American Indians Hit Hard By Swine Flu

December 25, 2009 from APR

Although H1N1 has proven less deadly than originally anticipated, it has taken a serious toll on American Indians.

According to a recent report released by the Centers for Disease Control and Prevention, the mortality rate from the virus is four times higher among American Indians and Alaska Natives than any other racial or ethnic group.

Phil Stago and his family were hit particularly hard by the virus.

Nationwide Reports Of Flu-Like Illness

Map: Nationwide Reports Of Flu-Like Illness

They live in a tiny house in the tiny town of Winslow, Ariz., just outside the vast Navajo Nation. On a recent morning, his 2-year-old watched cartoons and snuggled with her dad. The baby rocked in a swing.

The mellow day was quite a switch from the drama the household experienced in September, when Stago says swine flu wiped out his family for a whole month.

Stago's son got it first — itchy throat, fever and aches. Then 2-year-old Alicia picked up the virus. She’s feeling much better now, but when her newborn sister, Gabriela, caught swine flu, things got scary.

Stago took her to an Indian Health Service hospital nearby when her fever hit 100 degrees.

"They secluded us from her, and they put her in a little tent of oxygen," Stago says. "[We] had to wear the whole full isolation gowns and gloves and mask. That was pretty scary."

Indigenous People More Vulnerable

When patients require more intensive care than Gabriela did, they're sent to Flagstaff Medical Center, about an hour west of Winslow.

One day during the peak of the second wave of the swine flu virus, the intensive care unit was almost full of American Indians on respiratory ventilators.

The scene reflects a statewide trend. In Arizona, of the more than 1,500 people who have been hospitalized for swine flu, 13 percent have been American Indian. Yet American Indians make up only 5 percent of Arizonans.

Aboriginal Australians and First Nations groups in Canada have reported similar disproportionate findings.

There are plenty of theories as to why indigenous people are more at risk. John Redd, an epidemiologist for the Indian Health Service, says that crowding and poor housing, both risk factors for influenza, are more present in indigenous populations around the world.

In addition to poverty, Redd also points out that American Indians are prone to diabetes and asthma. When you combine swine flu with these pre-existing conditions, the outcomes are worse.

Access to health care is also an issue. There are a dozen Indian health care centers scattered throughout the Navajo Nation, but the reservation is the size of West Virginia.

Cindy Galloway, who works at a family health center that serves American Indians in the Flagstaff area, believes there are other factors contributing to the higher mortality rates.

"They are more stoic people. They don't complain, frankly," Galloway says.

She says it's typical for American Indian patients to wait until their symptoms become severe before they seek treatment.

"People will tolerate feeling bad longer and thinking it's going to go away," Galloway says. "When finally after four or five days they can't even take a deep breath, then they realize that this could be more serious."

Indian Health Service officials say many people have been exposed to swine flu or have been vaccinated now, so there's hope that the next possible wave of the virus, which could come as early as January, won’t be as severe.

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Flu outrunning vaccine, experts say - washingtonpost.com

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Shots may not be widely available until December or January

By David Brown
Washington Post Staff Writer
Thursday, November 5, 2009

Two state and city public health officials briefing Congress on Wednesday said they don't expect to have enough pandemic-flu vaccine to meet the needs of their high-priority population groups until well into December, and possibly not until January.

The officials said that their predictions are a result of maddening vaccine shortages throughout the fall but that they amount to little more than guesses.

Federal health officials at the same briefing refused to endorse the gloomy timetable -- or any other one -- although they acknowledged that the current wave of H1N1 influenza may be mostly over by the time the vaccine is abundant.

"Current projections show that 62 percent of Alabama's vaccine will not be available until after December 1," Donald E. Williamson, the state's health officer, told a House Appropriations subcommittee. Offering flu shots to people outside the five priority recipient groups "may not be possible until late December or January."

The director of the public health department in St. Paul, Minn., said he thinks it will be "sometime between Christmas and mid-January" before there is enough vaccine to fully immunize the high-risk groups -- pregnant women, health workers, parents caring for newborns, people 6 months through 24 years old and chronically ill people ages 25 through 64.

"I don't think we'll have enough before then," said Rob Fulton, adding that what's true for St. Paul is probably true for all of Minnesota.

The federal government has ordered 250 million doses of pandemic H1N1 influenza vaccine. It has said that will be more than enough to satisfy demand among the country's 308 million residents. The high-priority groups include 159 million people.

As of this week, 32.3 million doses of pandemic vaccine had been made available to states and cities by the federal government, which is controlling the entire U.S. supply.

Members of the House Appropriations subcommittee on Labor, Health and Human Services, Education and Related Agencies repeatedly queried the federal officials about timelines for future supplies. While five weeks ago they were still predicting that there would be more than 100 million doses by now, none of the officials would hazard a guess.

"We have been working extremely hard with each manufacturer to make sure all of the stumbling blocks are out of the way," Nicole Lurie, assistant secretary for preparedness and response at the Department of Health and Human Services, told Rep. David R. Obey (D-Wis.), chairman of the subcommittee. "Flu is really unpredictable. We're pretty hesitant about projecting ahead more than week to week."

Thomas R. Frieden, director of the Centers for Disease Control and Prevention, also declined to look ahead, saying, "We have been burned, quite frankly, by predictions that have not come to pass." Under later questioning, he did say that "it is quite likely that the current wave of influenza will peak, crest and begin to decline before there are ample supplies" of vaccine.

Pandemic influenza -- defined as a highly contagious strain to which virtually everyone in the world is susceptible -- tends to move through populations in waves, sometimes over several years. For example, the Asian flu of 1957, which bears many similarities to the current pandemic, was responsible for about 60,000 "excess deaths" in the United States. About 40,000 occurred in the summer and fall of 1957, and 20,000 in the late winter and early spring of 1958.

The chief reason there is so little flu vaccine is that the novel H1N1 grows slowly in fertilized chicken eggs, the medium where it is made in industrial quantities.

Normally, vaccine-makers expect to get two to three doses of vaccine out of each egg injected. At the start of production in the summer, the yield was 0.2 to 0.5 doses per egg, said Robin Robinson, director of the Biomedical Advanced Research and Development Authority, which is part of HHS. After tinkering with growth conditions and other variables, it is now 1.3 to 2 doses per egg.

"If we had been getting 2.5 doses per egg [throughout the summer and fall], we wouldn't be having this hearing now," he said.

The vaccine shortage is the consequence of the virus's biology, not human laziness or incompetence, the officials told the lawmakers many times.

"I don't want people to get the impression that it is the drug companies' fault in not getting this delivered," said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases.

Government officials have asked the four makers of injectable vaccine to put most of their current production into multi-dose vials, which can be filled about five times more quickly than single-dose vials or pre-filled syringes and may save a little time.

How to prevent getting swine flu and what to do if you have it - washingtonpost.com

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Sunday, November 1, 2009

Andrew Pekosz, an associate professor of molecular microbiology and immunology at Johns Hopkins University's Bloomberg School of Public Health in Baltimore, answers questions about H1N1 swine flu.

How can I tell if I have swine flu? And does it matter if it's that flu or the seasonal one?

Virtually all the cases of influenza occurring at this time are caused by 2009 H1N1. While individuals with severe flu-like illness are being tested to determine for certain which virus is causing the disease, there is no need for most people to get tested.

How do I know if I or someone in my family should go to the hospital?

Some key symptoms to watch for include rapid but shallow breathing, difficulty in breathing and lethargy or extreme weakness. A complete list of symptoms can be found at http://www.cdc.gov/h1n1flu/sick.htm#3.

What is the best source of information about the H1N1 virus?

There are couple of Web sites that provide good general information on the H1N1 virus; the one I like for information to the general public is http://www.flu.gov, but be sure to check with your state or county public health department.

Who should get vaccinated? What are the priority groups?

There are several priority groups being targeted for vaccination while the vaccine is in short supply. The complete list is at http://www.flu.gov/individualfamily/vaccination/vprioritygroups.html but includes pregnant women, health-care and emergency medical personnel, household contacts or caregivers of children under the age of 6 months, anyone between the ages of 6 months and 24 years of age, and people age 25 to 64 who have underlying medical conditions.

What's the difference between nasal spray and injection? Who should get what kind?

The nasal-spray vaccine is a weakened form of the virus that does not cause influenza but does generate a good immune response. The injectable vaccine is an inactivated or "killed" form of the virus which is injected into the muscle of your arm. The nasal spray is only available to healthy individuals age 2 to 49, while the injectable vaccine is available to a wider range of the population. More information is available at http://www.cdc.gov/h1n1flu/vaccination/general.htm.

If I can't get the vaccine right away, is it still worth getting it later?

Yes. . . . We are not certain how long the flu season will last, or if we will have several flu seasons or "waves" this year, so when vaccine becomes available, everyone should take advantage of it.

How quickly does the vaccination take effect? Is it possible to come down with the flu soon after getting vaccinated?

After three weeks, most people have an immune response that will protect them from infection with 2009 H1N1. The immune response begins to be detected seven to seven to 10 days after vaccination. The vaccines cannot cause the flu, but you certainly could catch influenza during the time after vaccination when your body hasn't developed a strong anti-influenza immune response.

Should everyone who comes down with the flu take Tamiflu or Relenza?

No. The CDC guidelines recommend that only individuals who are in high-risk groups should receive Tamiflu or Relenza at the first sign of symptoms. If you develop symptoms of severe influenza, then you should seek out medical treatment and begin to take Tamiflu and Relenza. For most people who will come down with the mild form of the disease, the use of Tamiflu or Relenza is not recommended in order to ensure enough of the drugs are available.

Obama Declares Swine Flu Outbreak a National Emergency - NYTimes.com

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By JACKIE CALMES and DONALD G. McNEIL Jr.

WASHINGTON — President Obama has declared the swine flu outbreak a national emergency, allowing hospitals and local governments to speedily set up alternate sites for treatment and triage procedures if needed to handle any surge of patients, the White House said on Saturday.

The declaration came as thousands of people lined up in cities across the country to receive vaccinations, and as federal officials acknowledged that their ambitious vaccination program has gotten off to a slow start. Only 16 million doses of the vaccine were available now, and about 30 million were expected by the end of the month. Some states have requested 10 times the amount they have been allotted.

Flu activity — virtually all of it the swine flu — is now widespread in 46 states, a level that federal officials say equals the peak of a typical winter flu season. Millions of people in the United States have had swine flu, known as H1N1, either in the first wave in the spring or the current wave.

Although there has been no exact count, officials said the H1N1 virus has killed more than 1,000 Americans and hospitalized over 20,000. The emergency declaration, which Mr. Obama signed Friday night, has to do only with hospital treatment, not with the vaccine. Government officials emphasized that Mr. Obama’s declaration was largely an administrative move that did not signify any unanticipated worsening of the outbreak of the H1N1 flu nationwide. Nor, they said, did it have anything to do with the reports of vaccine shortages.

“This is not a response to any new developments,” said Reid Cherlin, a White House spokesman. “It’s an important tool in our kit going forward.”

Mr. Obama’s declaration was necessary to empower Kathleen Sebelius, the secretary of Health and Human Services, to issue waivers that allow hospitals in danger of being overwhelmed with swine flu patients to execute disaster operation plans that include transferring patients off-site to satellite facilities or other hospitals.

The department first declared a public health emergency in April; Ms. Sebelius renewed it on Tuesday. But the separate presidential declaration was required to waive federal laws put in place to protect patients’ privacy and to ensure that they are not discriminated against based on their source of payment for care, including Medicare, Medicaid and the states’ Children’s Health Insurance Program.

As a practical matter, officials said, the waiver could allow a hospital to set up a make-shift satellite facility for swine flu patients in a local armory or other suitably spacious location, or at another hospital, to segregate such cases for treatment. Under federal law, if the patients are sent off site without a waiver, the hospital could be refused reimbursement for care as a sanction.

A few hospitals, including some in Texas and Tennessee, have set up triage tents in their parking lots to screen patients with fever or other flu symptoms. A Health and Human Services official said no hospitals had requested a waiver. David Daigle of the Centers for Disease Control and Prevention said he had not heard of any hospital that has faced a surge of patients so large that it had to set up a triage area or a treatment unit off site.

In Chicago on Saturday, health officials began giving free vaccinations at six City College locations, and within hours hundreds of people were turned away because supplies had been exhausted. The city distributed 1,200 vaccines to each site, immunizing more than 7,000 people, said Tim Hadac, spokesman for the Chicago Department of Public Health. All but two of the sites ran out of the vaccine.

At Truman College on Chicago’s North Side, lines formed at 7 a.m., two hours before the doors opened. Mary Kate Merna, 28, a teacher who is nine months pregnant, arrived too late to get a vaccination. “I thought I’d be a priority being nine months pregnant,” she said. “You hear it’s a national emergency and it scares you.”

In Fairfax County, Va., officials had planned to have swine flu clinics at 10 different locations on Saturday. But the county did not receive the number of doses it requested, and was forced to offer the vaccinations only at the government building. People began lining up with camping gear the night before to get vaccinations.

Merni Fitzgerald, Fairfax’s public affairs director, said officials were aiming to administer 12,000 doses of the vaccine to those most at risk for serious complications from the H1N1 virus, mainly pregnant women and children 6 to 36 months.

But that did not stop some other high-risk patients. “I lied and told the doctors I was pregnant,” said Theresa Caffey of Centreville, who has multiple sclerosis and nurses her 11-week-old son, Joshua. “I’m religious. I don’t lie. But it’s not about me. It’s for my son. It’s safer for him if I have the antibodies.”

In a briefing on Friday, Dr. Thomas Frieden, the C.D.C. director, acknowledged problems with the vaccine production. “We share the frustration of people who have waited on line or called a number or checked a Web site and haven’t been able to find a place to get vaccinated,” he said.

Federal officials predicted last spring that as many as 120 million doses could be available by now, with nearly 200 million by year’s end. But production problems plagued some of the five companies contracted to make the vaccine. All use a technology involving growing the vaccine in fertilized chicken eggs; at most of them, the seed strain grew more slowly than expected.

The manufacturers are “working hard to get vaccine out as safely and rapidly as possible,” Dr. Frieden said. But since it is grown in eggs, “even if you yell at them, they don’t grow faster.”

Since last winter’s more isolated cases of swine flu, the expectation that the virus would return with a vengeance in this flu season had posed a test of the Obama administration’s preparedness. Officials are mindful that the previous administration’s failure to better prepare for and respond to Hurricane Katrina in 2005 left doubts that dogged President George W. Bush to the end of his term.

There is no overall shortage of seasonal flu vaccine — 85 million doses have shipped, and the season has not started. But there are temporary local shortages. The seasonal flu typically hospitalizes 200,000 and kills 36,000 nationwide each year. But over 90 percent of the deaths are among the elderly, while the swine flu mostly affects the young.

Jackie Calmes reported from Washington, and Donald G. McNeil Jr. from New York. Crystal Yednak in Chicago and Holli Chmela in Fairfax, Va. contributed reporting.

Swine Flu Deaths Among Youths Rise as Epidemic Spreads - washingtonpost.com

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amer19 Fatalities Reported in Past Week, Including 2 in Maryland, as Vaccine Distribution Gets Underway

By Rob Stein
Washington Post Staff Writer
Saturday, October 10, 2009

The number of children who have died from swine flu has jumped sharply as the virus continues to spread widely around the United States, striking youngsters, teenagers, young adults and pregnant women unusually often, federal officials said Friday.

The deaths of another 19 children and teenagers from the new H1N1 virus were reported in the past week around the country, including two in Maryland, pushing to 76 the number of fatalities this year among those under 18, officials said. It was the largest number of pediatric deaths reported in a single week since the pandemic began in the spring.

"These pediatric deaths seem to be increasing substantially," said Anne Schuchat, who heads the federal Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases.

While most of the children who have died have had other health problems that made them particularly vulnerable, such as asthma, muscular dystrophy and cerebral palsy, 20 to 30 percent were otherwise healthy, Schuchat said.

Between 46 and 88 children died from the seasonal flu in each of the past four years, so the fact that so many have already succumbed is disturbing, Schuchat said.

"It's only the beginning of October," she said, noting that the flu season usually starts much later and runs through May. "We saw a peak of deaths, you know, starting April, May, June. It started to level off this summer. Now it's starting to shoot up again."

In addition to the two deaths in Maryland, three were reported in Tennessee, seven in Texas and one each in Alaska, Arizona, Colorado, Florida, North Carolina, Oklahoma and Wisconsin.

Since the pandemic began, at least 3,873 Americans have died from complications associated with the flu, primarily the H1N1 virus, including at least 28 pregnant women.

The increase in pediatric deaths comes as the federal government's unprecedented vaccination campaign is just getting underway. Millions of doses of vaccine began arriving around the country this week.

It provided more reason why parents should get themselves and their children vaccinated against the virus, Schuchat said.

"Vaccine against flu is the best way to protect yourself . . . and those around you," she said.

The federal government has spent about $2 billion to buy at least 250 million doses of vaccine in the hopes of inoculating more than half the U.S. population, and it has pledged to buy enough to vaccinate everyone if there is sufficient demand.

So far, states and cities have ordered 3.7 million doses of the 6.8 million that have become available, and the first doses were administered this week. Some doctors and clinics are reporting being flooded with requests for the vaccine. But several national surveys have found that only about 40 percent of Americans are sure they will get it, with those who are reluctant citing doubts about the severity of the virus and concerns about side effects.

The vaccine campaign is also fueling anti-government sentiments and false rumors that the vaccine is mandatory. Although New York state and some individual hospitals and private health chains are requiring their employees to get vaccinated this year for the first time, the vaccine remains voluntary for most people.

"Lots of rumors out there, and we're trying to address them," Schuchat said.

Additional data from federal studies testing the vaccine have found no evidence of any unusual risks and have confirmed preliminary indications that the vaccine is effective for most adults with one standard dose.

At least 37 states are reporting widespread flu activity, up from 27 a week ago. While the number of cases appears to be decreasing in some places, it is increasing in others and could rise again in areas where cases are dropping, Schuchat said. New York and some other cities that experienced large outbreaks in the spring are reporting fewer cases than expected, but Schuchat warned that could change at any time.

"It's hard to know how many waves we're going to have into the fall, winter and spring," she said. "We still think the vast majority of people in a given community are vulnerable or susceptible to this virus."

Although the virus causes mild illness for most people, some people become seriously ill, requiring intensive care to try to save them.

"Unfortunately, we do expect more illness, including more hospitalizations and deaths, to be occurring in the weeks ahead," she said.

Schuchat also encouraged people to get the seasonal flu vaccine. Some areas are experiencing shortages of seasonal flu vaccine, in part because manufacturers are juggling production of both vaccines. New data from another federal study aimed at determining whether people can get both vaccines at the same time found that was no problem.

Flu Worries Weaken Tourism to Saudi Holy Sites - WSJ.com

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Fewer Travelers Are Expected for This Year's Pilgrimage to Mecca, as Governments Watch Carefully for Signs of H1N1

By ASHRAF KHALIL

CAIRO -- Fears among Muslims world-wide that this year's pilgrimage high season in Saudi Arabia will become a breeding ground for the new H1N1 flu has Saudi tourism officials worried.

"We're receiving cancellations from all over the world," said Waleed Abu Sabaa, head of the Hotels and Tourism Committee for the Mecca Chamber of Commerce and the owner of a company that controls 20 hotels in Mecca and Medina, the two holiest cities of Islam. "It's tough. It's very tough."

The pilgrimage to Mecca, the Hajj, is mandatory for all Muslims once in their lives, if they are physically and financially able, and takes place during a specific time in the Islamic calendar -- this year, between Nov. 25 and Nov. 30. An average of three million Muslims arrive in that month alone to perform the Hajj. Pilgrims also flock to Mecca and Medina year-round for the Umrah, an optional pilgrimage often made during the sacred month of Ramadan, which ended Sunday.

Early estimates based on pilgrims already traveling to Saudi to perform Umrah rituals suggest a plunge in visitors this year, travel officials say, though it is still too early to conclusively tell just how this year's Hajj numbers will be affected by the flu. That is partly because pilgrims have delayed making reservations, holding off until the last minute to decide on whether to go.

To date, at least 3,205 people world-wide have died from the virus, according to the World Health Organization.

Health officials aren't reporting unusually high infection rates in the Mideast. Egypt, the Middle East's most populous country, has reported just two deaths. Authorities in Saudi Arabia, which has reported 28 fatal cases, say they are prepared to conduct the annual ritual safely.

Still, Egypt has postponed the opening of all schools until next month as a precaution, and the health ministry has said it will consider extending that if there is an outbreak. In Oman, officials canceled an annual cultural festival held in January in the capital, Muscat.

Mr. Abu Sabaa said his hotels have already lost $16 million in potential Umrah business. He estimated a 50% drop in attendance so far this year, and said bookings at five-star hotels have been the hardest hit.

Arabian Business magazine, which has dedicated a section of its Web site to swine-flu coverage, estimated businesses in Mecca and Medina are in for some $266 million in lost revenue because of fewer travelers this year.

The Hajj has been banned before because of health concerns. In 1947, Egypt banned its people from going due to a cholera epidemic.

The pilgrimage has long been a breeding ground for illness. The confluence of millions of pilgrims from around the world jammed together in physically exhausting circumstances ensures that many come down with some form of low-grade illness during or just after the experience.

"We call it the Hajj flu. Everybody gets it," says Sayed Moustafa Qazwiny, a Shiite imam from Costa Mesa, Calif., who has led annual Hajj groups to Mecca for more than 15 years. "It's something you just can't escape."

Mr. Qazwiny normally accompanies more than 100 Shiite pilgrims per year. He said he needs at least 70 commitments to make the trip worthwhile, but he is still well shy of that number this year. Five of Mr. Qazwiny's brothers also are imams in the U.S., and "they're having the same problems," he said. He is already preparing a backup plan: a trip to the Shiite holy cities of Najaf and Karbala in Iraq.

Saudi Health Ministry officials have repeatedly said they have sufficient stores of antiviral medicine in case of outbreaks. Attempts to contact the ministry for comment were unsuccessful.

Nail al-Jubeir, a spokesman for the Saudi embassy in Washington, admits that swine flu is a new wrinkle in the logistical challenge Saudi Arabia takes on each year.

"The flu for us was the least of our concerns in the past," says Mr. Al-Jubeir, who said the normal priorities were preventing stampedes and fires as well as diseases other than flu. "Yellow fever, meningitis, a few years ago, polio became an issue with some of the African pilgrims," he says.

Earlier this year, as a preventive step, the Saudis requested all nations sending pilgrims to impose age restrictions, allowing only those between the ages of 25 and 65. Other restrictions agreed to at a July meeting of Arab health ministers were that people with chronic illnesses and pregnant women shouldn't make the pilgrimage.

Iman Samy, vice president of Golden Tours, an Egyptian Hajj-trip organizer, said she expects government officials to be watching for outbreaks. "If we have a lot of cases from the Umrah, I would expect [the Egyptian government] will cancel the Hajj," she said. "Let's just cross our fingers and see what happens."

Unpopular Science

For twenty-three years Sabin Russell worked at the San Francisco Chronicle. A top medical writer specializing in global health and infectious diseases, Russell covered subjects ranging from bioterror threats to the risk of avian flu and traveled throughout Africa to report on the AIDS epidemic. He won numerous accolades, including a 2001 Science in Society Journalism Award from the National Association of Science Writers for his reporting on the flaws of the flu vaccine industry.

This article is partly based on Chris Mooney and Sheril Kirshenbaum's Unscientific America: How Scientific Illiteracy Threatens Our Future.

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Then came March 30, 2009--his last day on the job. Russell was at MIT, on leave from his paper for a fellowship. The struggling Chronicle had been cutting staff and now suddenly forced many older career journalists to either take a buyout or risk a reduced pension. At 56, Russell was at the peak of his game, but for him, as for many of his colleagues, there was really just one option. "We have not left journalism; journalism has left us," Russell remarked recently from San Francisco, where he is setting up a freelance office and looking for work.

Now the painful irony: Russell was pressured out of his job just as swine flu murmurs began to emerge from Mexico. This was his beat; few reporters are better equipped to tackle such a difficult yet urgent story, one so rife with uncertain but potentially severe risk. Russell even tipped off his old employer that the paper might want to get a jump on what was happening in Mexico City. "If I was covering this story now," he says, "I'd be all over the Southern Hemisphere. It's flu season there. How is Australia? How is the infrastructure to respond to a new strain holding up?"

Those are stories Russell won't be writing.

It's no secret the newspaper industry is hemorrhaging staff writers and slashing coverage as its business model collapses in the face of declining readership and advertising revenues. But less recognized is how this trend is killing off a breed of journalistic specialists that we need now more than ever--science writers like Russell, who are uniquely trained for the most difficult stories, those with a complex technical component that are nevertheless critical to politics and society.

We live in a time of pathbreaking advances in biotechnology and nanotechnology, of private spaceflight and personalized medicine, amid a climate and energy crisis, in a world made more dangerous by biological and nuclear terror threats and global pandemics. Meanwhile, advances in neuroscience are calling into question who we are, whether our identities and thought processes can be reduced to purely physical phenomena, whether we actually have free will. The media ought to be bursting with this stuff. Yet precisely the opposite is happening: even in places where you'd expect it to hold out the longest, science journalism is declining.

Take Mark Carreau, until recently the space reporter for the Houston Chronicle. He spent more than twenty years covering NASA, whose Johnson Space Center (JSC) lies in the Chronicle's backyard. Such expertise, however, failed to outweigh the need for newsroom cuts, and Carreau was laid off earlier this year. As one space wonk lamented on a blog on the occasion of Carreau's departure: "I'm guessing there are now more people in space than there are reporters in the JSC newsroom."

Or take the ailing Boston Globe, situated in a global center of science that leads the biotech industry. In March the paper dumped its specialized Monday "Health/Science" section, transferring health coverage to its arts and lifestyle pages and folding science reporting into its Monday business section. Soon after, the paper reduced staff significantly on its science desk. The Globe's decision wasn't about the relevance of science to readership; it was about the underlying economics.

The death of specialized newspaper science sections like the Globe's is a long-term trend--one that appears to be accelerating. From 1989 to 2005, the number of US papers featuring weekly science-related sections shrank from ninety-five to thirty-four. Many of the remaining sections shifted to softer health, fitness and "news you can use" coverage, reflecting the apparent judgment that more thorough science or science policy coverage just doesn't support itself economically.

And the problem isn't confined to newspapers. Just one minute out of every 300 on cable news is devoted to science and technology, or one-third of 1 percent. Late last year CNN cut its entire science, space and technology unit. The most prominent departure: Miles O'Brien, who covered the 2003 space shuttle Columbia disaster for the network.

How did the US media--serving a country that leads the world in virtually every aspect of science--reach this point? Certainly it wasn't always this way.

Science journalism began as a specialized beat in the early twentieth century but burgeoned in the United States after World War II. The 1957 Soviet launch of Sputnik was an especially galvanizing event; in response, US newspapers ramped up their science content, and a generation of writers cut their teeth covering the "space race." Another boom came in the late 1970s and early '80s, when Carl Sagan's Cosmos series reached 500 million people globally, and fifteen new science magazines, eighteen new newspaper science sections and seventeen new science TV shows were launched in the United States.

This "popular science" movement sought nothing less than to bring science to the entire public, to mediate between the technical and the lay, the wonky and the approachable. The thinking was that translating scientific knowledge into a form everyone could understand would help forge a more enlightened citizenry and, ultimately, a stronger democracy.

That ambition didn't last: deregulation and technological change would soon dramatically reshape the media industry. Policy moves during the Reagan and Clinton years, epitomized by the 1996 Telecommunications Act, helped foster mass media conglomeration, as a relatively small number of corporations began to pull together diverse media sectors--movies, television, book publishing, music, magazines, radio and many newspapers--and cram them into massive firms. Serious science journalism often fared poorly in this climate. Producing it required seasoned, highly trained journalists who expected to receive salaries commensurate with their experience and expertise. The conglomerates had a different plan--more revenue, less cost, rising stock prices.

Even as science coverage became squeezed in service to the bottom line, another trend emerged that made it increasingly difficult to reach broad swaths of America with scientific information--the loss of common media sources shared by large segments of the populace. During television's so-called golden age, the broadcast networks--ABC, CBS and NBC--provided a shared cultural experience and news environment and featured plenty of science. PBS joined them: Carl Sagan's Cosmos, its greatest science program, was a product of this era.

Then along came cable TV, providing myriad channel alternatives for those who wanted to detach from serious news, and increasingly politicized platforms like Fox News and MSNBC for those who remained plugged in. And already the Internet's transformative powers seem likely to make cable's impact on the media seem trivial by comparison. Newspapers are on the verge of extinction, but we have millions of blogs to suit every interest and political persuasion, Google News to sift our headlines and Twitter to titillate.

In this context, science media outlets like the Discovery Channel still exist, as do programs like PBS's NOVA--but only as one niche among many. Even the pinnacle of newspaper science journalism, the New York Times's Tuesday science section, reaches only perhaps a million people once a week, a small slice of America.

The problem with the decline of science journalism is not just that there is less attention overall to science; it's that the remaining science coverage is less illuminating. Instead, it indulges in a variety of journalistic pathologies that thwart an improved public understanding of science.

As a rule, journalists are always in search of the dramatic and the new. When it comes to science, however, this can lead them to pounce on each "hot" new result, even if that finding contradicts the last hot result or is soon overturned by a subsequent study. The resulting staccato coverage can leave the public hopelessly exasperated and confused. Should you drink more coffee or less? Does global warming increase the number and intensity of hurricanes or not? Are vaccines safe, or can they cause an autism epidemic? Experienced science journalists know how to cover such topics by contextualizing studies and deferring to the weight of the evidence. Inexperienced journalists, though, are likely to leave audiences with a severe case of media whiplash.

Then there's the problem of "balance"--the idea that reporters must give roughly equal space to two different "sides" of a controversy. When applied to science, especially in politicized areas, this media norm becomes extremely problematic. Should journalists really grant equal time to the small band of scientists who deny the causal relationship between HIV and AIDS when the vast majority of researchers accept the connection between the two? Should they split column space between the few remaining global warming "skeptics" and scientific experts who affirm the phenomenon's human causation? Again, experienced science journalists will know best how to cover such stories and will be aware of the scientific community's very justifiable abhorrence of unthinking "balance."

For a disturbing glimpse of what to expect from a media world with vastly fewer trained science journalists, we need only recount how much of the press managed to bungle the most important science-related story of our time: global warming. We were warned and warned again about climate change, yet for decades did nothing as the problem steadily worsened. In large part, that's because the US public continues to rate global warming as a low priority, and politicians respond to that public. Both have been getting their cues about what matters from the media.

The mass media, however, got the climate story wrong in multiple ways--first, by covering it as a "he said, she said" controversy during the 1990s (bowing to pressure from special interests and their pet scientists, who strategically attacked the scientific consensus) and then, even after moving away from such "balanced" coverage, by providing far too little attention to the story overall--hardly proportionate to the grave planetary danger it poses. Climate change keeps worsening, yes, but how often is it the kind of news that can trump all the other urgent matters demanding media attention?

In fact, though coverage of climate change in the worldwide newspaper media rose sharply in 2005 and 2006, it declined after that, apparently overshadowed by the economic collapse. But scientists are growing increasingly terrified of what global warming could do--among other things, submerge coastal cities--and are now contemplating further meddling with the climate system (so-called geoengineering) as a last-ditch effort to reverse it. We may yet escape such worst-case scenarios, but if we do, it won't be thanks to the press.

Here an obvious question arises: if the Internet is most directly responsible for the decline of newspapers, then can science blogs and science-infused websites fill the gap?

Science content on the web is certainly booming. It's estimated that there are some 1,000 science blogs, and that's undoubtedly a very conservative figure. Science blogs often focus on hot-button topics such as vaccination, the teaching of evolution and the politics of climate change, and devote considerable time to parsing new research findings. Often written by scientists or science journalists, they're highly attuned to the many problems that have plagued the coverage of science, like phony "balance," and tend to avoid or even denounce them--with verve and attitude.

In other ways as well, the Internet has become the go-to place for science. According to the National Science Foundation, it ranks second only to television among the leading sources of science information for the average citizen and is leaving other, older sources far behind. In particular, when Americans want to find information about a specific scientific topic, they go to the web far more often than they open a research book.

Undoubtedly, one can find excellent science information on the web, but the question is whether most people will find it. Newspaper science journalists in their heyday wrote for a broad and diverse slice of the public. On the Internet, though, it's all about finding your particular micro-community. The web atomizes us--and while it certainly empowers, it empowers good and bad alike. Accurate science and the most stunning misinformation thrive side by side--anti-vaccine advocates, anti-evolutionists and global warming deniers all have highly popular websites and blogs, and there is no reason to think good scientific information is somehow beating them back.

This problem was on full display in the 2008 Weblog Awards, a popularity contest that featured a tight race for Best Science Blog. The two leading contestants: PZ Myers's Pharyngula (scienceblogs.com/pharyngula), the online clearinghouse for confrontational atheism, and Watts Up With That (wattsupwiththat.com), written by former TV meteorologist Anthony Watts, a skeptic of the scientific conclusion that human activities have caused global warming. Both sites are polemical: one assaults religious faith; the other constantly attacks mainstream understanding of climate change.

In the end, Watts Up With That defeated Pharyngula, 14,150 votes to 12,238. The "science" contest came down to the religion-basher versus the misinformation-machine, and the misinformation-machine won. That speaks volumes about the form science commentary takes on the Internet.

That's not to say blogs lack any benefits; they have many. But the Internet is not unifying our culture around a comprehensive or even reliable diet of scientific information, and it isn't replacing what's being lost in the old media. Perhaps Sabin Russell put it best, on the very day he took his buyout from the San Francisco Chronicle. At 4:44 pm he posted his second entry on a social networking site that some tout as journalism's future. It read: "This is the way my career ends. This is the way my career ends. Not with a bang, but a Twitter." Russell had fourteen followers at the time.

Given that the decline of science journalism is being driven by overwhelming technological and economic forces, it might seem unstoppable. But perhaps instead, the answer lies outside the free market: with the creation of not-for-profit sources of science journalism and commentary, meant to last for long periods safely insulated from market upheaval. An example might be Climate Central, a new nonprofit that supplies a variety of journalistic content relating to climate change, including footage for television programs like PBS's NewsHour With Jim Lehrer.

Another group of nonprofits--universities--can take the lead in institutionalizing new priorities so that communication, a subject given notoriously short shrift among scientists in the past, becomes a focal point. Especially among the youngest generation of researchers--graduate students, recent PhDs and postdocs--there's a hunger for training in media outreach. These scientists want to obtain the skills that can help them explain their work to a broader public, and there is hardly a time when they will have greater need for them than now, when the journalists who might once have been expected to do this work simply don't have jobs any longer.

For such communication training to become more common, however, we'll need a paradigm shift among the nation's population of brilliant scientists. Immersed in vital research, they have paid relatively little attention to the business side of the media and how it affects them. They've tended to view the press as having a high moral "responsibility" to cover research--period. In some sense, they still think we're in the age of Edward R. Murrow. In fact, it's the age of Bill O'Reilly.

In light of the media upheaval, scientists can no longer assume that a responsible, high-minded press will treat their ideas with the seriousness they deserve, delivering them to policy-makers and the public for sober consideration. Instead, partisan media will convey diametrically opposed versions of where science actually stands on any contentious subject--consider, for example, the difference between how Fox News and NPR cover climate change--even as most of the public (and many policy-makers) will tune out science more or less completely, besieged by other information options.

That's the media reality we live with, and facing it head-on is necessary not only for scientists but for everyone who cares about the impact of science and good information on public policy. We must stop assuming today's media will dutifully carry the best and most reliable knowledge to policy-makers and the American public. Rather, it falls to us to shift gears and carry that knowledge to the entirety of the remaining media, and well beyond. In the latter endeavor, we may have to create media of our own.

About Chris Mooney

Chris Mooney is a visiting associate in the Center for Collaborative History at Princeton University and the author of The Republican War on Science, Storm World and, with Sheril Kirshenbaum, Unscientific America: How Scientific Illiteracy Threatens Our Future. more...

About Sheril Kirshenbaum

Sheril Kirshenbaum, a marine biologist at Duke University working to improve communication between scientists, policymakers and the public, is the co-author, with Chris Mooney, of Unscientific America: How Scientific Illiteracy Threatens Our Future. more...

Northern Hemisphere Braces as Swine Flu Heads North

By Rob Stein
Washington Post Staff Writer
Monday, August 10, 2009

As the first influenza pandemic in 41 years has spread during the Southern Hemisphere's winter over the past few months, the United States and other northern countries have been racing to prepare for a second wave of swine flu virus.

At the same time, international health authorities have become increasingly alarmed about the new virus's arrival in the poorest, least-prepared parts of the world.

While flu viruses are notoriously capricious, making any firm predictions impossible, a new round could hit the Northern Hemisphere within weeks and lead to major disruptions in schools, workplaces and hospitals, according to U.S. and international health officials.

"The virus is still around and ready to explode," said William Schaffner, an influenza expert at the Vanderbilt University School of Medicine who advises federal health officials. "We're potentially looking at a very big mess."

President Obama arrived in Mexico on Sunday for a two-day summit that will include discussions on swine flu, along with Mexico's drug wars, border security, immigration reform and economic recovery.

"Everyone recognizes that H1N1 is going to be a challenge for all of us, and there are people who are going to be getting sick in the fall and die," said John O. Brennan, the U.S. deputy national security adviser for counterterrorism and homeland security. "The strategy and the effort on the part of the governments is to make sure we . . . collaborate to minimize the impact."

Since emerging last spring in Mexico, the virus, known as H1N1, has spread to at least 168 countries, causing more than 162,000 confirmed cases and playing a role in at least 1,154 deaths, including 436 in the United States.

Scientists have been closely monitoring the flu's spread for clues to how much of a threat it might pose this fall. So far, no signs have emerged that the virus has mutated into a more dangerous form. Most people who become infected seem to experience relatively mild illness.

Still, the virus has caused major outbreaks involving a disproportionate number of younger people in Australia, New Zealand, Argentina and other countries, prompting schools to close, causing theaters to shut down, and straining some emergency rooms and intensive care units, sometimes forcing doctors to postpone other care, such as elective surgeries.

Swine flu has also begun to spread in South Africa, where at least two deaths have been reported; the national laboratory, meanwhile, was overwhelmed last week with samples that needed testing. In India, a 14-year-old girl became the first person to die from the disease in that densely populated nation.

In Britain, meanwhile, where anxiety was increasing because of high-profile cases including "Harry Potter" films actor Rupert Grint, health officials were trying to determine the cause of a sharp rise in reported cases in recent weeks.

"This is something that we could see here soon," said Arnold S. Monto, a University of Michigan infectious-disease expert who advises the World Health Organization, the U.S. Centers for Disease Control and Prevention, and other federal health agencies. He noted that some emergency rooms were overwhelmed by last spring's outbreak in New York City. "We have to be worried about our ability to handle a surge of severe cases."

Concern about a second wave has prompted a flurry of activity by federal, state and local officials, including intensifying flu virus monitoring and making plans to distribute vaccine and antiviral drugs and other treatments if necessary.

"There's a lot of moving parts to this," said Joseph S. Bresee, who heads the CDC's influenza epidemiology and prevention branch. "Hopefully we won't have a panic, but instead we'll have the appropriate level of concern and response."

The Obama administration has been updating recommendations for when to close schools, what parents should do if their children get sick, how doctors should care for patients and how businesses should respond to large-scale absences. Officials are hoping to navigate a fine line, urging precautions to minimize spread, serious illness and deaths while avoiding undue alarm and misinformation.

"The last time we had anything similar to this was prior to the Internet," said one senior official who spoke on the condition of anonymity last week during one of a series of background briefings for reporters.

A Gathering Storm

The virus could cause nothing more than a typical flu season for the Northern Hemisphere this winter. But many experts suspect the second wave could be more severe than an average flu season, which hospitalizes an estimated 200,000 Americans and contributes to 36,000 deaths. Because the virus is new, most people are not immune to it.

"This epidemic will transmit faster than usual, because the population is more susceptible," said Marc Lipsitch, a professor of epidemiology at the Harvard School of Public Health who has been helping the CDC project the severity of the upcoming wave. "It's fair to say there will be tens of millions of illnesses and hundreds of thousands of hospitalizations, and tens of thousands of deaths. That's not atypical. It just depends on how many tens of thousands."

Perhaps more important, in every country where the virus has spread, it has continued to affect children and young adults much more commonly than typical flu viruses.

"In a pandemic where a greater fraction of illness and deaths occur in kids and young adults, that will be clearly noticeable to the public. There will be a sense that this is a greater severity of illness even if fewer people die overall," the CDC's Bresee said.

Most of those who have developed serious illness and died have had other health problems. But those include many common conditions, such as diabetes, asthma and obesity. Pregnant women appear to be especially at risk. And the virus can cause severe illness and death in otherwise healthy people in perhaps a third of cases.

The virus continued to simmer in the United States over the summer, causing more than 80 outbreaks in camps in more than 40 states. Officials estimate that more than 1 million Americans have been infected.

The number of cases could increase rapidly as soon as schools begin to reopen in the next few weeks and could accelerate further as cooler, drier temperatures return, possibly peaking in October.

That is much earlier than the usual flu season, and it could create confusion. People could start becoming sick with the swine flu before a vaccine is widely available and nonetheless be urged to get the regular seasonal flu vaccine, which will be available first. Because different groups are being given priority for the different vaccines, officials are concerned it could be difficult to make sure the right people get the vaccine at the right time to provide optimal protection. The elderly are a top priority for the seasonal vaccine, but not for the swine flu vaccine.

The first batches of swine flu vaccine are not expected to become available until mid-October, assuming studies indicate it is safe and effective. And officials have yet to answer many key questions, including how many doses will be needed. If it is two, as many suspect, it could take at least five weeks after the first shot before vaccinated people are fully protected.

Southern Hemisphere

In the Southern Hemisphere, which experiences winter during the Northern Hemisphere's summer, the swine flu virus caused a more intense and somewhat earlier flu season in some places. In Argentina, which was hit particularly hard, school breaks were extended and the economy suffered as people avoided restaurants, clubs and other public places.

"There was panic and I felt it, too," said Cristina Malaga, a maid in Buenos Aires who stayed home for a week in July out of fear. "I was scared. It is three buses to get to work and there were many people on those buses who are coughing."

At the Gutiérrez Children's Hospital, officials set up a trailer with specially outfitted examination rooms to help deal with the influx of sick people.

"The system did not collapse, because we prepared special units for outpatients and for inpatients," said Eduardo López, who heads the hospital's medical department.

Paula Morey, a housewife who lives in an affluent neighborhood in Buenos Aires, said she and friends stopped sharing the national tea, which is served in a communal gourd. Now, she said, they bring their own gourd. Morey also began cleaning her 4-year-old daughter's hands constantly and carrying a tube of disinfectant to dab on the moment she touches anything like a doorknob.

"She had to learn to take care of herself," Morey said.

Greater Concerns

The appearance of the virus in countries such as South Africa and India is raising concern that the pandemic could be devastating if it begins to sicken large numbers of people in places with fewer resources.

"These are countries with vulnerable populations and fragile health-care systems," said Nikki Shindo, acting head of the WHO's influenza program.

Indian doctors and health officials were scrambling last week to prepare for a sharp increase in cases. Despite well-run clinics for the wealthy, many of India's government health services are overcrowded, understaffed, chaotic and antiquated.

"If we start investigating every case of H1N1 virus, I think the government facility will not be able to cope with the rush," said Dharam Prakash, the Indian Medical Association's secretary general.

In Kenya, white-coated health workers have been passing out questionnaires at the Nairobi airport and putting up glossy posters about the virus on the walls of downtown cafes. False alarms about the virus have spawned a sense of panic in some places. When a health clinic in a Nairobi mall recently suspected a patient of being infected, word leaked out and soon shoppers were sending out text messages across the city warning people to stay away. The clinic was shut down for a day.

Northern Hemisphere

In Britain, chief medical officer Liam Donaldson said there were several possible explanations for that country's recent increase in cases, including London's role as an international transport hub. In an effort to relieve intense pressure on doctors, the government recently launched the National Pandemic Flu Service, a phone and Internet hotline that allows patients to diagnose themselves and prescribe their own drugs.

"It's changing the way people are responding," said Alan Hay, who directs the WHO's World Influenza Centre in London.

Meanwhile, health officials in Virginia, Maryland, the District and other localities said they have been preparing all summer for the swine flu's return, including making plans to set up special clinics to treat and vaccinate patients if necessary.

"We're doing a tremendous amount of contingency planning," said Frances Phillips, Maryland's deputy secretary for public health.

Although strains of the virus have emerged that are resistant to Tamiflu, one of two antiviral drugs effective in treating it, scientists say both drugs generally appear to continue to be effective. The U.S. government shipped 11 million doses of the drugs to states to add to the 23 million they already had on hand and bought an additional 13 million doses to replenish its supplies.

"There's only so much that can be done to get ready. Flu, like a hurricane, is a force of nature. You can't stop it. You can't make it less severe than it would be otherwise," said Eric Toner of the University of Pittsburgh's Center for Biosecurity. "All you can do is try to be prepared to deal with the consequences."

The last flu pandemic, the 1968-69 Hong Kong flu, was the mildest of the 20th century, contributing to perhaps 1 million deaths worldwide, including about 34,000 in the United States. After emerging, many flu viruses continue to circulate for years, while others disappear or combine with other viruses.

Correspondents Juan Forero in Buenos Aires, Emily Wax in Mumbai and Stephanie McCrummen in Nairobi; special correspondent Karla Adam in London; and staff writer Cheryl W. Thompson in Guadalajara, Mexico, contributed to this report.

Singapore Confirms 26 New Flu A/H1N1 Cases

SINGAPORE, June 23 (Xinhua) -- Singapore confirmed 26 new cases of Influenza A/ H1N1 on Tuesday, bringing the total number of confirmed cases here to 194.

According to the country's Health Ministry, the newly confirmed cases comprise 10 local cases and 16 cases with travel history.

The ministry said that local pandemic preparedness clinics are gearing up to help manage and treat suspect Influenza A/H1N1 patients, adding that these clinics are located island-wide to ensure that Singaporeans have easy access to medical assessment and prompt treatment for influenza-like illness.

Singapore reported its first confirmed case of Influenza A/H1N1on May 27. So far, 68 patients have been discharged. The remaining126 patients are still in the hospital and their conditions remain stable.

Editor: Mu Xuequan