projected path shown above could change, the current forecast path of what is almost certain to become Hurricane Milton by tomorrow is one no Floridian want's to see. 


The 11 am discussion #1, puts this storm as a CAT 2 as it approaches the coast, but grants that it may be higher. 


With the strongest onshore winds to the right of where the eye makes landfall, much of the west coast of Florida could be in store for another major storm surge just two weeks after Helene.  A worst case scenario would be a landfall just north of Tampa bay, which could drive record surge tides into heavily populated Tampa, Pinellas County, Bradenton, and the barrier islands.

Areas that were already badly damaged during Helene. 

Warnings probably won't be issued until sometime on Sunday, and by then we should have the benefit of aircraft reconnaissance. But those in the path will then probably only have 48 - 60 hours to prepare, and much of that time will see heavy rainfall and risks of flooding. 

Some of the models suggest a Major hurricane (CAT 3+), but there is strong wind shear and dry air to the north, and that could inhibit the growth of the storm.  Or not.  In 2018, Category 5 Michael struck the panhandle despite initial intensity forecasts predicting a CAT 1 storm. 

For now, residents of Florida should be preparing for another damaging storm.  The Key Messages from the National Hurricane Center follow:

Like millions of others in its path, I'll be spending the next few days preparing, and depending upon its ultimate path, may be forced to evacuate.  

Stay tuned.