about public health
The World Health Organization (WHO) said earlier today, Tuesday, that countries should consider closing schools as a way to slow the spread of novel H1N1 swine flu.
The United Nations agency also said the official death toll of the disease since it emerged in April has risen to 700 from the 429 reported two weeks ago.
According to a Reuters news report earlier today, WHO spokeswoman Alphaluck Bhatiasevi told the press that 125,000 laboratory-confirmed cases have been reported, and that:
“School closure is one of the mitigation measures that could be considered by countries.”
Last week, because the virus has spread so fast, the WHO asked countries to stop reporting individual cases. The novel H1N1 has spread as much in 6 weeks as previous pandemic flu viruses spread in 6 months, they said.
Countries should now focus on reducing spread and looking for unusual patterns, such as how it affects absenteeism.
The WHO said it was up to individual countries to decide whether to close schools and it was up to their own health authorities to do what they thought was right to stem the spread of swine flu.
Bhatiasevi said different countries were facing the “pandemic at different levels at different times”.
“So it is really up to countries to consider what mitigation measures suit them in regard to the situation in individual countries,” she added.
A European team of researchers wrote yesterday in an article published in the Lancet Infectious Diseases that governments thinking of using school closure (known as “class dismissal” in North America) need to:
“Weigh the potential health benefits of reducing transmission and thus case numbers against high economic and social costs, difficult ethical issues, and the possible disruption of key services such as health care.”
Dr Simon Cauchemez of Imperial College London and colleagues also cautioned that it was still important to plan to minimize the negative consequences, whether school closure was to be a deliberate policy or just a result of too many staff being absent.
However, they did suggest that closing schools might slow the spread of the virus and buy time until vaccine doses were available.
Bhatiasevi told Reuters that the WHO was also co-ordinating a network of mathematicians, epidemiologists and virologists who are using mathematical models to work out various pros and cons of different measures and forecast the most cost-effective ways that countries might use to slow down the spread of swine flu.
An Ethical Can of Worms
I have often said that if I could do it all over again, I would study and major in medical ethics. It is a fascinating field that grows in complexity everyday. Medical research is growing exponentially and with it are growing questions.
How do we ever strike a balance between what we learn intellectually and what we question morally? A situation is now receiving public attention that centers around two topics that would seem to be unrelated: Superbugs and Alzheimer’s.
To bottom line it, the question is, “Do we administer antibiotics to someone with a disease such as Alzheimer’s, when we might be creating superbugs by doing so?”
That is a slippery slope and one I am glad I don’t have to try to navigate.
One side of the discussion says that patients with advanced dementia should not be given antibiotics when they contract an infection; pneumonia is a good example of a disease that can be treated. As most of the patients with severe dementia live in nursing homes, the patients and the environment have become the perfect breeding ground for bacteria that is resistant to antibiotics.
Therefore not treating the individual with an infection, prevents the bacteria from evolving into a superbug. The downside is that the lack of treatment is very likely the mechanism that kills the patient. The public’s health is protected but at what cost?
We believe that the widespread use of antibiotics in advanced dementia may pose a potential public health risk through the emergence of antibiotic resistance.
Archives of Internal Medicine, 2-16-08
The other side of the discussion takes the traditional approach: Life is sacred, we treat what we can and we don’t allow people to die due to lack of treatment. However, in doing so, we are likely creating bacteria that will reach the general population; these antibiotic resistant infections will then not be responsive to treatment and deaths will occur because of treatment (as opposed to the lack of treatment discussed above).
The problem centers around defining what end-stage diseases are; obviously the final days of cancer are end-stage. And most physicians treating Alzheimer’s feel it too is a terminal condition that once in an end-stage status, differs little from cancer.
This issue has by no means been settled. The study that was conducted was just published last month. But it has opened the dialog about how we handle less tangible, but equally devastating, diseases. Without a doubt end-of-life decisions are made all over the country, privately in hospital and nursing home rooms, between families and doctors; perhaps now some real and honest discussions can occur and some conclusions reached.
Study Suggests Antibiotics Are Overused
Antibiotics Overused in Dementia Patients
Antibiotics May Be Overused Near the End of Life
AMA Medical Ethics