Non Pharmaceutical Intervention, NPI meditations

Owl Train to NPI Station

Non Pharmaceutical Interventions Station reside in a Village in Regions of North America.

In these Villages they usually have few groups;

The Free for All,

Clean-Cut Red Necks and

The Ponderers

Among those who ponder on NPI there are  the Consensuals whose

Credo is Reduce morbidity and mortality in a crisis.

What is Great in NPI Station is the Gathering of Public Health Officers with the the groups of the Village.

At the Top of the door of NPI Station is written;

“First thing First”

At the Village, the Medias welcomed Public Health Officine on spot or somewhere else mostly tributary of the ‘Mood’ of a given Region.

In the Owl Train there are always newspapers or documents left on Purpose for the Next Host.

Here it is

H1N1: Why Do Schools Close, And When Do They Open?
by DemFromCT

Sun May 03, 2009 at 08:02:03 AM PDT

CDC says its own count is outdated almost as soon as it’s announced. More cases are being confirmed daily. About one-third so far are people who had been to Mexico and probably picked up the infection there. Many newly infected people are getting the illness in the U.S., and the CDC says it probably still is spreading.

In this case, there are a lot of things that really need explaining:
what a pandemic is (based on spread, not severity)

why there are school closures with only a handful of cases

why this appears to be no worse than seasonal flu – yet isn’t seasonal flu and has to be treated differently

why testing isn’t instantly available (needs sophisticated PH lab testing)

why not everyone needs tamiflu even though tamiflu “works” (mild flu does not need treatment, regardless of seasonal or swine designation)

So let’s tackle some of those difficult points, starting with school closure.

The rationale for school closure was developed in concert with the idea that a pandemic means a widespread geographic range — for the WHO, it has got to be on two continents:

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

For a given region, even in a pandemic, spread may have just started to get underway.

See CDC graph for the initiation, acceleration and peak:

We are not at the peak now (but we might be at the acceleration interval.) It’s early and worse things can come. So wouldn’t that mean we are at phase 6? Well, the thought all along was that it all would start in Southeast Asia and then at Phase 6, come to San Diego. Acceleration matches “spread throughout United States” on the top of the CDC graph and sits within phase 6, and with 21 states involved, we properly might now describe things as exactly that. That’s why WHO recently revised the phases. In the new method, phase 5 simply means widespread in one region. In fact, it’s in San Diego, and it will be Phase 6 when it moves to Hong Kong or New Zealand or the UK. Therefore, moving to phase 6 doesn’t affect what we already have in the US. Declaring a pandemic is for the rest of the world. We got what we got right here, right now, whatever it’s called.

The peak means sick people, and hospitalizations, and some death. It would be helpful to shrink it, delay it, and mitigate it.

The three major goals of mitigating a community-wide epidemic through NPIs [non-pharmaceutical interventions] are

1) delay the exponential increase in incident cases and shift the epidemic curve to the right in order to “buy time” for production and distribution of a well-matched pandemic strain vaccine,

2) decrease the epidemic peak, and

3) reduce the total number of incident cases and, thus, reduce morbidity and mortality in the community (Figure 1). These three major goals of epidemic mitigation may all be accomplished by focusing on the single goal of saving lives by reducing transmission. NPIs may help reduce influenza transmission by reducing contact between sick persons and uninfected persons, thereby reducing the number of infected persons. Reducing the number of persons infected will also lessen the need for healthcare services and minimize the impact of a pandemic on the economy and society.

The surge of need for medical care associated with a poorly mitigated severe pandemic can be only partially addressed by increasing capacity within hospitals and other care settings. Thus, reshaping the demand for healthcare services by using NPIs is an important component of the overall strategy for mitigating a severe pandemic.

The less severe the pandemic, the less mitigation is needed. But as far as that peak goes, here’s the goal:

Coherent, Clear,  Swift and Bold Pulic Health Message, a Must Read at,-And-When-Do-They-Open

What For, Why Now and … the Parent is left with Consequences.


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