How the CDC Would Deal with a Real-Life 'Contagion'

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How the CDC Would Deal with a Real-Life 'Contagion'

Post by Bravo4 on Thu Aug 01, 2013 5:54 pm


How the CDC Would Deal with a Real-Life 'Contagion'
By Lauren Cox

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Hollywood loves to bring us worst-case scenarios: catastrophic twisters, Earth-destroying asteroids or, in the case of the upcoming film "Contagion," a rapidly evolving virus that threatens to wipe out global society as we know it.

But while it's a fun fantasy for moviegoers to ask, "What would I do if that happened?" it's actually the job description of Assistant Surgeon General Dr. Ali S. Khan.

Khan oversees the brain trust of offices and laboratories set up to respond to the real pandemic threats that inspire movies like "Contagion." The U.S. Centers for Disease Control and Prevention Strategic National Stockpile, the Division of Emergency Operations Center, the Division of Select Agents and Toxins and other offices are constantly monitoring and preparing for a pathogen that could turn into a deadly pandemic.

"This is much more than about the health of America. This is about national security, our health security," said Khan, who is the director of CDC's Office of Public Health Preparedness and Response.

Khan said the CDC's first line of attack is to know its enemy: the genetics of the virus, how it attacks and who it kills. [5 Most Likely Real-Life Contagions]

"If you don't know what it is, you can't make a lab test for it, you can't make a treatment for it," Khan said. "Everything hinges on knowing what it is."

Disease Surveillance

CDC labs were on the front lines researching SARS, the coronavirus, some strains of the Ebola virus and others before they were under control. Khan said if a virus isn't understood internationally, the World Health Organization and others may send it to CDC laboratories.

"We don't outsource. The buck ends here," Khan said.

The CDC also has more than 500 people placed at county and state health departments "working shoulder to shoulder" with public health officials to track disease, Khan said. Local health departments manage most small outbreaks alone, but if something more widespread strikes, such as the H1N1 outbreak of 2009, the CDC will hear about it quickly.

But while understanding a virus's biology is a priority, officials can't wait to react until the threat is perfectly understood or they will miss the window of opportunity to contain a pandemic, said Ken August, spokesman for the California Department of Public Health.

Containing a contagion

State public health departments have tremendous legal power to take control of a situation with the help of local law enforcement, homeland security or emergency management offices.

A person who has come down with a virus with no treatment or vaccine would be considered "a case," said Dr. Tomas Aragon, director of the Center for Infectious Diseases & Emergency Readiness at the University of California, Berkeley, School of Public Health.

"We do what's called 'case isolation'; you identify them and then you isolate them so they can't infect other people," Aragon said.

Officials could quarantine people exposed to a virus, but haven't yet come down with symptoms. However, officials don't need to know whether someone has been exposed for them to act. In the practice of "sheltering" and "social distancing," Aragon said, officials could restrict the movement of unexposed people to prevent transmission, or to slow transmission among the public at large by closing schools, restricting travel and canceling mass gatherings.

"Yes, there can be isolation and quarantine. In California, a local health officer has broad powers to take whatever actions needed," August said.

But government powers fall short of pulling a person from his or her home, said Kris Eide, director of Homeland Security and Emergency Management for the state of Minnesota.

"The governor can order an evacuation, but we cannot force an evacuation — I think you'll find that in almost every state," Eide said.

Once a virus is identified, the CDC would work with pharmaceutical companies to develop a vaccine, manufacture it, test it for safety with the U.S. Food and Drug Administration and then distribute it through local public health departments, said Dr. William Schaffner, former board member of the Infectious Diseases Society of America.

While the CDC is in the business of developing treatments, Schaffner said local hospitals and officials practice delivering them.

"Public health departments, as well as hospitals, run drills. And by doing so, they do indeed find snags to plans," said Schaffner, who is also chairman of preventive medicine at Vanderbilt Medical Center in Nashville, Tenn.

Eide said a local public health department would take the lead, while her department would provide resources to protect stockpiles, build makeshift clinics or provide any other services needed.

As public health officials tried to save lives, they also would have to work with civilians to keep society functioning through the containment efforts.

"If a chain of grocery stores were to have 25 or 30 percent of their employees sick, how would they be able to keep operating?" said August, who said public health departments would communicate with truck drivers, hospitals and other essential civilian services to keep operations running.

The public health officials noted that communication with the public, even people who can't do anything to help, is a key to controlling a contagion.

"There's the disease, and then there's the fear, and you need communication so that people don't go bananas and cause further disruption," Schaffner said.

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Re: How the CDC Would Deal with a Real-Life 'Contagion'

Post by Bravo4 on Thu Aug 01, 2013 5:58 pm

5 Most Likely Real-Life Contagions

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5 Influenza
Credit: CDC/ F.A. Murphy

Given the 1918 scourge that killed millions, and the worry that the 2009 H1N1 outbreak brought, epidemiologists are willing to wager that influenza has the potential to turn into a deadly pandemic.

Flu viruses spread on airborne droplets when someone coughs, sneezes or talks. But people can also pick up the virus indirectly, because it can survive for some time on objects such as phones, buttons or keyboards, according to the Mayo Clinic.

Fevers, aches, sore throats, cough and fatigue are hallmarks of the flu. But the respiratory illness may bring complications such as pneumonia, which can be deadly if a strain is particularly virulent, according to the Centers for Disease Control and Prevention (CDC).

And because the flu mutates in animals and can jump to humans, epidemiologists could never rid humans of influenza through vaccination campaigns, said Dr. Tomas Aragon, director of the University of California, Berkeley, Center for Infectious Disease and Emergency Readiness.

"All the subtypes live in wild birds, and they're mutating, and when they come to the human population, we're not immune," Aragon said.

4 SARS
Credit: Dr. Mary Ng Mah Lee

When the virus that causes severe acute respiratory syndrome (SARS) struck in 2003, it showed how public health systems could react to an outbreak, and at the same time, how a deadly pandemic may hit the globe. That year there were an estimated 8,000 cases and 750 deaths, according to the CDC and the National Institutes of Health.

The SARS virus is a virulent mutation of a virus in the coronavirus family viruses in this family also cause the common cold.

"It was so pathogenic, that almost everybody who became infected became ill," Aragon said of the 2003 SARS outbreak in East Asia.

SARS symptoms such as fever, headache and cough often quickly turned to pneumonia. SARS had a 9 to 12 percent death rate among people who were diagnosed, according to the NIH. And in people older than 65, the death rate was more than 50 percent.

Aragon credits swift international actions, including closing schools, quarantining sick people and issuing travel advisories, with stemming a potential global pandemic.

SARS spreads through airborne droplets much like the flu, but much remains unknown about its origins; the virus could mutate again in animal hosts and jump to humans.

"SARS, even though it's disappeared, could return at any time," said Dr. Ali S. Khan, director of the CDC's Office of Public Health Preparedness.

Anthrax
Credit: CDC/Megan Mathias and J. Todd Parker

Public health experts must also look beyond nature for unknown pandemic threats. Diseases that are generally under control in nature could turn into deadly outbreaks if used as a bioterrorism weapon.

"Anthrax is most concerning," said Aragon, of potential bioterrorism threats.

Anthrax bacteria (Bacillus anthracis) can infect humans in three ways, and each route of transmission leads to different symptoms, ranging from an itchy sore on the skin to breathing problems, fever and shock. About 95 percent of known anthrax infections are passed to humans from livestock through skin contact, although eating tainted meat can also transfer the bacteria, according to the NIH and CDC.

But in 2001, 22 people became ill after breathing in anthrax spores sent through the mail. Inhaling anthrax can lead to a deadly infection that starts several days to weeks after exposure. Once anthrax spores germinate, they release toxic substances that cause internal bleeding, swelling and can kill tissue, according to the NIH.

Although antibiotics can usually cure a skin anthrax infection, the CDC estimates 75 percent of people who contract anthrax by inhaling spores will die, even with medical care.

2 Drug-resistant tuberculosis
Credit: CDC/Dr. Ray Butler

Some pathogens cause trouble not so much because they kill quickly, but because they can't be killed easily.

"Another infection that's widespread in the world, and we are holding it at bay, is tuberculosis, or TB," said Dr. William Schaffner, former board member of the Infectious Diseases Society of America.

Spread through airborne droplets in a cough, TB can survive as a low-grade infection in a person for years slowly spreading to others throughout a community. Symptoms include a chronic cough, severe weight loss and night sweats.

TB killed 1.7 million people in 2009, making it one of the world's deadliest infectious diseases, according to the World Health Organization. Many of these deaths could be prevented if patients were treated with a six-month course of medication.

Moreover, in the past 15 years, drug-resistant forms of TB have threatened efforts to fight the disease. As TB bacteria evolve to be drug-resistant, doctors worry they will loose ground fighting a disease that afflicted much of the world before the development of antibiotics


1 Ebola
Credit: CDC/ Brian W.J. Mahy, BSc, MA, PhD, ScD, DSc

The Ebola virus might not kill as many people each as TB, but it is still one of the deadliest pathogens on record and a subject in popular media since it was discovered in 1976.

Ebola can silently incubate in a person for two to 21 days, after which a person may suffer an abrupt fever and headache, according to the CDC. Joint and muscle aches, sore throat and weakness usually give way to diarrhea, vomiting and stomach pain. Some people with Ebola will have a rash, red eyes, internal and external bleeding, according to the CDC.

All four strains of the Ebola virus known to infect humans are spread through contact with blood, tissue or bodily fluids, according to the World Health Organization. The most virulent strains of Ebola kill 25 to 90 percent of people they infect. All outbreaks of Ebola have occurred in Africa, and scientists hypothesize the virus is carried within wild animals, according to the CDC.


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