welcome to usaapay.com

2020-

2020-05-07 b
Viral News - In the beginning …

This tyranny with a medical pretext has many parents and its gestation began in the U.S. during the time of Bush the Lesser. Though the “Anthrax Scare” had been an inside job, the younger Bush feared (after Cheney and Rumsfeld no doubt whispered into his ear) that “furriners” and “terrists” could infect the homeland when they weren’t lugging suitcases with “nukular” devices or wearing explosive sneakers or under shorts. Un-elected and unaccountable bureaucrats began to study the “threat” and thus developed the architecture of our enslavement and impoverishment. Some expressed minor reservations about the legality of their plans, yet were undeterred, They also developed the Orwellian vocabulary the talking heads of the mainstream media repeat at all hours to terrify those with weak minds and no critical thinking skills.

Below please find a chronological reading list. Some entries do feature excerpts.
______________________

2006
______________________

The Politics of Public Health Policy
https://www.ncbi.nlm.nih.gov/pubmed/16533115
Annual Reviews of Public Health. 2006; 27:195–233

Abstract
Politics, for better or worse, plays a critical role in health affairs. The purpose of this article is to articulate a role for political analysis of public health issues, ranging from injury and disease prevention to health care reform. It begins by examining how health problems make it onto the policy agenda. Perceptions regarding the severity of the problem, responsibility for the problem, and affected populations all influence governmental responses. Next, it considers how bounded rationality, fragmented political institutions, resistance from concentrated interests, and fiscal constraints usually lead political leaders to adopt incremental policy changes rather than comprehensive reforms even when faced with serious public health problems. It then identifies conditions under which larger-scale transformation of health policy can occur, focusing on critical junctures in policy development and the role of policy entrepreneurs in seizing opportunities for innovation. Finally, it reviews the challenges confronting officials and agencies who are responsible for implementing and administering health policies. Public health professionals who understand the political dimensions of health policy can conduct more realistic research and evaluation, better anticipate opportunities as well as constraints on governmental action, and design more effective policies and programs.
______________________

Disease Mitigation Measures in the Control of Pandemic Influenza
https://www.documentcloud.org/documents/6841076-2006-11-Disease-Mitigation-Measures-in-the.html
Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science
Volume 4, Number 4, 2006
______________________

Targeted Social Distancing Designs for Pandemic Influenza
https://wwwnc.cdc.gov/eid/article/12/11/06-0255_article
Volume 12, Number 11—November 2006

Abstract
Targeted social distancing to mitigate pandemic influenza can be designed through simulation of influenza's spread within local community social contact networks. We demonstrate this design for a stylized community representative of a small town in the United States. The critical importance of children and teenagers in transmission of influenza is first identified and targeted. For influenza as infectious as 1957–58 Asian flu (≈50% infected), closing schools and keeping children and teenagers at home reduced the attack rate by >90%. For more infectious strains, or transmission that is less focused on the young, adults and the work environment must also be targeted. Tailored to specific communities across the world, such design would yield local defenses against a highly virulent strain in the absence of vaccine and antiviral drugs.
...
Discussion

Results for our stylized small town suggest that targeted social distancing strategies can be designed to effectively mitigate the local progression of pandemic influenza without the use of vaccine or antiviral drugs. For an infectivity similar to that of the 1957–58 Asian influenza pandemic, targeting children and teenagers, by not only closing schools but also by keeping these age classes at home, was effective. However, given uncertainty in the infectivity of the influenza strain, underlying social contact network, or relative infectivity/susceptibility of the young versus adults, planning to implement strategies that also target adults and the work environment is prudent. To mitigate a strain with infectivity similar to that of the 1918–19 Spanish influenza pandemic, simulations suggest that all young and adults must be targeted regardless of the likely enhanced transmission by the young.

Implementation of social distancing strategies is challenging. They likely must be imposed for the duration of the local epidemic and possibly until a strain-specific vaccine is developed and distributed. If compliance with the strategy is high over this period, an epidemic within a community can be averted. However, if neighboring communities do not also use these interventions, infected neighbors will continue to introduce influenza and prolong the local epidemic, albeit at a depressed level more easily accommodated by healthcare systems.
...
This research was supported by the National Infrastructure Simulation and Analysis Center, a program of the Department of Homeland Security's Infrastructure Protection/Risk Management Division composed of a core partnership of Sandia National Laboratories and Los Alamos National Laboratory. Sandia is operated by Sandia Corporation, a Lockheed Martin Company of the US Department of Energy's National Nuclear Security Administration under contract DE-AC04-94AL85000.
______________________

2007
______________________

Non-Pharmaceutical Interventions
Interim pre-pandemic planning guidance: community strategy for pandemic influenza mitigation in the United States: early, targeted, layered use of nonpharmaceutical interventions
https://stacks.cdc.gov/view/cdc/11425
Published Date: February 2007
______________________

Public health interventions and epidemic intensity during the 1918 influenza Pandemic
https://www.pnas.org/content/pnas/104/18/7582.full.pdf
______________________

Interim Pre-Pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States—
Early, Targeted, Layered Use of Nonpharmaceutical Interventions
https://www.cdc.gov/flu/pandemic-resources/pdf/community_mitigation-sm.pdf
February 2007

Purpose
This document provides interim planning guidance for State, territorial, tribal, and local communities that focuses on several measures other than vaccination and drug treatment that might be useful during an influenza pandemic to reduce its harm. Communities, individuals and families, employers, schools, and other organizations will be asked to plan for the use of these interventions to help limit the spread of
a pandemic, prevent disease and death, lessen the impact on the economy, and keep society functioning.
...
This guidance will be updated as new information becomes available that better defines the epidemiology of influenza transmission, the effectiveness of control measures, and the social, ethical, economic, and logistical costs of mitigation strategies. Over time, exercises at the local, State, regional, and Federal level will help define the feasibility of these recommendations and ways to overcome barriers to successful implementation.

The goals of the Federal Government’s response to pandemic influenza are to limit the spread of a pandemic; mitigate disease, suffering, and death; and sustain infrastructure and lessen the impact on the economy and the functioning of society. Without mitigating interventions, even a less severe pandemic would likely result in dramatic increases in the number of hospitalizations and deaths. In addition, an unmitigated severe pandemic would likely overwhelm our nation’s critical healthcare services and impose significant stress on our nation’s critical infrastructure.
______________________

Nonpharmaceutical Interventions Implemented by US Cities During the 1918-1919 Influenza Pandemic
https://jamanetwork.com/journals/jama/fullarticle/208354
August 8, 2007
JAMA. 2007; 298(6): 644-654.

Abstract

Context
A critical question in pandemic influenza planning is the role nonpharmaceutical interventions might play in delaying the temporal effects of a pandemic, reducing the overall and peak attack rate, and reducing the number of cumulative deaths. Such measures could potentially provide valuable time for pandemic-strain vaccine and antiviral medication production and distribution. Optimally, appropriate implementation of nonpharmaceutical interventions would decrease the burden on health care services and critical infrastructure.

Objectives
To examine the implementation of nonpharmaceutical interventions for epidemic mitigation in 43 cities in the continental United States from September 8, 1918, through February 22, 1919, and to determine whether city-to-city variation in mortality was associated with the timing, duration, and combination of nonpharmaceutical interventions; altered population susceptibility associated with prior pandemic waves; age and sex distribution; and population size and density.
…
Conclusions
These findings demonstrate a strong association between early, sustained, and layered application of nonpharmaceutical interventions and mitigating the consequences of the 1918-1919 influenza pandemic in the United States. In planning for future severe influenza pandemics, nonpharmaceutical interventions should be considered for inclusion as companion measures to developing effective vaccines and medications for prophylaxis and treatment.

The influenza pandemic of 1918-1919 was the most deadly contagious calamity in human history. Approximately 40 million individuals died worldwide, including 550 000 individuals in the United States.1-4 The historical record demonstrates that when faced with a devastating pandemic, many nations, communities, and individuals adopt what they perceive to be effective social distancing measures or nonpharmaceutical interventions including isolation of those who are ill, quarantine of those suspected of having contact with those who are ill, school and selected business closure, and public gathering cancellations.5,6 One compelling question emerges: can lessons from the 1918-1919 pandemic be applied to contemporary pandemic planning efforts to maximize public health benefit while minimizing the disruptive social consequences of the pandemic as well as those accompanying public health response measures?7-10

Most pandemic influenza policy makers agree that even the most rigorous nonpharmaceutical interventions are unlikely either to prevent a pandemic or change a population's underlying biological susceptibility to the pandemic virus. However, a growing body of theoretical modeling research suggests that nonpharmaceutical interventions might play a salubrious role in delaying the temporal effect of a pandemic; reducing the overall and peak attack rate; and reducing the number of cumulative deaths.11-15 Such measures could potentially provide valuable time for production and distribution of pandemic-strain vaccine and antiviral medication. Optimally, appropriate implementation of nonpharmaceutical interventions would decrease the burden on health care services and critical infrastructure.

The historical record of the 1918-1919 influenza pandemic in the United States constitutes one of the largest recorded experiences with the use of nonpharmaceutical interventions to mitigate an easily spread, high mortality and morbidity influenza virus strain (ie, a category 4-5 pandemic using the Centers for Disease Control and Prevention February 2007 Interim Pre-Pandemic Planning Guidance).16 Our study focused on this data set by assessing the nonpharmaceutical interventions implemented in 43 cities in the continental United States from September 8, 1918, through February 22, 1919, a period that encompasses all of the second pandemic wave (September-December 1918) and the first 2 months of the third wave (January-April 1919) and represents the principal time span of activation and deactivation of nonpharmaceutical interventions. The purpose was to determine whether city-to-city variation in mortality was associated with the timing, duration, and combination (or layering) of nonpharmaceutical interventions; altered population susceptibility associated with prior pandemic waves; age and sex distribution; and population size and density.
…
Late interventions, regardless of their duration or permutation of use, almost always were associated with worse outcomes. However, timing alone was not consistently associated with success. The combination and choice of nonpharmaceutical interventions also appeared to be critical as confirmed by the multivariate model.

For example, New York City reacted earliest to the gathering influenza crisis, primarily with the sustained (>10 weeks beginning September 19, 1918) and rigidly enforced application of compulsory isolation and quarantine procedures, along with an enforced staggered business hour ordinance from October 5 through November 3, 1918.34 During this era, New York City's health department was renowned internationally for its innovative policies of mandatory case reporting and rigidly enforced isolation and quarantine procedures.35 Typically, individuals diagnosed with influenza were isolated in hospitals or makeshift facilities, while those suspected to have contact with an ill person (but who were not yet ill themselves) were quarantined in their homes with an official placard declaring that location to be under quarantine. New York City mounted an early and sustained response to the epidemic and experienced the lowest death rate on the Eastern seaboard but it did not layer its response. New York City's cumulative mortality burden, 452/100 000, ranked 15 out of the 43 cities studied.

In contrast, Pittsburgh, under orders from the Pennsylvania health department, executed a public gathering ban on October 4, 1918, but city officials delayed until October 24 before implementing school closure. A week later, on November 2, the state rescinded public gathering bans. The city applied its nonpharmaceutical interventions late and individually rather than combined. Pittsburgh's cumulative excess mortality burden (EDR = 807/100 000) ranked 43 out of 43 cities during the study period.

However, the benefits of these interventions were not equally distributed. Those cities acting in a timely and comprehensive manner appear to have benefited most in terms of reductions in total EDR. For example, St Louis, which implemented a relatively early, layered strategy (school closure and cancellation of public gatherings), and sustained these nonpharmaceutical interventions for about 10 weeks each, did not experience nearly as deleterious an outbreak as 36 other communities in the study (cumulative EDR = 358/100 000 population).
…
History is not a predictive science. There exist numerous well-documented and vast differences between US society and public health during the 1918 pandemic compared with the present. We acknowledge the inherent difficulties of interpreting data recorded nearly 90 years ago and contending with the gaps, omissions, and errors that may be included in the extant historical record. The associations observed are not perfect; for example, 2 outlier cities (Grand Rapids and St Paul) experienced better outcomes with less than perfect public health responses. Future work by our research team will explore social, political, and ecological determinants, which may further help to explain some of this variation.

The United States of 1918 had many similar features to the present era: rapid transportation in the form of trains and automobiles; rapid means of communication in the form of the telegraph and telephone; large, heterogeneous populations with substantial urban concentrations (although a much higher percentage of the US population lived in rural areas compared with the present); a news system that was able to circulate information widely during the epidemic, including many daily newspapers and broadsheets distributed in communities; and a wide spectrum of public health agencies at various levels of government.

When examining the 1918 pandemic, however, it is important to recognize the numerous social, cultural, and scientific differences that do exist between that period and the present. For example, the legal understanding of privacy, civil, and constitutional rights as they relate to public health and governmentally directed measures (such as mass vaccination programs) has changed markedly over the past 9 decades. In addition, public support of and trust in these measures, along with trust in the medical profession as a whole, has shifted over time. Finally, other features of the modern era that need to be considered when applying lessons from history to the present era include the increased speed and mode of travel, above all high-volume commercial aviation; instantaneous access to information via the Internet and personal computers; a baseline understanding among the general population that the etiologic agents of infectious diseases are microbial; and advances in medical technology and therapeutics that have expanded considerably the options available for dealing with a pandemic.

Historical contextual issues and statistical limitations aside, the US urban experience with nonpharmaceutical interventions during the 1918-1919 pandemic constitutes one of the largest data sets of its kind ever assembled in the modern, postgerm theory era.
…
These findings contrast with the conventional wisdom that the 1918 pandemic rapidly spread through each community killing everyone in its path. Although these urban communities had neither effective vaccines nor antivirals, cities that were able to organize and execute a suite of classic public health interventions before the pandemic swept fully through the city appeared to have an associated mitigated epidemic experience. Our study suggests that nonpharmaceutical interventions can play a critical role in mitigating the consequences of future severe influenza pandemics (category 4 and 5) and should be considered for inclusion in contemporary planning efforts as companion measures to developing effective vaccines and medications for prophylaxis and treatment. The history of US epidemics also cautions that the public's acceptance of these health measures is enhanced when guided by ethical and humane principles.39-41
______________________

Non-pharmaceutical public health interventions for pandemic influenza: an evaluation of the evidence base
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2040158/
BMC Public Health. 2007; 7: 208.
Published online 2007 Aug 15

Background

In an influenza pandemic, the benefit of vaccines and antiviral medications will be constrained by limitations on supplies and effectiveness. Non-pharmaceutical public health interventions will therefore be vital in curtailing disease spread. However, the most comprehensive assessments of the literature to date recognize the generally poor quality of evidence on which to base non-pharmaceutical pandemic planning decisions. In light of the need to prepare for a possible pandemic despite concerns about the poor quality of the literature, combining available evidence with expert opinion about the relative merits of non-pharmaceutical interventions for pandemic influenza may lead to a more informed and widely accepted set of recommendations. We evaluated the evidence base for non-pharmaceutical public health interventions. Then, based on the collective evidence, we identified a set of recommendations for and against interventions that are specific to both the setting in which an intervention may be used and the pandemic phase, and which can be used by policymakers to prepare for a pandemic until scientific evidence can definitively respond to planners' needs.
______________________

2012
______________________

The role of law in public health preparedness: opportunities and challenges
https://www.ncbi.nlm.nih.gov/pubmed/22147946
Journal of Health Politics, Policy and Law. 2012;37(2):297–328

Abstract
We report the results of a study designed to assess and evaluate how the law shapes the public health system's preparedness activities. Based on 144 qualitative interviews conducted in nine states, we used a model that compared the objective legal environment with how practitioners perceived the laws. Most local public health and emergency management professionals relied on what they perceived the legal environment to be rather than on an adequate understanding of the objective legal requirements. Major reasons for the gap include the lack of legal training for local practitioners and the difficulty of obtaining clarification and consistent legal advice regarding public health preparedness. Narrowing the gap would most likely improve preparedness outcomes. We conclude that there are serious deficiencies in legal preparedness that can undermine effective responses to public health emergencies. Correcting the lack of legal knowledge, coupled with eliminating delays in resolving legal issues and questions during public health emergencies, could have measurable consequences on reducing morbidity and mortality.
______________________

2016
______________________

A Tale of Many Cities: A Contemporary Historical Study of the Implementation of School Closures during the 2009 pA(H1N1) Influenza Pandemic
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5595096/
J Health Polit Policy Law. 2016 Jun; 41(3): 393–421.
Published online 2016 Feb 26. doi: 10.1215/03616878-3523958

Abstract
Applying qualitative historical methods, we examined the consideration and implementation of school closures as a nonpharmaceutical intervention (NPI) in thirty US cities during the spring 2009 wave of the pA(H1N1) influenza pandemic. We gathered and performed close textual readings of official federal, state, and municipal government documents; media coverage; and academic publications. Lastly, we conducted oral history interviews with public health and education officials in our selected cities. We found that several local health departments pursued school closure plans independent of CDC guidance, that uncertainty of action and the rapidly evolving understanding of pA(H1N1) contributed to tension and pushback from the public, that the media and public perception played a significant role in the response to school closure decisions, and that there were some notable instances of interdepartmental communication breakdown. We conclude that health departments should continue to develop and fine-tune their action plans while also working to develop better communication methods with the public, and work more closely with education officials to better understand the complexities involved in closing schools. Lastly, state and local governments should work to resolve lingering issues of legal authority for school closures in times of public health crises.
...
Education, Public Health, and Issues of Jurisdiction

In the United States, public health, public education, and city government seldom share the exact same jurisdictional and administrative boundaries. Some cities have their own public health departments, while others utilize county health departments. Public school districts and city borders are not always coterminous, resulting in some school districts that extend beyond city limits or cities with multiple, independent school districts. In Hawaii, both public health and public education are administered solely at the state level. This patchwork of jurisdictions, combined with the widely (and dearly) held values of home rule and federalism in public health and public education, undoubtedly played a role in the 2009 influenza pandemic preparedness and response (Oliver 2006; Ogden 2012).

The issue of which agency and at which level of government has the legal power to issue school closure orders is exceedingly complicated. A 2008 analysis found that legal authority to issue school closures during nonemergencies resides in health departments in twenty-six states, in departments of education in eighteen states, and in both in three states. In the remaining three states, there appear to be no laws formally authorizing a school closure by any governmental department in the absence of a declared state of emergency. Further confounding the issues of legal power, some states seem to authorize only state agencies to close schools during nonemergencies, while others seem to authorize such closures by either state or local authorities. Even in those states where jurisdiction for closures resides with state-level agencies, state departments of health or education may further allow their local counterparts to issue school closures. Local ordinances and policies add yet another layer to this confusing mix (Hodge, Bhattacharya, and Gray 2008).

A 2012 study of the law and public health preparedness and response discovered a large disconnect between actual legal conditions and perception of the law, and found that the primary motivation for action in public health events was the perception of legal authority (Jacobson et al. 2012). Similarly, our research found that officials tended to respond to the pandemic according to their perception of legal authority and their understanding of the most effective method to produce the desired public health goal. Thus, despite where legal authority for closing schools during the pandemic may have actually rested, all personnel and agencies involved universally turned first and foremost to their local public health department for advice on how best to proceed. Public health departments, in turn, preferred to recommend rather than mandate school closures when they felt such NPIs were necessary, thus dodging any potential legal issues.
______________________

2017
______________________

Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017
Recommendations and Reports
April 21, 2017 / 66 (1);1–34
https://www.cdc.gov/mmwr/volumes/66/rr/rr6601a1.htm
https://stacks.cdc.gov/view/cdc/45220

Summary

When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.

These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States — Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).
...
Social Distancing Measures for Schools, Workplaces, and Mass Gatherings

Social distancing measures can reduce virus transmission by decreasing the frequency and duration of social contact among persons of all ages. These measures are common-sense approaches to limiting face-to-face contact, which reduces person-to-person transmission.
...
CDC recommendations

Social distancing measures: Even though the evidence base for the effectiveness of some of these measures is limited, CDC might recommend the simultaneous use of multiple social distancing measures to help reduce the spread of influenza in community settings (e.g., schools, workplaces, and mass gatherings) during severe, very severe, or extreme influenza pandemics while minimizing the secondary consequences of the measures.

______________________

Permission is hereby granted to any and all to copy and paste any entry on this page and convey it electronically along with its URL,
______________________