NewPublicHealth began its 2014 Ebola coverage several months ago as the number of cases—and deaths—in West Africa continued climbing and concern about diagnoses in the United States emerged. Our daily news roundups frequently link to critical announcements from the U.S. Department of Health and Human Services and the U.S. Centers for Disease Control and Prevention, as well as prevention and treatment research news, and provide perspectives we haven’t seen elsewhere such as this week’s interview on the legalities of quarantines.
We’ve also continued posting stories on other infectious diseases, some of which—although deadly—have taken a back seat to Ebola in the daily U.S. news cycle.
Our colleagues at Global Health NOW, the global health blog of the Bloomberg School of Public Health at Johns Hopkins University, recently wrote about the potential for Ebola news overload. In the newsletter, editor Brian Simpson shared a note from a reader who noted that “It’s vital to not let Ebola crowd out other equally and more impactful health issues.”
Simpson replied that the writer “raises an important issue. Ebola has not made heart disease, AIDS, traffic injuries, gun violence, maternal mortality, schistosomiasis—or any other threat to human health—go away. However, dipping into any media stream might make you think so.”
Simpson adds that GHN “have run a slew of news...on Ebola since March 20” and adds that the challenge is reporting on the most important news while still maintaining perspective.”
“It’s a difficult balance, and sometimes we’ll screw up,” he said. “But we’ll always strive to keep things in perspective and find the essential news for you.” We feel the same way at NewPublicHealth.
Flu season in the United States typically runs from November through March, with the peak coming in January and February. But people can catch the flu both earlier than the usual start time and after the usual end of the season. In addition, the severity of the flu season can vary with from 3,000 to 49,000 U.S. deaths in a given year, an average of more than 200,000 hospitalizations and millions of illnesses, according to the U.S. Centers for Disease Control and Prevention (CDC).
Flu shot season has a shorter time table, so many pharmacies and doctors’ office that are well stocked at the moment can run out before Christmas, making it difficult for people who put off their vaccinations to find a vaccine location and protect themselves.
And despite a yearly campaign to get people to roll their arms up, less fewer than half of adults and less than 60 percent of kids received a flu shot last year. NewPublicHealth recently spoke with Carolyn Bridges, MD, the CDC’s associate director for adult immunizations about what keeps people from getting the flu shot and how more people can be encouraged to get the vaccine.
NewPublicHealth: What is it that keeps people from getting the shot?
Carolyn Bridges: I think there are a number of things. Certainly, we have pretty good awareness about the recommendations for the influenza vaccine, although some people may just not realize that they are potentially at risk. The current recommendations call for all persons six months of age and older to get an annual flu vaccine, with rare exceptions. But the vaccine recommendations have changed over time and in the last few years have been broadened to include [just about] everyone. For some people the message hasn’t gotten to them that in fact they are now included in the group recommended for a yearly flu vaccine
NPH: What common misconceptions do people still have about the flu vaccine?
Bridges: In terms of the safety, some people question or are worried about getting the flu from the flu vaccine. That’s still a common comment that we receive. Sometimes people will certainly have body aches or some tenderness in the arm where they get their flu vaccine, but that’s certainly not the same as getting influenza, and those symptoms generally are very self-limited and go away within two to three days. But the flu vaccine cannot cause the flu.
EBOLA UPDATE: WHO Officials See ‘Glimmers of Hope’ in Liberia as New Case Rate Declines
(NewPublicHealth is monitoring the public health crisis in West Africa.)
There are “glimmers of hope” in Liberia as officials from the World Health Organization (WHO) say the rate of new Ebola cases appears to be declining for the first time since the outbreak began. Still, an official with the global health agency said they are still very much concerned and on guard. “It’s like saying your pet tiger is under control,” said Bruce Aylward, the WHO’s assistant director-general in charge of the operational response, according to The Washington Post. “This is a very, very dangerous disease” and “the danger now is that instead of a steady downward trend we end up with an oscillating trend where the virus goes up and down” because areas become reinfected. Read more on Ebola.
Study: Infant’s Birthweight Tied to Disease Risk Later in Life
An infant’s size at birth may help predict their health later in life, with babies who are heavier have less of a risk for future disease, according to a new study in The FASEB Journal. Researchers based their findings on an analysis of cord blood of newborn babies from mothers with raised glucose levels during late pregnancy and blood taken later. "These findings support the hypothesis that common long-term variation in the activity of genes established in the womb may underpin links between size at birth and risk for adult disease," said Claire R. Quilter, Ph.D., study author from the Mammalian Molecular Genetics Group, Department of Pathology at the University of Cambridge in the United Kingdom. "If confirmed these could be important markers of optimal fetal growth and may be the first step along a path to very early disease prevention in the womb." Read more on maternal and infant health.
FDA Approves New Meningitis Vaccines
The U.S. Food and Drug Administration (FDA) has approved the first vaccine approved to prevent invasive meningococcal disease in the United States. The drug is to prevent Neisseria meningitidis serogroup B is approved for individuals ages 10 to 25 years. Approximately 500 total cases of meningococcal disease were reported in the United States in 2012, with 160 having been causes by serogroup B. “Recent outbreaks of serogroup B Meningococcal disease on a few college campuses have heightened concerns for this potentially deadly disease,” said Karen Midthun, MD, director of the FDA’s Center for Biologics Evaluation and Research, in a release. “The FDA’s approval of Trumenba provides a safe and effective way to help prevent this disease in the United States.” Read more on vaccines.
DOT Launches New Website for Cruise Ship Passengers
The U.S. Department of Transportation has launched a website with information and resources from several federal agencies to help people considering cruise ship vacations make informed decisis. Information includes consumer assistance, vessel safety and cruise line incident reporting statistics. “We are committed to providing the traveling public with as much information as possible to make informed decisions about their travel and making sure they know their rights before, during, and after their trip,” said U.S. Transportation Secretary Anthony Foxx, in a release. Read more on transportation.
Ten Foundations Receive HUD/USDA Secretaries’ Award
The U.S. Department of Agriculture and the U.S. Department of Housing and Urban Development (HUD) recently honored ten foundations for helping to improve communities in across the country. According to the departments, the ten foundations have helped foster significant improvements in housing and neighborhoods, education, health and recreation, transportation, community participation, arts and culture, public safety, sustainability and economic development across all American geographies—urban, suburban and rural. “These foundations understand that strong communities connect families with the promise of living the American dream,” said HUD Secretary Julián Castro, in a release. “Powerful outcomes occur when the philanthropic and public sectors come together to solve problems, enhance neighborhoods and expand opportunity for others. Read more on housing.
Americans Still Eating Trans Fats
A new study in the Journal of the American Heart Association finds that Americans are eating less trans and saturated fats than they were three decades ago, but they’re still consuming them in higher quantities than recommended for good cardiovascular health. The study was based on surveys of approximately 12,000 adults ages 25 to 74. Read more on nutrition.
Ebola and U.S. Quarantines: Q&A with James Hodge and Kim Weidenaar of the Network for Public Health Law
On Monday, the U.S. Centers for Disease Control and Prevention (CDC) released new guidelines for people who have been exposed to the Ebola virus, either returning home from affected West African countries or looking after patients in the United States.
The guidelines establish four levels of risk -- "high" risk, "some" risk, "low" risk and "no" risk -- and recommend restrictions and health monitoring for each category.
Under the guidelines, people at high risk of Ebola exposure would be confined to their homes in voluntary isolation, while people carrying some risk would have their health and movements monitored by local officials. Those at high risk or with some risk would have daily in-person check-ups from state and local health departments for 21 days.
Immediately after yesterday’s CDC press conference, NewPublicHealth spoke with James Hodge and Kim Weidenaar, attorneys with the Network for Public Health Law, responded to questions from NewPublicHealth about laws and regulations that impact quarantines.
NewPublicHealth: Is there any legal support under United States law for possible quarantines for returning health workers and travelers from West Africa?
James Hodge and Kim Weidenaar: Yes, provided quarantine is limited in duration, consistent with due process, and based on known or suspected exposures.
Public health authorities must be prepared to demonstrate that 1) the subject of quarantine is actually or reasonably suspected of being exposed to an infectious condition, 2) that the infectious condition (like Ebola) poses a specific threat to the public’s health, 3) that the terms of quarantine are warranted, safe, and habitable, and 4) that procedural due process including fair notice, right to hearing, and right to counsel are provided.
EBOLA UPDATE: U.S. Begins Isolating Soldiers Returning from West Africa; Australia Institutes Visa Ban
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The U.S. military has begun isolating soldiers returning from Ebola-fighting efforts in West Africa, while Australia has become the first “rich nation” to impose a visa ban on the affected countries. Public health officials, including those in Washington, D.C., say such measures risk turning the doctors and nurses who help Ebola patients into “pariahs,” according to Reuters. "Returning health workers are exceptional people who are giving of themselves for humanity," said Stephane Dujarric, spokesperson for United Nations Secretary-General Ban Ki-moon. "They should not be subjected to restrictions that are not based on science. Those who develop infections should be supported, not stigmatized." Read more on Ebola.
Study: Brain Injuries After Age 65 May Increase the Risk for Dementia
Brain injuries after the age of 65 may increase a person’s risk of developing dementia, according to a new study in the journal JAMA Neurology. Researchers analyzed data on almost 52,000 emergency room patients who had suffered traumatic injuries in California from 2005 to 2011, finding that while just under 6 percent of those with injuries outside the brain went on to develop dementia, more than 8 percent of those with moderate to mild traumatic brain injuries did so. While at ages 55 and older, moderate to severe brain injury was associated with increased risk of dementia, by age 65 even mild brain injury increased the dementia risk. "This was surprising and suggests that the older brain may be especially vulnerable to traumatic brain injury, regardless of the traumatic brain injury severity," said study lead author Raquel Gardner, MD, a clinical research fellow with San Francisco Veterans Affairs Medical Center. "Or to spin it more positively, the younger brain may be more resilient to mild traumatic brain injury or may take longer to show symptoms of dementia.” Read more on aging.
Study: Greater Use of Spices, Herbs Could Promote Healthier Eating
Using spices and herbs to make healthy food more appealing can help reduce sodium, calorie and fat intake, according to a new study in the journal Nutrition Today. A special edition of the publication, titled Spices and Herbs: Improving Public Health Through Flavorful Eating, includes 16 papers exploring the latest research on spices, herbs and their links to healthy eating. "We now understand that spices and herbs have a meaningful role to play in bringing flavor to the forefront of today's health and wellness conversations," said Johanna Dwyer, DSc, RD, professor of medicine and community health at Tufts University School of Medicine, editor of Nutrition Today. "It will take all of us working together – from scientists to chefs and product developers to policy makers – before we can really begin to improve public health through flavorful eating." Read more on nutrition.
The Washington Post reported this weekend on a website similar to the U.S. Department of Health and Human Services’ official HealthCare.gov . The other site—HealthCare.com—lets people shop online for health insurance using a licensed broker or agent. However, according to the Post there is a potential for “massive confusion among consumers trying to find the government’s official site.”
Consumer health advocates worry that users who believe they’re actually signing up for coverage through the government site could miss out on subsidies. For example, the alternate site does not explain that catastrophic plans—low-cost plans that pay little for routine care—are not eligible for subsidies. A disclaimer that HealthCare.com is not the official Affordable Care Act website appears only in tiny print at the bottom of the home page.
Consumers are already plenty concerned about this year’s health insurance sign up period, which begins November 15. A recent Kaiser Family Foundation poll found that nine out of ten people asked did not know they had to reenroll each year in order to get health insurance coverage. And this year’s open enrolment period is shorter than last year, ending on February 15.
Read the full story from the Washington Post.
EBOLA UPDATE: New York State Walks Back New Ebola Quarantine Process—Somewhat—After Heavy Criticism
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The state of New York has partially walked back its new quarantine process for health care workers returning from treating Ebola in West Africa after receiving heavy criticism from the federal government and health officials. New York Gov. Andrew M. Cuomo said health care workers who have been in contact with Ebola patients but show no signs of the virus must still be quarantined and monitored for 21 days, but may do so in their home.
The Obama administration’s criticism of the initial order was strong." We have let the governors of New York, New Jersey, and others states know that we have concerns with the unintended consequences of policies not grounded in science may have on efforts to combat Ebola at its source in West Africa," an Obama administration official said in a statement, according to Reuters. "We have also let these states know that we are working on new guidelines for returning healthcare workers that will protect the American people against imported cases, while, at the same time, enabling us to continue to tackle this epidemic in West Africa.” Read more on Ebola.
Survey: ‘Social Resilience’ More Valuable than Government Assistance in Helping a Community Feel Prepared for Disasters
“Social resilience”—the feeling of trust in a community, with neighbors helping neighbors and looking out for each other—can be more valuable than even government assistance when it comes to how prepared communities feel for disasters, according to a new Associated Press-NORC Center for Public Affairs Research survey. In a survey of more than 1,000 residents in a dozen communities hit by the 2012 hurricane in New York and New Jersey, researchers found that “residents in areas where people say their neighbors actively seek to fix problems in the neighborhood are three times more likely to say their community is extremely or very prepared for a disaster than people in communities without such social resilience.”
Among the rest of the findings:
- 37 percent of residents in areas reporting high levels of neighbors helping each other are very or extremely confident their neighborhood would recover quickly from a disaster, compared to 22 percent in areas with lower levels of neighborly cooperation
- 69 percent of respondents said they got help from neighbors in recovering from the storm, while 57 percent said local government assisted them and 55 percent cited federal government agencies as helpful
“Having that level of trust, that preexisting level of trust means you sort of have this reservoir to draw from in times of need,” said the survey’s principal researcher Kathleen Cagney, a University of Chicago sociology professor and director of the Population Research Center at NORC at the University of Chicago. “Money doesn’t buy these informal reservoirs. You need to foster this.” Read more on preparedness.
Tips on Warding Off Seasonal Affective Disorder
The shorter, darker days of the fall season also mean the potential to trigger seasonal affective disorder (SAD), a type of depression that can leave some people feeling overly tired and lacking motivation to the point they find it extremely difficult to go about their day. As much as 5 percent of the population is affected by what is believed to be a chemical imbalance linked to reduced exposure to light. Angelos Halaris, MD, PhD, a professor in the department of psychiatry and behavioral neurosciences at Loyola University Chicago Stitch School of Medicine, said there are ways to reduce the likelihood of SAD, which can severely impact an individual’s quality of life:
- Spend at least 30 minutes a day outside. Avoid wearing sunglasses during this period of time. If weather permits, expose the skin on your arms to the sun.
- Keep your home well-lit. Open curtain and blinds to allow sunlight in. You can also consider buying a high-intensity light box specially designed for SAD therapy. Sit near the box for 30 to 45 minutes in the morning and at night. Be sure to talk to your doctor before attempting this type of light therapy on your own.
- Physical activity releases endorphins and other brain chemicals that help you feel better and gain more energy. Exercising for 30 minutes daily can help.
- When all else fails, there are medications that can help ease the troubling effects of SAD. Halaris recommends visiting a mental health professional if extra sun exposure, indoor lights and exercise are not effective in treating your symptoms.
Read more on prevention.
News today that a fourth case of Ebola has been diagnosed in the United States underscores the urgent need to have health workers not just ready, but also willing to treat patients with the illness. Next Wednesday, the National Coordinating Center on Public Health Systems and Services Research (PHSSR) will be hosting a webinar on legal protections to help facilitate health worker willingness. Daniel Barnett, MD, an Associate Professor in the Department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health, will be the main presenter. Barnett and three Bloomberg colleagues, Leonie Ratko, JD, PhD, MPH, Jon S. Enrick, JD, MPH Carol B. Thompson, MS, MBA received funding from the Robert Wood Johnson Foundation and PHSSR to study the issue. PHSSR's Center is funded by RWJF and based at the University of Kentucky.
NewPublicHealth recently spoke with Barnett.
NewPublicHealth: What are the concerns with respect to health workers being prepared to take some risks in order to protect the public?
Daniel Barnett: There’s been a longstanding tacit dysfunction about preparedness trainings: That if you train someone in knowledge and skills in terms of how to respond, that will necessarily translate into a willingness to do so. But our work has shown that “training to knowledge equals training to willingness” is a false assumption. In other words, I can teach someone how to recognize anthrax or some other infectious disease agent under a microscope, but that in no way ensures that that individual will be willing to come to work to look at anthrax or another infectious disease agent under a microscope, and by analogy, any other type of frontline public health or health care response.
That’s been, frankly, a missing piece in public health preparedness training nationally and internationally, and I think that we need to really rethink paradigms of preparedness training and education to take a more holistic approach. In other words, an approach that recognizes that frontline healthcare workers and public health workers have fears and concerns attached to a whole variety of aspects of the events at hand.
Just about every think tank, school of public health and infectious disease association has held a conference on Ebola in the last few weeks, but two coming up are still absolutely worth tracking.
Now that New York City has seen is first diagnosis of Ebola, an already scheduled conference next week at Columbia University’s Mailman School of Public Health has taken on added importance. Presenters include ABC News Chief Health and Medical editor and former acting U.S. Centers for Disease Control and Prevention director Richard Besser, MD, as well as Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University's Earth Institute. While the conversation surrounding the Ebola cases in Dallas focused on the need for health care workers to receive better guidance and training, hours into the first case in New York City the focus is on the challenge of containing the disease in a huge urban setting—a topic the presenters will discuss at length.
And on November 7, the White House Office of Science and Technology Policy will host a simulcast workshop together with Texas A&M, the Worcester Polytechnic Institute and the University of California, Berkeley to discuss proposals to dispatch robots to aid in the care of Ebola patients and people who have succumbed to the disease. The idea is to augment — and not replace — health workers. Robots could spray disinfectant, respond to commands given by health workers in a remote location and even help bury the dead.
The conference will include not just engineers, but also public health officials and health care personnel who can speak to the human needs that need to be considered when design the robots. For example, Texas A&M engineering students are working on a robotic attachment that would pick up a dead body in movements that mimic compassion, rather than in another way that may be efficient but does not show sensitivity for the dead and their families.
>>Bonus Link: Read an interview with the conference conveners.