Often we think only of large institutions and foundations as the driving force behind global health solutions. But there are entrepreneurs in this space too, including idealistic designers.

I love this video from Adobe TV, and I hope you find it inspiring too!

Love the history-of-epidemics graphic published today on nytimes.com along with the short piece, "American Epidemics, A Brief History."

What the graphic does so beautifully is emphasize how often immigrant groups are scapegoats for being the agent of epidemics: Russian Jews in the 1892 cholera outbreak in New York, Chinese in the 1900 bubonic plague outbreak in San Francisco and ... Mexicans in the 2009 swine flu pandemic.

I had no idea that we actually forced Mexicans to take kerosene baths in 1917 to combat an outbreak of typhus fever!

Do you have a favorite book on the history of epidemics? Please share your recommendations with us!

Two of my favorites are Plagues and Peoples (William McNeill) and Guns, Germs and Steel (Jared Diamond).

How should we handle swine flu?

That was the assignment that CNN's iReport gave to its audience.

Public health officials may or may not agree with the advice being doled out on video by the folks who responded. There's a woman in Harlem, N.Y., who posted a video showing off a swine-flu mask she bought on Amazon that she says will protect her against infection. Her video has generated more than 14,000 views -- which makes the business side of CNN.com happy.



According to several commenters, this mask won't protect her against the virus. Here's a sampling of comments:

This is the kind of irresponsible journalism that has contributed to the mass hyteria being created by this strain of the flu. The 'reporter' doesn't even realize that her mask is not equipped with cartridges to filter the air. Basically she has a mask that will stop NOTHING.

The virus is about 100 nanometer, likely small enough that it would easily pass right through that filter. But besides, it's not like the flu is really that big of deal anyways. And who was the moron who put this on the front page of CNN? They should be fired immediately.

Media is more of a problem than the Flu.  Im a health care provider and people will die because you create a panic that clogs our resources and slows down care to people who ACTUALLY NEED IT.  You should be ashamed of yourself CNN.  Dont stoop to FOX levels

What do you think of CNN's posting of the video? Is this the future of journalism - a world without professional reporters?

Please add your comments!

The New York Times has an interactive map of the swine flu cases (er, H1N1 cases), but I don't think it's been updated to reflect the 10 probable cases in the Seattle area. When you roll your cursor over a circle, a pop-up box indicates the number of confirmed cases and suspected cases. Some of the boxes elaborate on the severity of the cases and how the infected cases may have been exposed to the virus.

The Washington Post has an incredible interactive map (which is part of a special web page dedicated to news and information on the swine flu outbreak) that allows the user to filter for only deaths, confirmed cases or suspect cases. The mashup also has buttons that enable the user to zoom in on a particular geographic region of interest -- Central Mexico, Europe, Asia, U.S., DC Metro, West, Texas, Midwest and East -- and click on the markers to learn more about the cases in each area. And most importantly, the newsroom is keeping it updated.

The Post seems to have put significant effort into creating a searchable mashup of readers' reports about the swine flu. The deck says, "Keep track of the swine flu outbreak in your community and around the country, then tell us about your own experience here." So far there are 7 people who have posted their comments. That's right. Seven. Given the tremendous outpouring of personal experiences on Twitter, Facebook and other social media, this may be a case example of how the news media have to go to the consumer rather than the other way around.

I love the fact that The Post created a blog called Swine Flu Report. There's a real opportunity for news websites to pursue niche topics in this way, thus making their content more accessible to search engine bots and readers. The experience for some users going to news websites now is like that of an explorer entering a dense ravine who's frustrated he can't see the footpath he's looking for. By curating the information for the user, The Post is giving users a reason to come to their website rather than trying to sort through the gazillion Google Search Results for "swine flu."

Of course the proof is in the pudding, and I don't know how much traffic The Post's blog on swine flu is getting. Only a few people have posted comments, but that may not be the right metric here. The posted items are case updates, not the provocative jabs one tends to see on a political blog. But I did notice a banner ad for a life insurance company asking the reader if his dependents are covered in the event of his death!

CDC should offer a prize!  Suggestions?


We've had a chance to see humanity's reaction to the pandemic play out in real-time on various social media platforms.

The Twitter Pandemic

While it's not the first time the CDC has disseminated health information through social media, this may be the first time many people have actually begun paying attention, thanks to its impressive page of social media tools related to swine flu, including widgets (try the Flu IQ quiz), buttons, and even its own YouTube channel.

The CDCemergency Twitter feed has more than 65,000 followers, up 86% since Tuesday, says Melissa Davies of Nielsen Online. Davies has posted an eye-popping line graph that shows just how much more traction the swine flu outbreak has gotten in the blogosphere compared to the salmonella-in-peanut-butter scare that made headlines earlier this year. (Davies says between 500 and 700 individuals were getting tweets from the government on the peanut butter scare.)

Some say the outbreak has shown how unreliable Twitter can be in communicating credible health information. See a recent CNN.com story on this controversy. Let the piling on begin. Here's an excerpt from a TG Daily column by Carmi Levy, a Canadian journalist:

So as an endless barrage of tweets – from individuals, citizen journalists and major news outlets alike – raises our collective panic level around this emerging global story, we find ourselves knowing more about things sooner than ever before. But at the same time, we’re more vulnerable to misinformation. Individuals with no primary newsgathering capability of their own send out hastily worded, ill=informed messages in the hope that hyperbolic language will attract more attention. Conventional media journalists are just as guilty for using their Twitter pulpits to hawk upcoming shows and goose ratings. Like the teaser spots they play before going to commercial, they’re usually just exciting enough to get us to hang in – even if they’re misinformed and irresponsible.

I understand the concern. But hey, everyone knows Twitter is not Moses. It's an echo chamber of bits of fact and fiction. It's DIY journalism in the moment. Twitter is a tool, not a publisher with editorial standards and ethics codes. The humans who use the tool and tweet the information deemed bogus or misleading are the ones to blame. And there's likely to be humans who tweet right back with the correct information and links to more credible sources.

Dave Fleet has an interesting post about crowdsourcing and whether during such crises we see the wisdom - or idiocy - of crowds. I think he raises a valid point for companies and individuals who are thinking about using social media to participate.

Here's my bottom line: If people think Twitter is a malevolent force of misinformation during a crisis, perhaps we should also disconnect all landlines, cell phones and pagers. Anyone ever hear of a bomb threat? Does anyone remember the 911 call hysteria in 2001 when anthrax copycats were dropping white powder in envelopes and public hallways? On some level, we have to cultivate a healthy dose of skepticism when we consume information (especially online) and triangulate our sources to reach conclusions.

Mapping the pandemic

Everyone loves a map!  There are quite a few maps that have been created since the swine flu outbreak became public. Some are open, others are not. Facebook used its Lexicon tool to analyze words and phrases that show up on users' Wall posts to generate a map showing the percentage of people discussing "swine flu" on Facebook across the nation. One surprise: A higher proportion of people based in Washington state and British Columbia are talking about swine flu than people in some states with larger exposure to Mexico, such as Florida and New Mexico. Check out all the maps here.

I checked HealthMap a few days ago. I spotted an alert marker in Washington state before there were any cases. When I clicked on the alert, it seems what gave rise to it was a report from a local news organization about cases elsewhere. You've got to credit HealthMap, though, for their pioneering work in nearly real-time mapping of outbreaks: They launched three years ago and received a major grant from Google.org in 2007. No doubt the swine flu outbreak will test the quality of HealthMap's algorithms and provide the HealthMap team with valuable insights.

Then there's the Google Maps: One is being managed by two people and has about 355,000 views. Another is put together by "L," a self-described computer scientist in the UK with the help of 25 collaborators and has drawn more than 1 million views! The map purports to show confirmed and suspected cases of swine flu (H1N1), with source attributions and links to sources, dates, and current known status. (Click and drag in the map as well as zoom in and out for better views by clicking the Plus (+) and Minus (-) signs at the top-left of the map.)


View H1N1 Flu Map in a larger view

View H1N1 Flu Map in a larger view



These unofficial maps have come in for criticism, just like Twitter, according to one news story:

"One danger is that you create panic, public panic, and that creates pressure on the government to respond not to the real health problem but to respond to the panic," said Jonathan H. Marks, an associate professor of bioethics, humanities and law at Penn State University.

Rachel Powell, a spokeswoman for the CDC, said the effort amateurs were putting into tracking flu "definitely shows that people are concerned and they want to take matters into their own hands." But, she said, the CDC had no plans to begin releasing an official record of the location of each confirmed case.

Personally, I think this pandemic is an opportunity for the general public to learn quickly what social media is and what it isn't. Even if there are occasional posts in the blogosphere or Twitter or Google Maps that are misleading or inaccurate, they represent small annoyances in the great sloshing ocean of the Web, in which the official sources like CDC are the grey whale.

I've been using Google News and Twitter to stay current on the latest updates on probable and confirmed cases in Washington state. (Unfortunately I also get many stories about the politicking in the other Washington.)

If you've found some neat uses of social media to report the pandemic, please leave me a comment!

The World Health Organization put out this news release today about the swine flu (renamed influenza A(H1N1)):

As of 23:30 GMT, 1 May 2009, 13 countries have officially reported 367 cases of influenza A(H1N1) infection.

The United States Government has reported 141 laboratory confirmed human cases, including one death. Mexico has reported 156 confirmed human cases of infection, including nine deaths.

The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (34), China, Hong Kong, Special Administrative Region (1), Denmark (1), Germany (4), Israel (2), Netherlands (1), New Zealand (4), Spain (13), Switzerland (1) and the United Kingdom (8).

It's clear that a global pandemic is underway. Consider the following statement on April 29 from the Director-General of the WHO, Dr. Margaret Chan:

For the first time in history, we can track the evolution of a pandemic in real-time. ... WHO will be tracking the pandemic at the epidemiological, clinical, and virological levels. ... The biggest question, right now, is this: how severe will the pandemic be, especially now at the start?

We're all waiting for the answer to that question -- with our masks at the ready. And never before have we had so many ways to scare ourselves silly with immediate updates on the outbreak that may be true. That'll be the subject of my next post.

For the epi-geeks in the audience, there's a pretty good discussion on the Effect Measure blog, particularly on the issue of whether closing airports and borders would be dumb or effective at this point. There's also some discussion of whether airplane ventilation systems deserve more regulation to prevent disease transmission.

The most intriguing comment on this blog comes from a Dr. Grattan Woodson, an Atlanta physician who's written a book on how people can prepare for a catastrophic outbreak of avian influenza. Here's his three scenarios:

My current view is that there are three reasonable probabilities of how this outbreak may play out.

#1: The outbreak spreads widely around to globe but self-terminates due to the onset of summer weather in the Northern Hemisphere (although the Southern Hemisphere is now entering fall!). The virus would then re-emerge in the NH fall as occurred in Sep 1918.

#2: The virus defies the usual seasonality seen with ordinary flu and goes pandemic worldwide right away. Non-seasonality was a feature of the Spanish Flu pandemic.

#3: The virus outbreak peaks shortly without spreading very far and simply goes away never causing a pandemic.

Of the three, I think #1 is most likely with #2 beginning possible and #3 being most unlikely.

If the pattern suggested in #1 does occur, what can we expect?

The CDC has the new H1N1 sequence and is currently trying to decide how to develop it into a vaccine. Obviously, if we go the egg route, we will not get any doses before October. This will be too little vaccine available too late to contain the pandemic re-emergence. What would be really a heroic move by the US DHHS would be to go ahead an allow production of vaccine by several of the new methods using cell culture and other innovative techniques currently under development. These early stage methods have the potential to produce vaccine in less than half the time compared with using fertilized chicken eggs and can be scaled up to produce exponentially larger quantities of vaccine. Given the current state of pandemic risk, I sincerely hope they support this approach.

If #2 occurs, then most will be caught flat footed since it will become very difficult to prepare as the panicked public rapidly deplete stocks of commodities useful for pandemic survival as well as regularly needed food and medicine. Most people take for granted that there will always be an abundance of food on the grocery store shelves. Our old nemesis, Just In Time Inventory Management will result in empty store shelves causing more panic even though food is still being produced and in a full pipeline to retailers every day. Panic buying though could keep store shelves relatively empty due to public hoarding. The risk for civil disorder would rise dramatically as a result of the public's concern about both the pandemic as well as their perception of widespread food shortages whether true or false.

Obviously we can all pray for scenario #3 despite its relative improbability. One good result of this is it could serve as a wake up call for our leaders and public but OTOH it might also be seen as another pandemic false alarm that increases complacency even more than has been present over the past two years.

Forbes has a piece on how poorly prepared the US is for pandemics, citing recent investigations by the GAO.

LA Times has a story on what the last great swine flu epidemic was like (in 1976).

Grist.org has a story that raises the question whether the outbreak could be traced to a US agribusiness' pig farm in Mexico.

This swine flu outbreak, if it becomes a pandemic, has the potential to cause panic. Public health officials are racing to contain it and understand the epidemiology of this influenza strain, which is not the same as the avian flu strain that has killed people in Asia.

As of today, there are eight cases of swine flu confirmed in the United States, according to the U.S. Centers for Disease Control and Prevention in Atlanta: seven in Southern California, two near San Antonio, Texas, and two in Kansas. Another eight New York students have tested positive for a strain of influenza believed to match the swine flu that has killed 68 people in Mexico City.

Symptoms of swine flu include fever, lethargy, lack of appetite, coughing, runny nose, sore throat, nausea, vomiting and diarrhea, according to public health leaders.

Richard Besser, acting director of the CDC, is acknowledging up front that this swine flu strain is an unknown quantity:

"At the early stages of an outbreak, there’s much uncertainty, and probably more than everyone would like.  Our guidelines and advice our likely to be interim and fluid, subject to change as we learn more."

That is a much healthier way to begin to inform the public about this, a very different approach from the way federal officials (notably Tommy Thompson) handled the public statement on a confirmed inhalational anthrax case in Palm Beach County, Fla., in 2001.

He also says we do not know if this flu outbreak will "lead to the next pandemic":

Based on the currently available information, CDC is not recommending any additional precautions for travelers to California, Texas or Mexico.  Our standard recommendations, however, do remain in place.  Cover your cough or your sneeze, wash your hands frequently and see your doctor if you have fever, cough, sore throat, body aches, headache, chills and fatigue, and we do want people to realize that some people have reported diarrhea and vomiting associated with the swine flu.

But there is certainly a lot of hand-wringing about whether this could be the one. Influenza experts at CDC and the World Health Organization believe the world is closer to another influenza pandemic than at any time since 1968, when the last pandemic occurred. The WHO is currently at a level 3 alert, meaning "no or very limited human-to-human transmission." If more evidence develops of human to human transmission, the WHO would have to consider upgrading the pandemic alert to level 4 and ultimately taking steps to interrupt the virus' spread through quarantine and border-closing measures.

Here are some important links:
     -- PandemicFlu.gov
     -- CDC page on Swine Influenza
     -- WHO page on Swine Influenza

Keep reminding people that the most important thing they can do to stop the spread of this virus is common sense precautions. Here they are cut and pasted from CDC's website:

There are everyday actions people can take to stay healthy.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread that way.

Try to avoid close contact with sick people.

• Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
• If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

If you want to see a video CNN put together on the 1918 pandemic, click here.

More to come.

Human cases of swine flu in California, Texas and Mexico. Disease detectives are trying to determine the source of the outbreak, and the US Centers for Disease Control and Prevention is working closely with public health agencies in the affected states.

Here's the AP story on the outbreak:
Mexico swine flu deaths spur global epidemic fears

And the New York Times story on the outbreak:
Fighting Deadly Flu, Mexico Shuts Schools

More to come...

Several prominent global health organizations have announced their goal to establish Nov. 9 as the annual "World Pneumonia Day."

For those who remember the global Millennium Development Goals (of course you do!), a key target in 2015 is reducing deaths of children under age 5 by two-thirds from the 1990 level. And the biggest killer, global health officials say, is pneumonia. It's also preventable with the right vaccines. 

Save the Children, the GAVI Alliance, Hedge Funds vs. Malaria & Pneumonia and Johns Hopkins Bloomberg School of Public Health made their announcement today, noting that pneumonia rarely gets any news media coverage and hoping that dedicating one day of the year to the problem would change that.

Remember Earth Day, anyone? Environmentalists still haven't reached consensus on whether Earth Day fulfilled its promise or became a politician's token opportunity to show he cares about the planet's health. Even those who believe Earth Day has been a wild success will acknowledge that it's relatively easy to mobilize neighbors to plant a tree, hold a recycling challenge or commit to biking to work on one day.

But how does a movement organize and inspire people to take action to fight a threat they can't see or help villages they don't experience in their own daily life? What do you think?

I know that there are other days dedicated to other causes that haven't changed my habits or ways of thinking. But back to World Pneumonia Day! Here's what they say in a press release:

“Pneumonia is the world’s number one killer of children. But with new vaccines, early diagnosis and proper treatment with antibiotics that cost less than a dollar, a child’s health can improve and lives can be saved,” said Charles MacCormack, president and CEO of Save the Children.

Pneumonia kills more children than AIDS, malaria and measles combined. UNICEF and WHO estimate that pneumonia accounts for nearly 1 out of 5 deaths in children under five years old. For each child who dies from pneumonia in an industrialized country, more than 2000 children die from pneumonia in developing countries.

“In wealthier countries, we don’t often see life-threatening child pneumonia. It’s easy to forget that around the world, pneumonia is still killing more than 5500 kids every day,” said Dr. Orin Levine, a pneumonia expert and associate professor at Johns Hopkins Bloomberg School of Public Health. “Pneumonia is both common and extremely serious, but with existing tools like vaccines and antibiotics, we can save more than a million children every year.”

In addition to killing more than two million children a year, pneumonia causes severe financial difficulties and emotional burden for families and communities and contributes to the cycle of poverty. Few caregivers can recognize pneumonia symptoms. Consequently, less than one third of children suffering from pneumonia receive antibiotics, which are available for less than US$1.

The coalition has created a website and the PneumoADIP initiative at the Bloomberg School offers with a video in multiple languages. It's a good start toward helping "put a face" on the problem.

To learn more about some of the research and efforts underway to save children from this killer, check out a bulletin published last year by the World Health Organization. The coalition also has put together a list of links.

If you have ideas for stories you think should be written about pneumonia, please let me know. Thanks.