Minneapolis physician weighs in on the loss of the personal touch in medical care; part of the "social contract"?

Minneapolis physician Ronald B. Glasser has an interesting outlook in the Washington Post today (May 31, 2009) about health care, “Marcus Welby? He’s History,” (also the followup page: "Today's Medicine is not a calling, it's a job") with link here. Having lived in Minneapolis from 1997-2003 and having had an accidental surgical emergency, I can say that the actual delivery of health care there is close to the best in the nation (at least at the University of Minnesota) – at least, I got a first-of-a-kind surgery without charge, and it worked.

Glasser discusses the attitude of physicians, now as “employees” of large hospital corporations, influenced by malpractice concerns and aware of what insurance companies and the government will cover. The personal touch is gone, he says. Somehow I’m reminded of the country doctors in the original “Invasion of the Body Snatchers” movie.

Having watched the PBS “Sick Around the World” documentary recently, I wonder why we keep on doing all this to ourselves. Would a private-government system like that in Germany, Taiwan, or especially Switzerland work well here and solve our problems? Would doctors get some personality back? (I’ll just mention that all the conservatives are complaining that Obama wants government to “compete” with the private insurers and drive them out of business.)

Glasser also points out that in a few years we will have more people over 80 than we have under 18, and he points out that few physicians want to go into geriatrics. But even with a European-style health system, we’ll have to deal with the fact that eldercare is labor intensive, and dependent on the intervention and hands-on presence of blood or immediate family, which has itself become weaker. Phillip Longman could be right – we need a new “social contract” about what family responsibility means. But we may already have some of it, at least in the 28 states with filial responsibility laws. And with the economic crisis and shrinking state budgets, these states might start implementing the social contract soon.

How debate on issues goes around and comes around.

CDC documents "Lujo", a new Ebola-like virus in Africa

The Centers for Disease Control and Prevention is reporting a new deadly virus called “Lujo” in Africa. (It rhymes with Stephen King’s “Cujo”). The virus causes aggressive hemorrhagic fever in a manner similar to Ebola and Marburg. It is spread by direct blood and body fluid contact. It is not easily transmitted by casual contact the way influenza is, but is probably more communicable than HIV or Hepatitis B and C. Four out of five patients died. Patients who recover from these fevers may have serious organ damage, as the virus causes some tissues to almost “liquefy”.

The AP by Mike Stobe story appeared on AOL today, and the original AP link is here.

The CDC has a "Special Pathogens Branch" information page on Ebola, which does not yet mention Lujo, but presumably will do so soon.

Ebola and Marburg were subjects of Robert Preston’s book “The Hot Zone” and there is a story at a contagious form of Ebola was found in animals and almost released in 1989, a germ called “Ebola Reston”.

Obama picks Sonia Sotomayo for Supreme Court vacancy

Major media outlets report that President Barack Obama has named Judge Sonia Sotomayo as his nominee for the United States Supreme Court, to replace Justice David Souter for the fall term in 2009. She serves on the United States Court of Appeals for the Second Circuit in New York (link).

The CNN news story is here.

She would be the first Hispanic to be nominated to the Court, if she is confirmed.

The Washington Post has a profile of her here.

Generally, the media is reporting that Republicans will have difficulty challenging her.

President Obama has said that he seeks a nominee with empathy as well as intellect and logic. Perhaps he is remembering Al Gore’s comment, in Gore’s book “The Assault on Reason”, that logic itself can run amok. He said he wants a justice who looks at how problems play out in a real world. "Conservatives" claim that "empathy" is a code name for "court made law" (people say that some of my postings lack "empathy").

Sotomayo ruled against the baseball owners in 1995 and forced them back to the negotiating table, ending the baseball strike that had started in August 1994 and ended that season without a world series. (I remember "No baseball"). She grew up in the Bronx and supposedly is a Yankee fan.

The Los Angeles Times has a story about the baseball strike: "It could qualify as restorative justice; Supreme Court nominee Sonia Sotomayor got the strike-threatened 1995 major league season rolling by issuing a temporary injunction", by Mike Penner, link here.

She once said, "It is at appeals courts where policy is made. I know I shouldn't say this."

President Obama is certainly setting up a pattern of letting Congress and others take the reins on debating the details of issues.

Teachers are giving up pay to save jobs in recession

The New York Times, on Sunday May 24, 2009, ran, on p A23, a local story by Winnie Hu, “The New Math: Teachers Share Recession’s Pain,” link here

Given all the hype about the shortage of teachers, it seemed that teaching was recession proof, but in some school districts teachers are accepting pay cuts or reducing extracurricular programs to avoid layoffs.

This is said to be the first time in recent history that teachers had to budge. But back in 1975, during the New York City financial crisis (after the “Ford to City: Drip Dead” headline (blog story) in the New York Daily News) the teachers’ union, under Shanker, gave in somewhat to help solve the crisis.

John Stossel has reported that New York City has a holding pen for bad teachers who remain on full salary.

But I suspect there will be more political pressure to use economic stimulus money to pay and attract teachers again.

Washington Post piece Memorial Day recalls the draft

The Memorial Day weekend Sunday outlook section of the Washington Post features a remembrance by Michael R. Austin, “Old Army Buddies: The lasting bonds of the last draftees,” link here.

The group comprises mostly men drafted in the late 50s and early 60s, after the Korean War and before Vietnam heated up. The period includes the time that the Berlin Wall went up. I served from 1968-1970, did not go to Vietnam (was sheltered) but I still remember some of my buddies from the eyebrow barracks at Fort Eustis, VA (“Fort Useless”), where I worked for the Combat Development Command Transportation Agency in “than building” as an “01E20” (mathematician). We didn’t do much. One of the guys was a Berkeley graduate who called himself “Rado Suhl”, a wiry man who could jack a softball out of the park easily.

The article says that the draft helped define the culture of mid century America, which it did. But it was the deferments that caused the controversy – the student deferments, which encouraged a nasty culture of “better than …” and led to the use of the term “cannon fodder”. Back in 1961 or so, John Kennedy actually wanted to defer all married men, and then we had the “Kennedy fathers”, but eventually marriage and fatherhood didn’t get you out, but good grades in college (in math and science) did. You survived by learning nomenclature for those organic chemistry tests.

Obama signs law protection renters from owner foreclosures

J. W. Elphinstone, of the Associated Press, has a story today about a law that President Obama has signed into law to help renters stay in properties after the owner has been foreclosed. The link is here.

Renters with leases must be allowed to stay in their apartments until the ends of their leases plus 90 days, for 90 days if living month-to-month.

According to the National Low Income Housing Coalition, the bill is S. 896, PL 111-112, described in a press release May 21, 2009. The bill, originally introduced by Senator Christopher Dodd, is the "Helping Families Save their Homes Act of 2009," link here.

Families forced out of apartments or homes because of owner foreclosure have sometimes been unable to find other apartments because of their own credit problems, and become homeless.

So the new law should be a major help in preventing or reducing homelessness in most cities.

A similar story appears in The Washington Post on Saturday May 23 in the Real Estate section, p. F1, in the "Local Address" Column, "Renters Enjoy New Protections Against Landlord Foreclosures".

Older people may have some immunity to H1N1; some populations are much more vulnerable

Donald G. McNeil, Jr. has some articles about H1N1 influenza (“swine flu”) in the New York Times, and a particularly important story appears Thursday May 21 on p A23, “U.S. Says People Born Before 1957 May Have Some Immunity to New Flu Strain,” link here.

That’s because all seasonal influenza until the 1957 “pandemic” was of the type H1N1 and was distantly related to the 1918 Spanish influenza. After 1957, other types dominated the mix, making development of the specific H1N1 antibodies less likely. I turned 14 in 1957, and would have developed some H1N1 antibodies. I had one severe case of influenza in October 1958, going home sick in first period from tenth grade biology class as the fever came on very suddenly. I was in bed for about five days and I remember that my nasal passages swelled up shut. The only other severe case of influenza that I ever had was in Army Basic in March 1968, where I was in the infirmary for four days and was recycled. It came on very suddenly. That may have been pandemic flu; we were well vaccinated in the Army, but it may have been a strain that had escaped. As a working adult (living in major cities, riding subways, visiting bars), I had shots every year and almost never had severe influenza, because of shots and because of built up immunity.

I remember that the flu shots in those days were developed from eggs and were given subcutaneously on the underside of a forearm.

The new H1N1 virus seems to be causing more aggressive disease in people under age 50, and sometimes in people who are obese or in pregnant women. The latter would happen because of more strain on lung function.

Inactivity can make pneumonia more likely. When I had a acetabular hip fracture in 1998, I got a mild pneumonia that only cleared when I could get up and walk around enough (which therapy makes one do very quickly now).

Other reports indicate that, particularly in New York City, calls for “social distancing” are difficult to enforce. Closing schools and sanitizing them makes little difference; it keeps up appearances. Young people, however, are probably developing some antibodies and resistance now to H1N1 which could protect them later this fall, even before a special vaccine is ready, possibly by the end of the year.

The Centers for Disease Control and Prevention (CDC) has a detailed press briefing dated May 20, link here. Science reporter Robert Bazell (well known for his reporting on HIV in the 1980s) from NBC interviews the CDC.



Friday: May 22, 2009

David Brown has a major story in The Washington Post, "Study Detects Flu Immunity in Older People: Antibodies Found In One-Third of Americans Over 60", link here. Public health officials will be very concerned about the appropriate dose for each age group once a vaccine is available. Younger people, or people without specific antibodies from a half century ago, may need two doses.

Waxman bill talks tough, puts price on carbon emissions; would it fall short?

The American Clean Energy and Security Act of 2009 (HR 2454), introduced May 15, 2009 by Henry Waxman (D-CA), aims “To create clean energy jobs, achieve energy independence, reduce global warming pollution and transition to a clean energy economy”.

Govtrack has the full text and progress here.

Joseph B. White has an article today in The Wall Street Journal and calls it “one of the most ambitious efforts to re-engineer American social and economic behavior in decades.” The heart of the bill seems to require businesses to purchase “tradeable permits” in order to pollute.

Greenhouse gasses, including carbon dioxide and methane, are to be cut by 85% from the 2005 levels by 2050.

We also know that President Obama has called for cars to get over 35 mpg by 2016. The price tag of about $1300 a car sounds mild. I remember the reduction in car sizes after the 1973 Arab oil embargo, but the quality of American small cars continued to be poor until the mid 1980s. My 1979 Chevette was a real clunker. It fell apart in 40000 miles.

Credit card companies may look to "responsible borrowers" to subsidize those with large balances

Some financial columnists are warning that banks will be nudged into forcing stable and debt-free credit card users to help subsidize the easing of penalties on delinquent borrowers. Today (Tuesday May 19) Andrew Martin, on the front page of The New York Times, has an article called “Overhaul likely for credit cards: issuers may drop perks for risky customers”, and a similar entry online called “credit card industry aims to profit from sterling payers”, link here. The Times had several other related stories, including a summary of the "new rules", at midday Tuesday; check for these.

Insiders call people who pay their balances in full every month “deadbeats” because credit card companies cannot make much money on them. Companies could start re-instituting or upping annual fees, or removing certain perks such as frequently flyer miles. They could charge interest from the time of a charge. These changes could be necessary because Congress is in the process of limiting the extra fees they can charge delinquent borrowers, and particularly regulating fine print changes in rules.

Should “responsible” borrowers subsidize the “less responsible”? That sort of question makes sense in health insurance (the cherry picking question) but much less so in a capitalist economy in general. This sounds like another good topic for John Stossel on ABC 20/20.

Some “responsible” borrowers might want to react by dropping some credit cards, but closing out cards to avoid paying annual fees could lower one’s FICO score. It sounds like people could be paying fees just to increase their scores, which sounds “morally” wrong, and counterproductive.



Update: May 24, 2009

Michelle Singletary, in "The Color of Money" Sunday (Business, p G1), has an article "Revealing the hidden costs of credit cards". She writes :You probably never considered that the credit pushers made your access to "free" money possible by gouging the less fortunate with hideous penalty fees and wicked double-digit interest rates." She adds "That is how capitalism works. And at times it's a selfish system. We live in a society where many people who do well can't sympathize with those who don't."

Renters who were "pressured" to buy unsound conversions should get proper help

A lot is said to criticize individual American (and European) homeowners who tried to “live beyond their means” when signing up for subprime mortgages a few years ago and now winding up in “pineapple upsidedown cake” status on their homes.

One particular situation should get attention. A few years ago, in many cities, apartments were rapidly converted to condos and tenants did not have leases renewed. In some cases, tenants may have been “forced” to take on substandard loans in order to have a place to live and could have been unable to make payments later.

Mortgage relief plans associated with TARP, bailouts and various other measures ought to take this situation into consideration. Former renters who were pressured into buying apartments with unsound mortgages should definitely have the opportunity to renegotiate and make payments (including homeowners dues) comparable to what rent might have been.

This is symptomatic of a mentality that treated renters as transient and as “second class citizens.” There is no reason why the market should not offer properties with full amenities and lifestyle arrangements (like pets) at competitive prices.

The "silent majority" is becoming pro-life, at least almost: the "rare" word

A Gallup poll shows that Americans are shifting toward a pro-life position, with 51% saying they are basically pro-file. 53% said that abortion should be legal in some circumstances, and the percentage who say it should be illegal in all circumstances about balances the percentage who say it should be illegal in no circumstances.

The Christian Science Monitor story by Jimmy Orr, on “The Vote Blog” is here.

The article attributes the shift to the politics in the Republican Party.

But Mary Kate Cary, on the Thomas Jefferson Street blog, writes “Obama Abortion Agenda Solidifies Silent Pro-Life Majority at the Center” and emphasizes the “rare” part of the Democratic “safe, legal and rare”. Her url at U.S. News is this.

Along these lines, it’s interesting to review the life story of the original Roe v. Wade plaintiff Normal McCorvey.

CDC reports that single motherhood is increasing in the U.S.

The National Center for Health Statistics of the Center for Disease Control and Prevention has issued (on May 13) a report “Changing Patterns of Non-Marital Childbearing in the United States,” link here.

Rob Stein and Donna St. George have a story on p A6 of the Washington Post, in “Politics & The Nation”, titled “Number of Unwed Mothers Has Risen Sharply in the U.S.: Women in 20s, 30s Are Driving Trend, Report Shows,” link here.

There is a large number of women who want motherhood but who do not relate to the value of marriage, which they see as a social invention for the benefit of others, particularly men (when it actually benefits women and children). The reduction in the social stigma against single motherhood helps explain the increase.

I wondered how this tracks with the conservative claims that gay marriage would undermine traditional marriage. The report does not match what these claims mean at all. I think that social conservatives miss is the idea that marriage (and the supposedly monopoly that marriage used to have over sexuality) becomes a governing institution not only for raising children, but for mediating the role of all adults, including the elderly and less abled or competitive, within the extended family unit. The new social norms of individualism certain grew out of and reduce the effects of racial and class discrimination, but they run the risk of leaving specific individuals out of the system.

Because of demographics, we are reaching a situation where “neglect” or abandonment of elders will become as morally repugnant as failure to raise children; we can have “deadbeat adult children” as well as “deadbeat dads.” Ironically, such concerns can encourage people to have more children, as Phillip Longman has pointed out (March 8 2008 on this blog).



Julia Duin has an interesting "Culture" counterpoint on p A16 of the May 14 Washington Times, "Marriage as a Mormon value", link here. I remember a similar article in the 1990s in the Hebrew magazine Tikkun, claiming that singles needed wholesome places to meet, in some critical mass. The tone is coercive, but I get the point. And, Oh yes, she mentions "family home evening."


Attribution page for Wikimedia Commons picture of the CDC headquarters near Atlanta (first picture, at the top of this posting). I think that I saw it in the fall of 1972.

Obama jawbones health insurance industry, but is it enough?

Multiple media sources are reporting that President Obama is meeting with multiple health insurance industry trade groups, jawboning them into saving over $2 trillion in health care costs by avoiding unnecessary procedures and my automation of records.

The Associated Press and Reuters have consistently carried the most detailed stories today (May 11). Ricardo Alonso-Zalvidar asks “will health care savings add up?” link here.

Earlier stories were discussing Obama’s plan to have a government insurance plan available to compete with private plans.

But a PBS Frontline special “Sick around the world” following on the heels of “Sick around America” shows that other countries have some success in combining private health care with public management and universal care with some principles: generally, mandatory coverage (Massachusetts style) with government subsidies, and carefully structured incentives for providers, to be compensated on quality of care rather than volume. Health care in a number of capitalist countries (even say Switzerland) is much less costly than in the U.S., and individuals do not go bankrupt for face calls from debt collectors.

However, some of these countries have low birth rates and face serious problems with a rapidly aging population. Countries have generally reduced waiting lists (even Britain with nationalized health care) but could face rationing or limits in the future because of aging. And rationing or limits brings up potential questions about filial responsibility.

The New York Times reported later today, in a story by Jackie Calmes, "Change in Estate Tax Suggested to Pay for Health Care", link here.

The AARP Bulletin has an Opinion piece on p 31, May 2009, listing two principles to adhere to: (1) controlling health care costs (2) securing affordable insurance regardless of pre-existing conditions, and two problems to avoid (1) people losing health care when they lose jobs or get sick (2) private plans drop out of Medicare. European plans effective comply with these points.

College grads this year face lower earnngs, with reverse "compound interest": how to save when in debt

Back in 1998, a dual-citizenship friend and recent Minnesota college graduate headed back to London, where he said he could get by barbacking in Brighton for “low pay”. (He’s doing well now.) This year, economists are projecting an earnings bloodbath for 2009 college graduates. Try the Wall Street Journal (weekend, May 9) article by Sara Murphy, “The Curse of the Class of 2009: For College Grads Lucky Enough to Get Work This Year, Low Wages are Likely to Haunt Them for a Decade or More,” link here.

The article predicts a reverse compound-interest effect on recent graduates, who may be addled with student loan debt and a need to save for their own retirement, and who could wind up, giving demographics, having to take care of their own parents (the filial responsibility problem that I have covered). That ties into some of the discussions of the birthrate and working age “family policy” discussions by Phillip Longman and others, already presented here.

For right now, adult kids are moving back in with their parents, having to live by their parents’ house rules, when they will needs to be in a position to acquire property and make rules themselves to take on intergenerational responsibility. Suze Orman smackdowns hardly provide any answers. No wonder, suddenly grads find that the world isn’t “fair”: employers look at their Facebook or Myspace pages and make snap judgments (maybe on the wrong people) when employers are not in a position to reward political or social “loyalty” themselves. This is the now notorious “online reputation defense” problem. So many of the jobs grads try to get seem to be raising money for someone else’s agenda. There’s not much room for real creativity there. Recent grads face real “stress tests” and they may become scathing.

Picture: global warming "demo" on a construction crane near State Department, April 27, 2009

Amtrak holds National Train Day at Union Station in Washington: a plug for train travel?

Today, Saturday May 9, Amtrak held its second annual “National Train Day” at Union Station in Washington DC. The event tries to promote “energy efficient” rail travel, as well as improve the political image of Amtrak for funding.

The blue passenger car “Georgia”, which Barack Obama rode down from Philadelphia for Inauguration Day, was available to be seen without reservations, on a track on the west end of the station. The public could not go through the car, but could see the individual roomettes and facilities (the end room [shown], leading to the balcony for waving to crowds, has the presidential seal). The passenger overnight train to Chicago was attached for a tour of the double-decker sleeper cars, which gave the effect of the inside of a UFO.

On the next track as a Virginia Railway Express train for display, and a 1940s brown Pullman car.



There was an N-scale model railroad on the concourse, and a larger, toy-like display in the track area. The crowd was moderate. The wait to get onto the Chicago train tour at 2 PM was about twenty minutes.

In the United States, train travel has a long way to go to catch up with European or Japanese maglev trains.



On April 16, President Obama had given a speech proposing high speed rail and discussing it in other countries (like France), but he used 100 mph as high speed, which today's Acela sometimes tops.



The Department of Transportation has a proposed high speed rail map (PDF) here. Note some glaring omissions: no train route between Tulsa and Kansas City.

GE offers innovative health care program as example for country

General Electric Company has announced a $6 billion program of innovation that it says will serve as a model for America to reform health care.

Included are sophisticated wellness programs and technology for associates of all of its companies (that includes NBC-Universal – I worked for NBC myself 1974-1977), and cutting age health care information technology, which it says would set an example for the nation.

There is a story in Workforce Management May 7 “GE Launches $6 Billion Plan to Develop Health Care Innovations”, link here.

GE calls its program “Healthy Imagination”. It is a fancy website with embedded flash slides but without direct internal hyperlinks.

Paid parental leave for federal employees passes federal committee; will the U.S. face "ideological" challenges over "equality"?

Joe Davidson, in his featured “Federal Diary” in The Washington Post on Thursday, May 7, 2009, brings back the topic and controversy over paid parental leave, at least just with federal employees this time.

The story title is “Parental Leave Passes Committee as Foe Foresees Families Stocking Up on Kids” link here. Rep. Carolyn B. Maloney (D-N.Y.) has sponsored the bill, providing four paid weeks of leave after birth, adoption or taking on a foster child. The bill for the Treasury would be $850 million.

The story says that Republicans remained mum, leaving Rep. Darrell Issa (R-Calif.) to “play Scrooge” and complain about the cost. Politically, the measure seems ironic, since it is generally Republicans who play "family values". But not on this matter, perhaps.

There’s no question that employees of governments and private companies alike have to plan carefully to have children. Most countries in Europe and other democracies have some form of paid parental leave, quite generous in some countries. European countries are finding that they need to do this to encourage the birth rate to raise more to replacement levels. Having children is just too expensive and too risky for a couple to bear all the responsibility, but in individualistic America, that’s how it is, critics like Phillip Longman say.

But that certainly leads to another ideological trap. If parents are paid for their time to have children, the childless are “sacrificing” for their benefit and that leads to rather merciless inevitable logical consequences: that the childless are second-class citizens. Those who don’t sing the Song of Solomon and enjoy marital sexual intercourse (or those who do but who are infertile unless they adopt) bow down for those who do. In time, it would also make gay marriage and gay adoption contentious issues out of the drive for equality.

One problem that happens sometimes is that the childless work hours unpaid for those with kids. It doesn’t happen much in government, where there is comp time (or overtime for some jobs with union representation) but it would happen in the military and sometimes in law enforcement. But in private industry in salaried jobs, the people are likely to work oncall time at their own expense and without compensation, and the childless often have to do more of it.

Another way to structure it would simply to create a separate benefit for adoption or birth, but handle it outside the employment situation. That would not raise such objections over “justice” or “equality”.

In Europe, paid family leave is not viewed as a source of inequality because the social safety net is much larger to start with. Further more, many European countries are recognizing gay unions.

In Elinor Burkett’s 2000 book “The Baby Boon: How Family Friendly America Cheats the Childless,” one observer who supports parental benefits said, “it’s not about justice, it’s about living in a community.”

Former CDC expert on sanitation raises questions for all of us, maybe

John Boyle (chief of the Infectious Diseases Section at the Hospital of Saint Raphael in New Haven, Connecticut, was lead author of the Centers for Disease Control's national hand hygiene guidelines for health-care workers) in a special commentary on CNN today, “Keeping your Hands Free of Flu Virus” (link) certainly highlights a dilemma that we have.

I’ve always thought that people get stronger by gradual exposure to common infectious diseases. Adults are often less sickly than they were as kids because they have gradually developed resistance to common infections, by being exposed to them repeatedly. In developing countries, people have more resistance than westerners to common food-borne bacteria and can eat raw produce that Americans can’t east.

But some diseases don’t behave like that. As a recent PBS series (“Guns, Germs, and Steel”) central African communities built low density communities at higher altitude as a way of protecting themselves from mosquito borne diseases, especially malaria, and some other communicable diseases, like smallpox. European “invaders,” so successful in cooler climates, learned this lesson the hard way.

This is a real ethical dilemma. Adults over 50 may well have resistance to the new H1N1 (“swine” [sic] and bird) from past infection. Are they really responsible for “becoming finicky” to protect others from inadvertent transmission for something that they personally probably won’t get sick from? Particularly when the disease so far is so mild? It’s the “so far” that is hard to say. This flu, they say, is unpredictable, based on past pandemics (which demonstrate a repeating pattern of coming back in the fall). But so are all flus, or are they? We tolerate ordinary flus.

HIV does not provide a comparison. For the most part (except for recipients of blood transmissions and unborn babies) people could “take responsibility for themselves” by avoiding unprotected sex outside of known relationships. An influenza epidemic doesn’t follow those rules.

It’s hard to draw the line. It’s easy to see that schools will become very intolerant of risk. Ordinary businesses cannot afford to show the same deference to the most vulnerable. Except that look at what is going on in Mexico (although businesses will reopen in Mexico City mid week, according to latest reports).

Or what does happen here if a Stephen King purification (“The Stand”) does happen?

But most of us never intended to have to become nurses. Yet, if there were really a deadly 1918-style pandemic we would have to. The fully recovered would have to take care of the sick.

Meanwhile, we wait for WHO to announce a Level 6 pandemic soon.

Suburban Maryland school officials say that H1N1 is "community acquired", mention "social distancing"

Scientists now say that the H1N1 virus, as transmitted in the United States, seems to lack a gene that normally would make the virus replicate more rapidly, and that this anomaly, however fortunate, helps explain the mild nature of the cases in the U.S.

There has also been a lot of material published on the web comparing the past four flu pandemics, and maintaining that a mild outbreak in the spring was followed by a much deadlier one in the late summer or fall, particularly in 1918. This history does weigh on the minds of health officials.

In Montgomery County, Maryland, one high school (Rockville) was suddenly closed today, for an indefinite period, although it is possible that it could reopen Monday May 4. One student who had not traveled to Mexico and who did not have family members with symptoms apparently has tested for probable or certain H1N1 infection. Health officials say that this is “community acquired infection.”

An official of the school system said that the student had special needs, and said that the student might not be able to follow hygiene instructions commonly given; I was, frankly, surprised to hear this kind of comment on a public broadcast (on NBC Washington, Channel 4). The official mentioned “social distancing” (discussed on this blog Tuesday) and defined it here as staying six feet away from other people if symptomatic. NBC4 carries a video of the announcement, here. WJLA (channel 7) mentions the matter in its noon news story here.

Officials are still concerned about the “uncertainty” about this virus even if the overwhelming evidence so far is that the virus is mild in this country. Yet the “missing gene” sounds like good luck.

The Washington Post has (May 1) published a story by Daniel De Vise, Lori Aratani and Debbi Wilgoren, "Probable Case of Swine Flu Closes Rockville High School: Students Are Asked to Avoid Public Places Until Cases Are Investigated." The link is here. The story says, "County health officials this morning asked students from the school to stay home and not go to shopping malls or public places until more is learned about how the student got sick." Their "request" would seem to apply to students without symptoms. This does sound like the "hysteria" of the Washington Times Editorial Tuesday.

A CDC story about two persons in California in April also suggest community acquired infection, here.

AOL featured a "Daily Finance" story by Jonathan Berr, "Airline CEO should leave flu advice to the doctors", about comments from Ryanair Chief Executive Michael O'Leary, who runs Europe's "leading" discount air carrier, link here.

Update: May 2

Wesley Pruden, editor of the Washington Times, published (on Friday) a humorous perspective on H1N1 "hysteria" with "More to panic about: Biden's hoof-in-mouth", link here. See also May 28 posting for more Times articles.