Operational Biosurveillance

Post-Sandy Influenza Forecast Validation

We had been concerned about the potential for influenza transmission post-Sandy among stressed, displaced citizens.  Particularly in emergency shelters. 

Reporting from the state of New York on Nov 17th revealed an increase in influenza activity (see attached).  The question that will likely go unanswered is to what degree, if any, population displacements due to Sandy influenced transmission.  We know that much of the country has been reporting early activity of influenza, likely mitigated by higher vaccination rates post-the 2009 H1N1 pandemic.  This was a validated forecast that applied to North America writ large.

Download Flu_report_current_week

Intercept Team SitRep (Rockaway and Statten Island)- UPDATE 1

We have a correction and additional information to post, which do not substantively change the forecast:

• It was previously reported that a physician in New Jersey, working in an area that was not effected by Sandy, was seeing a substantial increase in bronchitis and bacterial (influenza negative) pneumonia.  This was an error.  These patients were from Sayreville, New Jersey, which received flood damage and population displacement.  Again, these patients were managed at the outpatient level with no admission required.

• We have received report of responders with upper respiratory symptoms, but no serious disease.

The forecast remains valid, however we continue to monitor the situation and will adjust the forecast as appropriate.

Intercept Team SitRep (Rockaway and Staten Island)

So far, the previously released infectious disease forecast has held.  These are the current observations over the last 24 hrs of relevance to infectious disease transmission potential:

• Ongoing problem of elderly and other inhabitants who either chose not to evacuate or were unable to evacuate residing in areas without power, ready access to safe drinking water, food, medications, or medical attendings.  For Rockaway, this has been mitigated by the tremendous influx of volunteers, medical personnel, and officials over the weekend.  

• The disposition of generators has been a contentious issue, as there does not appear to be enough to go around. 
  

• Food spoilage has been an issue, which is not unexpected and has been reported previously.  The concern is consumption of contaminated or spoiled food which can lead to vomiting and diarrhea.  Again, in isolated elderly who may already be dehydrated, this is an issue.

• Victims have been observed to use fire hydrants for their water supply.  It is unclear how safe this water is to drink, for instance, on Rockaway.

• We have had reports of bronchitis and bacterial pneumonia from one family medicine physician who has a clinic in New Jersey- an area NOT effected by Sandy.  Nevertheless, this provides us with information that these are issues that are being seen.  None of the patients that were seen at this clinic required hospitalization.  We suspect these were actually VIRAL, not bacterial, based on the clinical description.  No influenza positives in these patients.

• We really have NOT seen much reporting of vomiting and diarrhea.  We HAVE seen two previously reported outbreaks of what looked like viral diarrhea thus far- either food contamination or infection- which was self-limited and required minimal medical intervention.

• An outbreak of diarrheal illness in abandoned elderly can mean death… that, in addition to all the other factors that may result in mortality such as using portable gas stoves indoors for cooking or heating; lack of access to power, food, water, meds, and medical care; lack of heating; etc.  Obviously, hypothermia and asphyxiation has been a much bigger issue right now than infectious disease. 

Up to this point, our team focused predominantly on operational support to several large volunteer response groups such as Rockaway Relief.

Post-Sandy Infectious Disease Forecast [UPDATE 2]

We have received additional information this afternoon to warrant minor adjustments to the forecast and additional ground observations:

• As mentioned in the prior forecast, we assess there will be minimal medical infrastructure strain due specifically to infectious disease UNLESS mass groups of abandoned or sheltered-in-place elderly are not addressed by medical responders.  The surge of response today in Rockaway is a positive step in mitigation.  We have seen evidence of food safety issues emerging due to loss of power and refrigeration.  This issues are accentuated among the abandoned or sheltered-in-place elderly who are attempting to care for themselves without external support.

• Communication with physicians in New Jersey have revealed report of increased case counts of bronchitis and bacterial pneumonia without laboratory diagnostic evaluation to determine the specific pathogen.  These cases are influenza negative and are able to be dealt with at the outpatient level.  This is consistent with the original forecast.

• Deployed medical responders in Rockaway did not indicate significant diarrheal disease, consistent with the original forecast.

• To date, we have observed no report of significant medical response infrastructure strain due to unexpected infectious disease activity.

This forecast will be updated as conditions warrant.

Post-Sandy Infectious Disease Forecast [UPDATED]

Yesterday, the Ascel Bio National Infectious Disease Forecast Center activated its Intercept Ops Team to assist volunteers in Rockaway and Statten Island. 

After a review of scant reports of diarrhea in Rockaway and media reports of "norovirus" (unknown what laboratory diagnostics were performed) affecting several shelters in Brooklyn and national guard troops at Jersey City, we assess at this time the forecast has been accurate up to this point.  It is important to note that true peaking norovirus activity, especially among the elderly in nursing homes, is not expected until January.  Norovirus circulates year-round and is capable of limited outbreaks at any time in the year.  That said, there are a plethora of other pathogens capable of causing self-limited diarrhea including rotavirus and endemic coronavirus, for example.

The lingering, late impact effects observed in Rockaway, for example, compells us to make several adjustments to the original forecast:

• We assess there will be minimal medical infrastructure strain due specifically to infectious disease UNLESS mass groups of abandoned or sheltered-in-place elderly are not addressed by medical responders.  We have received reports of elderly without power, access to safe drinking water, food, and medicine for 4+ days.  There are reports of fatalities due to hypothermia as reported elsewhere.  Sanitation has reportedly been compromised.  This is an unhealthy, unsafe environment for vulnerable elderly who are at high risk for poor outcomes, including fatality, due to diarrhea disease.  Reports from the ground indicate scattered cases of diarrhea, which is not unexpected.  There remains opportunity to stay ahead of the problem and not compromise the lives of the elderly.

• Influenza remains a potential disruptor due to this being a drift year that required updating of the influenza vaccine.  We have encountered significant opposition to influenza vaccination, representative of the anti-vaccination movement by local volunteer responders.  We have worked to correct misconceptions about the safety of the vaccine, acknowledging it is not as effective in the elderly but yet might keep them out of the hospital.

The National Infectious Disease Forecast Center remains in tight communication and support of local volunteers who are fighting to keep their neighbors safe in a difficult time.  Communications with local hospital medical staff have indicated a lack of awareness of field conditions, which is not uncommon given their focus on in-house patient care.  We have seen much controversy and social outcry regarding local perception of national, state, and local response efficacy.