- MEASLES IN NEW YORK CITY – Spread by aerosolized droplets from coughing, measles is one of the most contagious infectious diseases. Prior to an effective vaccine, measles infection was almost universal in childhood. Immunizations have almost eliminated measles in the US, so many have forgotten its danger. In the last US epidemic during 1989-91, 123 deaths occurred among 55,000 infected individuals. Deaths are due to pneumonia or encephalitis. It is easy to mistake early nonspecific fever, cough, runny nose, and irritated eyes for a common cold. Unfortunately the infection is already contagious. The diagnosis is more obvious when the characteristic Koplik spots appear in the mouth, followed by a red rash on the face, trunk, and extremities. The current outbreak in New York City involves children too young to have been immunized, others whose families refused immunization, as well as adults with uncertain immunization status. Hundreds of potential exposures to unrecognized measles-infected patients occurred in New York City emergency departments in February and March. See opinions about mandatory immunizations versus exemption from required vaccines. What justifies refusal of an immunization? What if the unimmunized child becomes the source of infection that endangers others? When too many families assume their own child is safe without immunization because others have immunized their children, then an outbreak is ready to happen.
- FAILING INFRASTRUCTURE – A fatal gas explosion destroyed a building in Harlem last month about 20 minutes after a neighbor reported smelling a gas leak. In 2012, 9,906 reported gas leaks occurred along 6,302 miles of natural gas pipes under New York City and Westchester County, far higher than the national rate of 12 leaks per 100 miles of pipes. In New York, almost half of gas mains are older than 60 years, an example of the national problem of aging and failing infrastructure.
- GIMME SHELTER – The 2014 Pritzker Architecture Prize was awarded to Shigeru Ban for his designs of temporary shelters in communities recovering from disasters. His insights into “what it means to have a roof over your head”, use solutions developed at the disaster site with those in need of shelter.
- DISASTER MEDICAL RESPONSE – Experience in Philippines typhoon relief provides guidance promoting professionalism and preparation by medical teams and flexibility to integrate with local resources.
- “RATIONING SALT WATER” – Isotonic saline is the standard intravenous fluid to resuscitate patients with dehydration, septic shock, or any critical illness or injury. Recently IV salt water joined the list of inexpensive emergency drugs in short supply nationally. The shortage is not because these medications are so advanced and difficult to manufacture. Rather their low cost provides insufficient incentive for reliable production. Other medications recently in short supply include reliable antibiotics, cancer treatments, cardiac emergency drugs, neuromuscular blockers, antiemetics, analgesics, and steroids. A commentary in the New England Journal of Medicine outlines some organizational emergency management backup plans that might be used by hospitals to mitigate the shortage. However, inefficient fragmentary improvisations at the clinical front lines miss the real issue. Is there any role for government action in healthcare and public health? If so, it is surely to promote systematic solutions defending basic public safety. When market forces fail to ensure access to simple standard evidence-based life-saving therapy, public interests are threatened. We already have federal laws guaranteeing access to emergency departments. Shouldn’t basic tools be available when patients arrive at the ED? Should we really be talking about substituting, conserving, and rationing inexpensive standard treatments on a normal day? How can we imagine stockpiles for future mass casualty emergencies when we cannot even guarantee routine supplies? Rationing should be for real disasters, not to compensate for national system failures in the operation of everyday healthcare.
- TUBERCULOSIS AND CHILDREN – New estimates suggest that 1 million children worldwide develop tuberculosis each year. Previous surveillance appears to have underestimated pediatric infections because diagnostic tests for childhood tuberculosis remain less sensitive in detecting disease than in adults. Over 30,000 of the annual pediatric infections involve multidrug-resistant disease, a proportion similar to adults, reflecting local antimicrobial resistance patterns.
- SCHOOL INTERVENTIONS AFTER DISASTERS – Interviews with healthcare providers and school staff described the important role played by schools in Joplin recovering after the 2011 tornado.
Edited by: Dr. Bob Kanter