Thursday, April 30, 2009

A Letter From Mexico

I wanted to share this e-mail from a Doctor in Mexico. He is a member of an emergency management mail list and has been letting us know how things are going down there. Some lessons for all of us up here in the states.


Hello everybody, there have been long days these days. To make it different I will begin to just throw my ideas, I don't know if it is helpful for you... but might give you and idea on how I am living it here. I need some kind of catharsis. At the end I will sumarize if you want to skip the rest.Today just before comming back to home my wife told me my two year old son was warm. I came home he was on this bed, he was sweating but he was ok, his temperature was 37.o C... I hope you can make the translation to Farenheit... (Editor: 98.6F) but had no fever. He is OK and I am pretty sure he will be. I think fear is more contagious than flu.My wife is kind of mad: when I am home I am tired, making phone calls trying to get a hospital for a non Flu/cold patient who has an infarction and is not able to get attention in the public hospitals because they are packed with flu-like symptoms, most of them colds, or just the idea of being sick.

Once I have the opportunity to be with her, I am so tired that the only thing I can do is sleeping, to get a phone call from one of my patients just an hour later... "No, madam, no, if she has no fever, no sore throat, no aches, etc it is quite possible is not -The Flu- ... you want me to check her, of course is your daughter, I put on my jeans go, check the girl with a common cold and then come back home". Nevertheless I have the feeling the number of calls was lower today.On the other hand I am called by the physicians at the local General Hospital: "Juan, there are many patients comming, one out of 10 or 20 is suspicious, but the epidemiologist doesn't take a swab on those that are only symptomatic and doesn't have hospitalization criteria.

They are only testing... and treating, patients that have respiratory failure or some reason to put them into the hospital. What do we do". ... Nevertheless they tell me they have the feeling the numbers are lower. Fewer patients are coming, and less of them that can be classified as suspicious. And I think that is only happening in the local general hospital, not in the other two hospitals here where they have treatments. On monday, some of my med students called me from Mexico City, there are 6 of our students doing their internship there. "Doctor Fraga, the students from other universities have already left... they are asking us to stay and to do our job and their job... we want to stay and help, but there is a lot to do here" later during the day the University asked the hospital to let our students leave if they wanted too without any academic punishment. There is no written word on what is the duty of an intern, but generally speaking interns from public universities are still there, interns from private universities are not working during these days... ¿?

At the local red cross we have a small hospital, more like a clinic... we don't have spaces to have patients isolated, so we agreed with the local Health Ministry to send the suspicious cases to the general hospital, I call the following day to the state's epidemiology director to see if the patients were confirmed. We have refered around 10 patients... none of the patients have had a sample taken.... were they misdiagnosed at hour hospital or finally the test was not done to them because of another reason?? I don't really know. The thing is that I personally checked today one of our physicians... he had 38.5o C, Strong headache, Astenia, coughing, myalgias, artralgias... I gave him the treatment, but the only place he was able to test was the health secretariat. Finally he had the swab taken at 19:30 we will now if he had influenza A in a couple of days.

Apparently tomorrow we might be able to get quick tests from the health secretariat and be able to treat the open population that doesn't need to be hospitalized.... in compensations to what is happening at the local general hospital.I am watching the news, the national Health Minister is smiling and saying that things are not as big (apparently) they have got confirmation from the first cases and they can say that there have only been (until now) 99 confirmed cases of swine flu (not only type A influenza but N1H1) and from these confirmation 91 are OK and 8 died... obviously there are many confirmations pending... There are anouncing a presidential message on the TV: He is repeating most of the information that you have seen in the news, including the recommendations that have been around the media since the weekend: avoid public places, use face mask on the public transport, use hanckerchiefs, etc. We have some free days coming and he is recommending the population not to go on holidays, to stay at home (good I think).

He is saying that all hospitals and clinics are open to treat the people... mmm he might want to come to Queretaro, I think. He is saying that people should receive treatment since the first hours... I hope that our state's epidemiologists see the TV today.... More activites will stop tomorrow... mainly non critical federal government activites until may 5 but most of these days correspond to non laboral days (May 1, and 5 plus weekend). Well at the end he only said that they will continue with the efforts until next week.Sumarizing and adding some interesting points:-

There are clear indications on how to behave for the population, the health care facilities, etc... they can even be downloaded from the Health Ministry webpage: soon they will place statistics there.- Data reporting is not consistent, some states report suspicious cases (based on symptoms), some states wait to have results on influenza type A results (48-72 hours), others (like mine) will wait to have H1N1 results (1 week). Remember this year is also an electoral year... (I feel awful admitting it can change the way they communicat things). I think a healthy behaviour would be to sumarize cases using the information on three columns: suspicious --> influenza A --> H1N1 it would also help estimating how good is each diagnostic strategy (clinical, inmunofluorescense, etc) for future experiences. People would understand a little bit more.- Monday and tuesday were tough days at the hospitals, today they are still busy but either more organized or with less patients, my colleagues don't complain as much as the other days. - Many cold cases, few flu-like cases... I have get tired of insisting it might be a good idea to open mobile clinics or check patients at their homes... day-to-day activities at the hospitals were many before this, now they have to work on both things... and extra effort needs to be placed to avoid overwhelming hospitals.-

Until now I have personally checked two health care providers, one was a bacterial infection (not flu) the other one is suspicious... I will have results in a couple of days... if he comes positive, that will mean that one of the patients he saw, sent to the general hospital and were not studied further, was also positive.... I really hope he comes negative.- Private hospitals (until today) were not included as part of the response here. Until today they would only detect suspicious cases, isolate them and call the health care authority to have the treatment and study brought to the patient. Apparently tomorrow they are beginning to do some diagnosis and might be able to get antivirals which are controlled by the government right now.-

On Monday you could get N95 masks at 9 pesos/piece (0.80 american dollars), today they are at 20 pesos (1.5 american dollars). Wouldn't it be a better business for 3M and similar companies on the long term to donate this masks? I mean, right now I think they are selling less of the rest of their products (paints, etc).- The people at the community level is behaving fine, they are responsible and do what the TV says: stay at home, increase your hygiene if you think you can have the flu go to the hospital.I am pretty sure that many of the suspicious cases will end up not being confirmed, nevertheless some kind of aproach should be established, I am with the early blind treatment people (remember treatment in the first 48 hours is better than later on) and then wait for the result. Some institutions are waiting for Influenza A confirmation between starting treatment. I think there is not an homogenous approach here. Speaking from many perspectives: communication, treatment, etc. I know some exercises were made at the federal level, but few at the local level. They are not considering much the EMS services as part of the response, I have to be quite proactive to communicate with the state's epidemiology director and honestly I don't have the feeling I got many answers there.Because of my words, you might have the feeling that things are worsening here, but honestly speaking I see people more calm, less visits to the hospitals, and the official numbers are not growing as fast, as well as the unofficial (colleague to colleague) impressions.

Today I am just kind of tired and a little bit frustrated knowing that some suspicious cases are not being treated nor studied further than the clinical testing at the local hospital. I really think most of this people doesn't have swine flu, but some of them might and if there is not an opportunity to run a test in every patient, then at least it might be good to offer them "empirical" treatment if it increases the patients' prognosis.Remember that I am only speaking about one small city, not the big picture...

I think that in Mexico City things are better with the response, but the hospitals are still busy.I am sorry I was not very objective today, I hope tomorrow I can send again some raw data...........My wife is sleeping now... she will be mad again.... I think I will have to by her flowers tomorrow :)I hope she allows me to open my computer again tomorrow at night to write you what's happening here... See you soon :)

Wednesday, April 29, 2009

The Six Principles of CERC - Crisis Emergency Risk Communication

Just got this from the CDC and wantd to share it...

The Six Principles of CERC - Crisis Emergency Risk Communication

Be First: If the information is yours to provide by organizational authority—do so as soon as possible. If you can’t—then explain how you are working to get it.

Be Right: Give facts in increments. Tell people what you know when you know it, tell them what you don’t know, and tell them if you will know relevant information later.

Be Credible: Tell the truth. Do not withhold to avoid embarrassment or the possible “panic” that seldom happens. Uncertainty is worse than not knowing—rumors are more damaging than hard truths.

Express Empathy: Acknowledge in words what people are feeling—it builds trust. “We understand this is worrisome”

Promote Action: Give people things to do. It calms anxiety and helps restore order.

Show Respect: Treat people the way you want to be treated—the way you want your loved ones treated—always—even when hard decisions must be communicated.

For more information or to request CERC materials, please contact CDC’s Barbara Reynolds, Ph.D. at

Tuesday, April 28, 2009

Swine Flu: Not a disaster yet but keep an eye on it

OK, time to write about Swine Flu. I am trying to just report the facts and stay away from the hype but I want to share what I know and suggest what can help... please understand, there is no need to get stressed out about this but at least pay attention to the common sense stuff at the end of this message (like avoiding contact with sick people).

What most people want to know now is if this is all being hyped. I must say that, while it is not a "disaster" at this point, there is clearly the potential for this to turn into a pandemic. Many people question this as the rate of illness and death is far behind the normal flu in terms of morbidity and mortality. But, pandemics are different than the normal seasonal influenza epidemics that happen annually. While these cause an average of 36,000 deaths in the US, pandemic influenza refers to a worldwide epidemic due to a new strain of influenza virus to which there is no immunity. If this turns into a pandemic, the new virus will be spreading rapidly from person to person around the globe and may cause high levels of disease and death around the world. The numbers go into the hundreds of millions...

Today, we still have a situation which is evolving rapidly. There are 64 confirmed cases in the US, with no deaths. Mexico has reported only 26 confirmed human cases of infection including seven deaths. Many other countries now have suspected cases but are reporting mild symptoms. This is all good news. Hopefully this does not amount to much. However, you might want to take a hint from my field: we hope for the best but prepare for the worst.

Current Situation

Currently, there is no restriction recommended for regular activities or travel. It is considered prudent for people who are ill to delay international travel and for people developing symptoms to seek medical attention.

What can you do?

The single best way to prevent the flu is to use good "health habits" like covering your mouth when you cough and washing your hands often can help stop the spread of germs. There also are flu antiviral drugs that can be used to treat and prevent the flu.

Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too. Stay at least six feet away from anyone who is feeling ill.

Stay home when you are sick. If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness.

Cover your mouth and nose with a tissue when coughing or sneezing. If you don’t have tissue, use your sleeve, not your hands. Washing your hands often will also help protect you from germs.

Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.

Practice other good health habits. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

Stay healthy,


Monday, April 20, 2009

2009 Urban Area Security Initiative Conference

One of my "hobbies" is to support an annual confernce for the Urban Area Security Initiative.

This conference was originally conceived from information sharing partnerships between the UASI program managers of the Charlotte and Miami UASIs, who recognized a distinct need for an information sharing platform. The first of these conferences was held in Dallas, TX in 2005; supported by the International Association of Fire Chiefs, Metro Chiefs Committee. This conference was largely attended by fire professionals and UASI administrative professionals, who recognized the need for greater information sharing.From this conference it was identified that a larger conference was needed to provide similar information, across first responder disciplines, from all UASI cities. The 2007 National Conference was conceived of as a platform for exchange of ideas on the management of UASI programs. Participants and contributions were expanded to include all disciplines, industry, government and academia. This continued with the 2008 National Conference with the largest attendance in conference history.

The 2009 conference will build on the previous programs to continue as a premier event for UASI program participants. If you have a role in a UASI program you are encouraged to attend.

Sunday, April 19, 2009

Twittering about Social Media

Recyling an old blog to get started. Looking to tryout this software as opposed to my blog at

Oct 15
Getting Connected - Web 2.0
Posted by Steve in Technology, homeland security

"During an emergency is not the time to be exchanging business cards."
How many times have your heard this refrain? Do you have stacks of business cards as I do? How on earth can one find the time to connect with the people you meet?
To me, technology is making the business card obsolete. The technology is out there to scan the cards into my contact list (and italready has thousands of people in it) but how do I manage to find the right person when I am looking for a contact in a particular agency or specialty area. Someone whom we have not yet swapped business cards with?
Isn't there a better way to connect? Can we find a way to connect like our kids (and some of us old timers) are doing on facebook?

There is a better way and our kids are taking full advantage of it. Now it is our time to take advantage of what is being called "Web 2.0".

Web 2.0 is a generally used to designate a web site or software that enhances interpersonal, collaboration, information sharing, and a sense of community on the world wide web. Web 2.0 is not really new as these capabilities have been around for quite a while. It is more about the evolution of web-based communities or social-networking groups that use web sites to share video, forums, wikis, and blogs.

As a matter of fact, if you are reading this on, as I assume you are, you are already in the world of Web 2.0. This site has all of the capabilities envisioned in a web-based community of interest (COI). The challenge for us is to find the time and the way to use the site to its fullest advantage. Many of you are using the site to research issues related to your education or profession. Others are looking for helpful tools such as plan templates or presentations.

Back to business cards, the All-Hands site has a members directory (select "Members List" under the "User Menu". The directory can be used to make contact with other registered site members but it not the ideal way to meet community members. The community forum, on the other hand, is a great way to get into discussions with others interested in a particular topic.

It is relatively easy to create sites like these, the trick is to get people to come together as a COI. Community sites can be done at an office or regional level and can be restricted based on membership approval processes.

Another web site that I like to use for networking is Linkedin. This site is a professional's version of facebook and provides an easy way to find and maintain connections. My page is located at and includes a link to the All Hands Community Group within Linkedin. Check it out.

I would like to see more of you connecting through this virtual community. These are great tools and we should all be taking advantage of them.

So, get connected, post to the forum, update your profile, do a blog, whatever you want. Get out there and be part of your professional community.

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