- DETROIT: CHILD & INFANT MORTALITY – Detroit’s bankruptcy follows a bewildering cascade of poverty and loss. Children especially suffer the consequences, forcing us to focus on priorities. 2010 vital statistics: Detroit had the worst child mortality rate of any major US city with 120 deaths per 100,000 children. Detroit also led the nation in infant mortality with 13.5 deaths/1,000 live births. Complications of prematurity were the leading causes. Homicides, mostly due to gun-related assaults and accidents, were the second leading cause of child deaths. Detroit’s child and infant mortality rates are more than twice US national averages (26/100,000 children and 6/1,000 live births in 2011, respectively). Mortality statistics are the visible markers of wider problems. For example, national observations show that for each gun-related death of a child, there are 10 more serious gun-related injuries, many causing lasting disabilities, and each with complex potentially preventable causes. As Detroit works to emerge from bankruptcy tentative plans include the demolition of hazardous abandoned homes that contribute to violent crime and low property values, and capital improvements for the city’s police, fire, and recreation departments. Tradeoffs: retirees will lose pensions and creditors will lose investments. We await more details about better prenatal care. Meanwhile other less visible US cities face similar disasters accompanying public bankruptcy.
- “ONE SHOULD NOT ATTEND EVEN THE END OF THE WORLD WITHOUT A GOOD BREAKFAST.” – Robert A. Heinlein. One business consistently stays open in the aftermath of public health emergencies. Continuity of operations is a priority at Waffle House, whether after a snowstorm or a hurricane. Lessons for the rest of us?
- WEATHER REPORT – Although the US has been more concerned about the polar vortex this season, Australia has battled a terrible heat wave. Public health strategies to save lives in a heat wave include good forecasting, public advisories, reminders about hydration, access to air conditioning, and community engagement to check on neighbors.
- RESOURCES FOR SCHOOL EMERGENCY PREPAREDNESS – See the website on Readiness and Emergency Management for Schools Technical Assistance Center from the US Department of Education.
- DISASTER BEHAVIORAL HEALTH – The US Department of Health and Human Services has released a publication outlining concepts of operations for agencies involved in behavioral healthcare after major emergencies.
- AFTER THE FLOOD – Historically, industries were often located in urban population centers. Defunct and buried, latent environmental dangers are often forgotten. Many communities only realize the potential hazard after toxic chemicals are dispersed from former industrial sites by natural disasters. A study of former lead smelting plants in urban neighborhoods analyzed their proximity to high-risk disaster zones (floods, earthquakes, tornados, or hurricanes). Of 229 former smelting plant sites in the US, 29% were in relatively high-risk locations for natural disasters. The findings suggest that identification of point sources of toxic chemicals by local hazard analyses prior to a natural disaster would enable more timely surveillance and intervention to prevent human exposures after a natural disaster. Major concerns about human exposure to toxic chemicals were encountered after Hurricanes Sandy, Rita, and Katrina, as well as following the Joplin tornado of 2011.
- SEVERE INFLUENZA – It is easy to understand why influenza causes severe illness in the elderly and chronically ill. Comorbidities result in impaired compensation for any acute illness. The reasons why influenza causes severe acute illness in otherwise healthy young patients is less clear but may involve differences in prior immunity, viral load, or inflammatory responses in the young. A recent clinical study of infants, children and adults shows that neither prior immunity nor viral load correlated with varying severity. Rather, the sicker patients tended to have a distinct pattern of cytokines and monocyte subsets in respiratory mucosal secretions, across all ages. Another study of sicker patients showed that influenza deaths tended to be associated with bacterial coinfection, low neutrophil counts, and a distinct pattern of inflammatory cytokines. Characteristics of the inflammatory response are associated with severity of influenza pneumonia. Therapeutic implications are yet to be determined.
Edited by: Dr. Bob Kanter