New Info about hypoxia

This is a follow up to a Long Island Sound Muck sample.
It may have provided some answers, unexpectedly.
It may be pointing to a disaster that regulation will no longer solve.
The issue came about when I was asked by Art Glowka if there was any iron in the Sound sediment.
I knew there was because the H2S /carbonate/sulfate laden muck had now some Iron Oxide showing.
I had sealed the container some time ago and the only oxygen that would have been in there would be from the Quart container.
I never thought much about it, until Art asked the question.
I had thought that the H2S would deal with the oxygen and there would be no chance of oxidation, but here it was, not the entire contents, but small portions.
And the oxygen was gone from the container.
Someone else has proposed that there are anaerobic sink holes from the oxygen data in the sound.
The oxygen in the container was scavenged by the iron, that would cause a sink hole.
What has happen has happened, but no amount of regulation is going to get rid of this oxygen scavenger.
This is permanent and the only way to fix the problem will be to provide large amounts of oxygen to the system...directly.

Scofield

I did not know where to post this, really.
One part is a commentary on people and my own attitude to my problems, the other is environmental.
The Stamford Advocate predicted a difficult meeting tonight on Scofieldtown issues.
People expect that the board will say that the contamination issues are not the dump and that the board is lying and covering up.
The question would be why would they cover it up?
Very few of them have anything to gain by covering it up, but what if all the facts point to the current contamination found not being from the dump?
Everyone wants someone to blame. They have health problems that "must" be coming form contamination.
As I have written before, this country has a long history of misuse of pesticides and it is coming back to bite us.
The problem will be if the "city" does not take some action to help the people who have or may have a problem.
The personal part; when they found that big old tumor in the back of my head, i was scared, but I did not blame anyone for its presence in my body. It was there, it had to come out.
It was no ones fault, get it out and let me go on.
That was the solution. it had serious consequences. That was not anyone's fault either. I am learning to deal.
The problem will be if officials say; "well its not the dump. Its your problem, we won't help in anyway."
That would be wrong.
A testing program needs to continue. When there are problems, filters must be provided.
Water company water should be expanded where it can. Wells need to be abandoned.
The dump needs to be cleaned up so it will never be an issue again.
That is all.

It is all our fault

We have not been active enough.
We were not concerned enough.
We took to long to act when we knew it was necessary.
While I will not yet share all the the things I have seen in the study of the wells around Scofield park, I still believe it is all of the environmental professionals fault that this issue has occurred.
We did not know enough and did not require the proper observations to protect peoples health.

The expert thing and global warming

Okay, so I have made myself into some kind of an expert according to this blog, but what does that mean and why?
First I no way did I every intend to be an expert, I just wanted to be a bench chemist, that is the work I love.
I did not go for a masters degree because that would mostly mean administrative work and i really wanted to be on the bench. I did not want to get a PhD, but obviously with the peer reviewed research i have done, I guess I could have, but that is not what I wanted to be known as.
What I wanted to do was two fold - I wanted to feel useful to others and i wanted to satisfy my curiosity.
The job at the Health Department was the door, my boss was the vehicle, he let me "go" in anything environmental as long as we did not have to spend too much money getting there.
When i worked for private industry, what you did with a sample was strictly limited to what you were asked to find, even if you "saw" hints of something that might be important.
At the Health Department, if I wanted to look at chloride for every sample that came into the lab, I could. If I decided nutrients were a was of time for beach samples, it was my decision.
The restriction was my curiosity.
That of course led to the first paper on softener discharge and increased salt levels in the water nearby wells.
The learning programming languages and databases help all of that, I could compile information easier and look at more variables with much greater ease.
Curiosity is then my major thing. If i saw nitrite in well water, i looked for bacteria. If they had a softener treatment on the water, I looked for chloride levels.
Learning about bacteria at beaches help begin processes at a national level.
I was just curious.
And that brings me acknowledgment from state and Federal scientists, that certified me as a expert, but it was all curiosity, always asking questions. Always asking: "What is this telling me?"
Global warming - I said i was going to say something about this.
It is based on a simple observation this year.
I have lived in Connecticut 33 years and seen 33 winters and 33 Thanksgiving and I always wanted to have parsley from my garden in the feast.
This is the first tine in 33 years that has happened.
Global warming is real.

What has happen, we have done to ourselves!

This is not about the dump, even though the Advocate wrongly says the underground water for North Stamford is bad.
No, this is about a whole host of things that have happened as we push "suburbia" further into undeveloped land.
The first portion of this is Lyme disease, it was discovered relatively recently, but in all actuality, it has existed for a long time.
As we pushed housing developments further into the woods, we eliminated the various predators of deer and the white footed mouse. The change in species allowed a proliferation of both and Lyme and the tick became more prevalent. This is not my study, this was a study done in Westchester county and clearly categorized the changes in species, but anyone could easily tell that the deer population has increased.
The second portion is Long Island Sound - this year there were fewer fish than ever before and everyone who has concerns is worried because all the things they have done to "clean up" the Sound have failed miserably.
How we changed the Sound and made it dependent on our "organic" pollution (Read treatment plant waste) and then fed into it all the things we put on ur lawns to make it prety has killed the Sound. Although I am involved, the biggerstudies have been done by the Marine fisheries division of NOAA and some graduate students in New York.
The third portion has to do with our drinking water - This is more complex, but still our fault.
Small farms , which prospered after World War II, did so using the new and amazing chemicals we made to control pests. Soon it was not profitable to have a farm of only a 100 acres or so and the land became more valuable as real estate. Small farms were subdivided into lots where houses were built and who would ever think that they were time bombs? They were away from public water and wells were drilled.
So for 30 to 50 years, these homes have been pulling down the clean out products of the farmer. the land was not pristine, it was hazardus, for after every spray with these "wonder" chemicals, the farmer had to clean out his canisters and those become hot spots.
Others of us dumped still more chemicals into land fills and backyards and into septic systems never dreaming that there would ever be a problem.
This has been found by epidemiologist studing developed farm land and cancer clusters.
We did it to our selves in our precieved needs and our lack of understanding.
All of these occur because

H2S not out of the picture

The other day, as I was relaxing a bunch of chemical "balancing" equations came to mind, mostly having to do with the Long Island Sound Oxygen deprivation.

2O2 + H2S + CaCO3 → H2CO3 + CaSO4
NH4+ + 2O2 → NO2 + 2H2O
NO2 + O2 → H2O + NO3-

The reality is that we are getting a lot of low oxygen levels with no or little plankton/algae present.
What i saw in the sediment suddenly came to life as I realized that it was the reaction of H2S with carbonates, using up significant oxygen in the process.
The issue Art Glowka brought up for consideration is not out of the equation, rather may be an even more important part of it.
He brought to mind cyano bacteria, bacteria which fix nitrogen into ammonia and then to Nitrite and then on to Nitrate. They are not facultative anaerobic organisms and so need oxygen to survive, unlike the organisms that are and many times produce H2S as a byproduct.
The high level of Sulfate in the water fits the balanced equation.
Still asking questions about all of this, so this is not an end post.

H1N1 Influenza A - update for Stamford

Please refer inquiries for H1N1 vaccine to our website (www.cityofstamford.org) -- link on front page, or our hotline 977-4213. We are now extending the vaccine to healthy children 2 years to 6 years of age and healthy non-pregnant parents, care-givers, and household contacts of infants less than 6 months of age.

Questions and more questions

As I scratched my thoughts about H2S and Hypoxia, several new things have emerged.
First a paper published on Lake Erie (so definitely not by me) gave phosphorus and phosphate a new role as the limiting factor in algae growth in marine waters (this has always been true of Fresh water, but the thinking has always been that it was different for salt water).
This apparently has gotten many from the EPA to question their direction in the Sound (about time).
Two questions were posed to me by Art Glowka.
The first was concerning cyano-bacteria, which are now known as blue-green algae. They fix Nitrogen, meaning that they take available nitrogen and turn it to ammonia, which in turn is changed to Nitrite (2 oxygens) and then Nitrate (3 oxygens). Could this be a pathway causing Hypoxia?
The second has to do with a graph, long published in the New York water quality report and now omitted, showing the beginning of significant Hypoxia in the Long Island Sound occurring around 1977.
This coincides with two events, me moving up to Connecticut and the beginning of sewage treatment plant "clean up".
Is it all coincidental? For one part of that, I certainly hope so, the other is a question that we may try to answer when I try to get back to the Long Island Sound.

What is the deal (H1N1 Infuenza A novel)

The CDC stopped tallying cases,
They estimated the US has had already had 1 million cases!
The Normal Flu season does not start until late November, we are experiencing large numbers of Flu cases...
it is ALL H1N1 at this point.

The vaccine is available, just like all other flu vaccines, except they have a way to give it with out sticking you.

Get the vaccine...if your doctor recommends it.

influenza

I saw this in a public health presentation and knew it must be posted.
Normally i am very serious on the site and the various influenzas we are dealing with have many people concerned.
The vaccines are here. I got the regular one already and the H1N1 will be distributed soon, I will get that one also.
How about you?

The use and misuse of hysteria

This week has been an interesting week with news concerning the H1N1 influenza novel circulating about, the arrival of the vaccine at the health department, some differed knowledge about rabies, more information and misinformation on the Scofieldtown dump and surrounding wells and several unrelated well water issues.
The news about the influenza is that there are deaths, which is not surprising, all flues kill an amazing number of people. The issue is that this flu is particularly dangerous for Healthy individuals. the vaccine is here and we should be fore armed with it.
The rabies info had to do with a scratch of someone pregnant. I do not know the issues with the rabies vaccine and pregnancy. I deferred that info to more qualified persons. The person calling called the incident minor ( a scratch by a raccoon), but I had to say that because a raccoon is a major vector of rabies, it is still serious.
The hysteria about the dump is currently very difficult to manage, there a lot of erroneous information being spread by word of mouth that only heightens fear and serves basically none one. The most ridiculous one was that the water company uses the water from the Rippowan river for drinking. that was a malicious lie and anything else that person spreading that lie should also be disbelieved.
The demand for heavy metal testing is one I can understand because most people do not understand metals. in the environment, especially here in Stamford a well drilled 50 feet away from from a well high in the normal metals found in the area (iron and manganese) will not have any.
The reason is because metals tend to turn into not just insoluble compounds of oxides, chlorides, carbonates, sulfates and the like, but these compounds actually bind with the surrounding soil making it almost impossible for them to move through the ground. This is true of most of the metals found at the dump. they will be carried above ground by rivers and streams and rain, but in the ground they do not move well at all.
Of course because of the real concerns in the Hannah's Road, Very Merry Road and Larkspur Road, many people are becoming aware that they need to have their water checked.
Well's have seals that over time can fail, about 5% in a 30 year period. When the water does not taste "right" suddenly, check for bacteria.
Such was the case this week and it was contaminated with bacteria. The issue is that the seal on the well can deteriorate and allow surface water into the well and also the bacteria it carries. It is not an underground problem, it is an above ground issue, soil carried the bacteria we look for, wells should not have it. Of course the question was first asked by the homeowner, "We do not live anywhere near the dump, how could this be?" Of course it had nothing to do with the dump.
The final story had to do with a plumber/ well person calling me hysterical because I called Hydrogen Sulfide dangerous. Strange, you can look in any hazardous chemical book and find out how dangerous it really is. the source may be very simple, a uncared for "swimming hole" which was full of decomposing organics (leaves and such) creating an anaerobic (without oxygen) situation where bacteria creates hydrogen sulfide. The well was close to this spot and so would draw it down. the battery of treatment units on the water did not remove the problem. There were other issue with the home, but the constant head aches can be linked to constant exposure to the hydrogen sulfide at low levels over time.
The good news? Water company water is readily available.

Other issues had to do with bacteria being found in homes with carbon filters. Carbon filters do NOT remove bacteria, but the tests were done by outside labs but when I repeated the test, there was no "coliform" bacteria. There were a few non-coliform colonies which the people will take the info to their doctors because of special situations. the bacteria may have been introduced by plumbing work (most likely).

So endeth the lessons.

What goes in the ground....

The protection of well water.
We will start with what people do not want to hear first and go from there.
If you are on a well, I would never add man made fertilizer or insecticides or herbicides to the lawn. Period.
It will get into the well.
A well draws in a manner that can be almost considered conical. That deep water "aquifer" that seems to be a prevalent notion is not all that is talked about.
Bedrock is not a solid impermeable mass that keeps surface water from deep water. It is full of cracks and crevices and areas where the water from top goes down into the water bearing rock.
The recharge area for a well can be describe as a direct relation between its depth and yield. The deeper a well or the more yield it has, the further the draw range of the well.
Rain water provides a good portion of the water that comes from a well, so what you put on your lawn, you drink.
Soils filter out a great number of things - bacteria, very quickly and many common items that are nutrient based.
Gasoline and oils, not at all. And pesticides. even though they are not generally water soluble, will slowly find their way to a well.
If the well is near a river, what is in the river, what is dumped in the river, will also find its way into the well. A river will skew the conical draw of a well with it giving more to the well than the rain.
Then there are septic systems, usually put on the other side of a house, but septic systems are considered the primary recharge for wells. All the normal stuff is well filtered out by 25 feet, but what if you clean out your oil based paint brushes in the slop sink leading to the well? Right into your drinking water.
How far is this influence of a recharge zone? Deepends on the draw of the well, the depth and yeild, but it can be up to 200 yards, easily.
What about a dump?
It could effect wells near it.
Here though is also where the idea of an "aquifer" comes to play. Ground water and subsurface water slowly seeps in a down slope manner.
In Connecticut, the Glaciers created a general movement North to South.
You look to the south of a dump for the worst of the situation here.
How much well contamination is from homeowners? Most.
How much from dumps? Too much.

Water woes

There will be a couple of posts to clarify the main subject of this post.
This first one will deal directly with what I believe are import elements when searching for contamination in the ground.
I will focus first on the searching at Scofieldtown dump area.
Lots of things were dumped there, so a review of what should not be looked for is important.
The first 2 are metals, arsenic and mercury. They are not good things period and may or may not have been dumped at the site, but guaranteed they are in the soil. Why?
Arsenic was the primary insecticide for apple trees for years. Guess what Connecticut used to (and still does in some parts) grow abundantly? Apples.
Do I expect to be able to find arsenic in wells? Yes. Is it related to the dump? No.
Is it important? Very and my predecessor will have a machine to be able to do those surveys. I just could not coax the necessary sensitivity out of the 1985 Perkin Elmer graphite furnace AA that I got for our lab.
Mercury. the reason we have to be careful of the fish we eat is mercury and in Connecticut its main source is the Ohio coal burning electric power plants that the EPA refuses to regulate.
Right now of course the big furor is over pesticides and the residents have every right to be concerned, they are dangerous, but did it come from the dump? I doubt it.
The pesticides found were used extensively for years. Are they dangerous? Yes.
Do they get into wells after years of not being used, Yes again.
The wells in question are only a few feet from the homes, but that is a topic for another day.
The city needed to help the people. That was my push. They did.
So what should one look for?
Solvents. VOCs is the technical term, but when I find methyl ethyl ketone or toluene or trichloroethylene or any oil cutting solvent in any of the test results, that is definitely coming from the dump.
Chromium would be anothwer one, but all the past and recent tests do not show it even at the dump site.
That is my thinking.

The H2S Issue

Now that we have some time to digest what we found, I can share.
We took 2 sediment samples from one point off of Todd's Point and one in Stamford harbor.
Both reasonably deep water (30 feet)
They were black and heavy, they did not smell of Hydrogen Sulfide.
The initial test I forgot to take a pH, we will do that again.
Adding acid released a lot of H2s and CO2.
When I did the actual test one came back with 2 mg/L (they were suspended in Sound water) and the other 5 mg/L
They were trapped in the carbonate material which was released during the first part of the test.
Sulfate (SO4) was 2,000 mg/L and 4,300 mg/L respectfully.
The H2S smoking Gun did not prove itself.

The Theory, the pitfalls, the execution, intial results

I now have enough samples with some that do not fit the mold to understand what I am seeing.
The Theory - was that pH would allow me to tell if fresh water (and thus water with bacteria) was influencing the beaches.

The pitfalls - Although it is a determined fact that the pH of fresh water in this area is more acidic than the Estuary of Long Island Sound, there are other factors which will affect the reading.
Temperature will drive CO2 out of the water and you will get a more basic reading.
Fresh water does indeed "float" on top of the saltier and denser Long Island Sound Water.
There maybe still another temperature defendant reaction which makes the water more basic as the temperature climbs.

Because of these variables, I have also been measuring chlorides (simple way to measure salinity) and there is a good correlation between the intrusion of fresh water and pH.

Measurements were conducted of beach water (3 feet deep), shellfish waters (up to 20 feet deep) and spots in the Sound itself (up to 80 feet deep).
Outfalls from treatment plants and rivers were also measured.
This is a minimum of 20 samples a week.
All samples are taken at about 1 foot depth.
Samples were measured for pH and chlorides along with the normal bacteria densities I would perform.
Duplicate samples were used to determine validity of samples and testing and that is where the first surprise occurred. On one sample set. there was no duplication between either chloride of pH.
Since we also maintain a log of rain events and weather conditions, we could see that a 0.2" rain the night before had not mixed yet.
Tides are known and added in to the mix.
pH and chloride levels matched with information we already had deduced on tidal currents in 2 places.

Initial results - What I believe is this is an excellent method to determine flow and current in the shoreline.
Since the flows in the shoreline is difficult at best this provided a tool to assist determining this for different tide levels.

What it feeds

Rain that is. June 16th we had one of those heavy rains - 3 + inches. I said then things may improve.
I was right!
Before this there seemed to be nothing living in the Sound. There was no algae, there were no small bunker (peanut bunker), there were no small game fish. There were no big fish. The jelly fish that started early in the year had also disappeared. The Sound appeared to be a dessert.

July 13th Art Glowka told me that he was suddenly seeing some algae and seaweed around. I said 3 or 4 weeks for life to come from the food that was washed into the Sound, lets see when the fish come.
This last weekend apparently the cycle came to fruition and everyone was catching, well everything!
Listen to the creatures and what they say!

Learning

Approaching a new idea is not always an easy road and there are many pitfalls. So it is with my understanding of what pH and chloride levels mean in the water.
I already have maybe 40 or so samples in a week and I think I am seeing patterns of flow from the results.
I will keep looking and see what shows.

Something simple?

I get "Eureka" moments when I am in the lab.
What it usually entails is more work for me to figure if something is valid or not.
Fortunately, I have the samples coming in.
It has to do with something simple. It has to do a connection I need to prove.
The first step is to show that it will work for Stamford, CT. It does not have to work any place else.
The second is to verify many times that pH and salinity are related.
The third will be to show a correlation between pH and bacteria.
This is based on the fact (already proven many times in 30 years) that all of the elevate bacteria levels come from fresh water sources.
I already have one fact, all fresh water sources have a pH more acid than the Sound.
If I can show this correlation, someone will be able to go down to the beach and determine is the water is being affected by enough fresh water to initiate a closing.
There is no waiting period for the reading, it is instantaneous. If this works, it will be far better than anything anyone has thought of.
Will it work?
I have to test this theory to find out.

The truth about what goes into the Sound

You know I have been doing a significant study with Art Glowka on the discharges from treatment plants.
What I am beginning to understand is how the Sound does and does not mix with the fresh water coming from shore.
The pH reading surprised a bunch of PhD's at the Marine Fisheries Division of NOAA.
I decided to test a theory put to me by Art, that the lower pH was because the fresh water was not mixing with the Sound water because of its salinity. He was right on the money. chloride levels and pH do have a great deal of correlation.
Not a real surprise there, but it gave me a number of good ideas and one was that pH might be useful at predicting fresh water intrusion (and thus bacterial pollution) at beaches.
Another was even tho the 2 do not mix well, the nutrient load from fresh water is rapidly absorbed into the Sound and used up.
That is an important concept and one not widely accepted by anyone.

Beaches, Beach Closings and why Stamford does it

An article in the New Haven Advocate had me bemused. New Haven does not close the beaches when they have high bacteria levels.
They have not figured out that it is better to protect the public's health (and what then is a Health Deaprtment?), than sit on their hands and do nothing. They feel the data comes late and so is not valid.
I figured some of it out over 20 years ago. I did the testing and saw a pattern. Rain caused an elevation in bacteria at the bathing beaches.
We figured (We had a very proactive Health Director then and was very supportive) it was better to close a beach before we had proof positive that it would cause trouble (the bacteria tests) than to let people get sick.
In 1988, we had many reports of illness from people who ignored our warnings when we put up signs saying it might not be a good idea that they swim. The next year, we were more forceful about it and because many remembered the year before, they stayed out of the water.
We were also sure this was not sewage. We did know when there was a sewage problem and that was easy to close down areas affected, but this was not.
After a year of exhaustive testing, we found out it was the storm water.
We first thought it was all the raccoons that were living in the storm drains, but in 1990, rabies came and dropped the raccoon population 95%. The water was not as bad, but it would still close the beach for bathing.
The reality, we are an urban environment, water washing over the land and into the Sound did not get treated naturally, it was piped directly to the Sound. It was not "bad" water, but while it was coming out, we needed people to stay out of the water. It only took 24 hours till it was no longer in the water. We asked why and other people, part of the USGS, figured it would go into the sand and lie there waiting to be distrurbed, but unless there was an additional "load", it would not reach health concern levels.
We looked every year at the data, learned new things, saw new patterns, learned a lot. The marine police, the lifeguards, the recreation department all could observe things and help us out. It worked. People do not report being sick from swimming in the water at the beaches. They all lnow that you do not swim after a heavy rain. They even figured it would affect the fresh water lakes and ponds, People are smart, they need to be informed and they need to be protested. Since is my part.
Whats wrong with New Haven?

Ticks and Disease

It is time again that the main ticks that are active are the little larva, the ones who never fed on any thing yet and have never tested positive for any disease organism. Besides that, they are so tiny (the size of the dot in my "i") that I am always surprised when some one brings one in.
The good news is that for the next 3 months, there will be very little transmission of Lyme disease into the human population (the other ticks mostly are not feeding) until mid October!
We are still getting back reports from all the submission we have had ( it can take 6 weeks, but mostly 4 weeks) for us to get a report back from the CT Agricultural Station .
Why so long? Because they are testing all of Connecticut! That is a lot of ticks for a limited staff doing the work for free (these are really good people,trust me).
In the mean time, I put some thing on my plate that I probably should not have (see my post on overwhelmed). I was looking at tick data, data that no one else has because I will call every positive from the CT Ag Station to make sure people understand and go to their doctors. I also ask a few questions.
One thing we keep stressing is that if you find one tick, there is a chance there are more.
So when people report having symptoms and the tick is not positive or is unengorged, we make a very rational assumption that there was another tick.
While the Ag Station will put a disclaimer on all their tests, it is a very, very good test. It tests for the spirochetes in the tick by PCR. It has found the disease in ticks with no body, so it is very good!
So symptoms are the big thing. Why?
Besides the one issue I just raised, there are other issues, there are other diseases. While Lyme is spread by the white footed mouse, who remains infected for life (3 years) once it is infected. Deer do not get Lyme and can not transmit it, but they are know to carry babesia and Ehrlichia organisms. I have only had 5 posts on Lyme, so it gets to be more interesting to me than a lot of things.
Why all of this? Because one of the things I found in the survey was people having real symptoms when the tick they submitted was either not infected or unengorged.
Many doctor do treat quickly. There many cases of single dose Doxycycline being given, with no reports of symptoms afterward.
There were also cases where the doctor would not treat with out a positive blood test even though there were classic symptoms and a positive ticks.
The variance on the treatment was amazing, different drugs, different time periods, very little would even be considered standard.
That is the medical profession.
Should the Health Department take the lead on education? I think so, but it is not going to happen, the interest in being a front runner in anything is minimal.
There are many doctors who are very proactive in this area and this is a good thing.
This was just the begining of me taking apart my little survey. It does make life interesting.

Treatment plant outfall tests and why

I will not probably post the raw data anymore. I will tell you that the testing was performed verifying each tests using standard, USEPA and FDA methods, quality control and collection procedures. That is if you are interested, they are logged in at the Lab.
The results are some what surprising and you may question why I did certain tests.
An example is pH. Salt water oceans tend to be significantly more basic than the fresh water feeds. This tells me more about mixing of the two than anything I could think of. Why not salinity? Because treatment plant discharge will have significant salinity (not as much as the Sound, but still, I needed a better handle and pH seems to provide that).
Turbidity? The measure of particles in the water. comparable to secchi disk readings? maybe or maybe not. Rough water would increase the reading and might give a rise in the bacteria that I looked for.
Reactive phosphate - a nutrient, suggested ny one group as the limiting factor in the Sound for algae growth.
Nitrite - nitrogen - allwos be to look at possible bacterial activity and for the test performed alows me to determine Nitrate nitrogen.
Nitrate nitrogen is the bad boy according to the US EPA, but the levels have remained consistant inthe Sound for 50 years of testing.
Total coliforms - a good general bacteria that might live anywhere.
Fecal coliforms - more of fecal origin (all kinds), but are like total coliforms saphorites (meaning they will grow in warmer water). This is used as a standard by the FDA to determine if it is okay top harvest shellfish.
E. coli - the natural kind (not H 0157) again fecal in origin.
Enterococcus - a group D spterptococcus and used by the US EPA as an indicator of health at bathing beaches. It Likes salt water!
That is what I tested for and why.

Hysteria - again

The hysteria over swine flu appears to have ebbed.
The initial hysteria (mostly created by media misunderstanding) seems not to have effected to many people, yahoo recently reported that the US led the world in Swine Flu cases, there does not seem to be the initial hysteria at this point but why is this so?
It has to do with the shear volume of testing done in the US as part of routine surveillance.
What do the statistics really say?
I will use Stamford since I have access to all of that data.
in 2009 we have a total of 197 reported cases of influenza, this is more than all the other years and almost 2/5 of the total cases recorded since 2002 (7 years). This is all because of testing!
Influenza A (the normal one) accounts for 60% of the cases, H1N1 Novel (swine flu) accounts for 27%. There other types that are also being reported.
In May and June (when we began looking for the swine flu) 58% were normal influenza (even though it is NOT flu season). 37% were the H1N1 Novel (swine flu).
So cases are here, there is no need to panic or get hysterical.
The average age it affects is mostly of health young adults (~21 years) and it is not causing deaths (at least in Stamford).
The reality is that we are really looking hard and finding out more than ever before!

Combating Hysteria

All who have met me in my 30 something years of working with the city, know that I am a fairly no nonsense kind of guy when it comes to m work (I won't go to out of work or non-work areas with that attitude though).
When the data has been against the city, I stand against the city, when the data does not support what the public thinks, I am sorry, I will not make things up for anyone's convenience.
StamfordNotes has a quick review of the new "documentary" about Lyme and I also heard some discussion on NPR concerning the info on the movie.
I have a rather strange stand when it comes to Lyme disease, there is a lot of unnecessary hysteria over the disease and a lot of mind boggling complacency also.
The complacency comes in the form of doctors not being proactive when it comes to treating when symptoms are present, preferring to rely on blood tests.
I take my cue in this from the state health department lab, which a number of years ago (10?), stopped offering a blood test for Lyme, even tho it is on the significant illness list of reportable diseases. Their Reasoning? The test was inaccurate! That was more than enough for me. After years of working on it, the tests still relies on an antibody response from humans to be effective. We do not all get the rash, we do not all or can identify that lousy feeling that comes form the infection. Those are immune responses, without them, the test will not work.
Now for the hysterical part. Lyme is every where, it is spreading, it will get us all.
Partly true, mostly because of man. An environmental organization in Westchester presented that the rapid spread of Lyme has been mostly because of our own push into the suburbs and the decline of predators of the white footed mouse.
Well we know that the deer population explosion is due to us and our desire to protect "Bambi", but what woth the mouse?
The mouse is the primary vector of Lyme disease, not deer. They get infected and stay so for their entire 3 year life. The deer do not get and can not pass on Lyme.
We have given them great hiding spots in loose stone walls and have pushed creatures like owls out of the area. Even the raccoon population has decreased by over 95% since 1`990 (this is due to rabies, not specifically man) and they did feast on the mice as well.
But Lyme disease has remained at a constant infection level since 1989 (when we did the first testing), It has not increased in prevalence and the reality is that we were very late is discovering something that has been in this country for long before we were.
So whay is not every one crippled with Lyme?
Thjat is the next point of hysteria - when doctors prescribed antibiotic for just about everything, a person with sudden aches would go on a quick course and weather theree were other things involved or not any possibility of Lyme disease was stopped in its tracks.
The organism is very susepible to antibiotics. Its effects may linger for years, but that is not the disease anymore, it is not dissimilar to syphilus in that way, if you do not treat it early, you will always have a "marker" showing you have been exposed.
Quick treatment works!
The studies on the single dose have been performed and by several orginizations, the New England Journal of Medicine and the Chicago Journal of Medicine are a couple.
It works, convincing doctors of that is a different sstory, the CDC refers to those orginizations in regards to the single dose of doxycycline within 72 hours of a tick bite, other wise it is 4 weeks.
Convincing people who have not discovered a problem until months after and having doctors who now are reluctant to treat gives great rise to hysteria.
It is actually understandable, but it is not the end of the world and we are not all going to be horribly crippled by untreatable Lyme.
And yes I have had Lyme, twice and do understand it well.

What happens in Greenwich

The following are taken in similar intervals as from Stamford's treatment Plant. There are major differences! The tides are incoming on both samples (Greenwich and Stamford).

Outside Captain's island (Basically in the Sound)
total coliform CFUs/100 mL 20
fecal coliform CFUs/100 mL 2
Escherichia coli CFUs/100 mL 2
enterococcus CFUs/100mL 16
phosphorus as reactive phosphate less than 0.221 mg/L
nitrite nitrogen less than 0.003 mg/L
nitrate nitrogen 0.588 mg/L
pH 8.33
turbidity 1.52 NTU

mid Greenwich harbor
total coliform CFUs/100 mL 44
fecal coliform CFUs/100 mL 4
enterococcus CFUs/100 mL 32
Escherichia coli CFUs/100 mL 4
phosphorus as reactive phosphate less than 0.221 mg/L
nitrite nitrogen less than 0.003 mg/L
nitrate nitrogen 0.647 mg/L
pH 8.22
turbidity 1.36 NTU

Indian Harbor Yacht club
total coliform CFUs/100 mL 500
fecal coliform CFUs/100 mL 90
enterococcus CFUs/100 mL 160
Escherichia coli CFUs/100 mL 70
phosphorus as reactive phosphate 0.224 mg/L
nitrite nitrogen less than 0.003 mg/L
nitrate nitrogen 0.772 mg/L
pH 7.90
turbidity 2.15 NTU

Grass island Boat Ramp (near the treatment plant discharge)
total coliform CFUs/100 mL 670
fecal coliform CFUs/100 mL 120
enterococcus CFUs/100 mL 190
Escherichia coli CFUs/100 mL 80
phosphorus as reactive phosphate 0.471 mg/L
nitrite nitrogen 0.004 mg/L
nitrate nitrogen 0.935 mg/L
pH 7.72
turbidity 2.30 NTU

Note the gradual increase in Nitrogen . Phosphate and turbidity and decrease in pH as the samples approach the treatment plant discharge.

Statistics and epidemiology

I am posting this so that you will take the next post(s) with a proper understanding of what you can and con not say using statistics.
The following is a very good example of the convoluted way to say something that is absolutely WRONG by using statistic (and epidemiology).

For those of you who watch what you eat, here's the final word on nutrition and health. It's a relief to know the truth after all those conflicting medical studies.

1. Japanese eat very little fat and suffer fewer heart attacks than the British or Americans.

2. Mexicans eat a lot of fat and suffer fewer heart attacks than the British or Americans.

3. Africans drink very little red wine and suffer fewer heart attacks than the British or Americans.

4. Italians drink large amounts of red wine and suffer fewer heart attacks than the British or Americans.

5. Germans drink a lot of beer and eat lots of sausages and fats and suffer fewer heart attacks than the British or Americans.

CONCLUSION: Eat and drink what you like. Speaking English is apparently what kills you.

You will be referenced to this page after the next post(s) when appropriate.

H1N1 Influenza A - update

Sent: Wednesday, July 08, 2009 2:49 PM
Subject: Centers for Disease Control and Prevention (CDC) Update

You are subscribed to Updates from Centers for Disease Control and Prevention (CDC). This information has recently been updated, and is now available.

July 7, 2009

CURRENT SITUATION

· Three novel H1N1 influenza viruses that are resistant to the antiviral drug oseltamivir have been detected from 3 countries.

· These rare instances of oseltamivir resistant novel H1N1 influenza viruses remain isolated findings at this time.

· The oseltamivir resistant viruses identified have been sensitive (susceptible) to zanamivir.

· There is no evidence of genetic reassortment with seasonal H1 viruses among the three cases of oseltamivir resistant novel H1N1 influenza viruses.

· At this time, WHO and CDC do not recommend any changes in antiviral guidance.

· The few people who have been infected with oseltamivir-resistant viruses have had illness similar to that caused by oseltamivir-sensitive viruses. Illness has not been more severe, and oseltamivir-resistant viruses have not been identified among close contacts.

· Surveillance for the detection of antiviral resistance in novel H1N1 influenza is ongoing among domestic and international isolates submitted to CDC.

· There are two influenza antiviral medications recommended for use against novel H1N1 influenza. These are oseltamivir (trade name Tamiflu ®) and zanamivir (trade name Relenza ®). Either medication can be used.

· Highest priority should be placed on treating patients hospitalized with influenza or those who are ill with influenza who have an age or medical factor placing them at higher risk for more severe illness or influenza-related complications.

· See Interim Guidance on Antiviral Recommendations for Patients with Novel Influenza A (H1N1) Virus Infection and Their Close Contacts for more information.

GENERAL INFORMATION ABOUT ANTIVIRAL RESISTANCE

· Influenza viruses can develop resistance to antiviral medications.

· Antiviral resistance means that a virus has changed in such a way that the antiviral drug is less effective in treating or preventing illnesses caused by the virus.

· Influenza viruses constantly change as the virus makes copies of itself. Some changes can result in the viruses being resistant to one or more of the antiviral drugs that are used to treat or prevent influenza.

· Antiviral resistance is detected through laboratory testing.

· Additional cases of antiviral resistance are likely to be detected.

· CDC and its WHO partners continue to conduct surveillance for antiviral resistance. The data indicate that the prevalence of oseltamivir resistant viruses is low. Among 202 novel influenza A (H1N1) viruses from the United States tested by CDC this year, none have been resistant to oseltamivir.

· Information on resistance of influenza viruses to the four antiviral medications is updated weekly on the CDC FluView surveillance report which is found at: http://www.cdc.gov/flu/weekly/fluactivity.htm

INFLUENZA ANTIVIRAL MEDICATIONS

· Influenza antiviral medications are prescription medicines (pills, liquid or an inhaled powder) with activity against influenza viruses, including novel H1N1 influenza viruses.

· Antiviral drugs work by decreasing the spread of flu viruses in the respiratory tract.

· Influenza antiviral medications work best when started soon after illness onset (within 2 days) , but treatment with antiviral drugs should still be considered after 48 hours of symptom onset, particularly for hospitalized patients or people at high risk for influenza-related complications.

· There are four influenza antiviral medications approved for use in the United States . The four antiviral drugs are oseltamivir (brand name Tamiflu ®) ; zanamivir (brand name Relenza ®) ; amantadine (Symmetrel®, generic) ; and rimantadine (Flumadine®, generic) .

o This novel (H1N1) influenza virus is sensitive (susceptible) to the neuraminidase inhibitor antiviral medications, zanamivir and oseltamivir (other than the three viruses recently identified). It is resistant to the adamantane antiviral medications, amantadine and rimantadine.

· Most persons with novel H1N1 influenza have had mild illness lasting several days and have recovered without need for antiviral treatment. Treatment is generally reserved for patients hospitalized with influenza or those who are ill with influenza who have an age or medical factor placing them at higher risk for more severe illness or influenza-related complications.

· Use of antiviral drugs to prevent illness (chemoprophylaxis) is usually reserved for certain specific situations. Widespread use of antiviral medications for chemoprophylaxis is not encouraged as injudicious use of antiviral drugs might be a factor in causing more viruses to become resistant.

Centers for Disease Control and Prevention (CDC) · 1600 Clifton Rd · Atlanta GA 30333 · 800-CDC-INFO (800-232-4636)

Stamford's Sewage treatment Plant

It is a very well run operation. This last year they received a million dollars in Tax credits for their managing the effluent so well. The Nitrogen discharge is under 1 mg/L with its methods and usually about 0.1 or 0.2. This is some contrast to the normal Nitrogen (as Nitrate) levels that are found naturally in The Sound (0.58 mg/L).
So part of the study Art Glowka and I are undertaking is to see how the treatment plants effluent is absorbed.
The test case was Stamford's Plant and the numbers were very typical of something clean.
The first 2 samples, going up the discharge point were typical of Long Island Sound Water. No Phosphate, no Nitrite Nitrogen and a Nitrate Nitrogen around 0.52 to 0.55 mg/L
Because this was much closer to shore, there were bacteria. In the furthermost sample, no Total or fecal coliform and 2 colonies/100 mL of enterococcus.
The second sample, which was near the break wall, had 20 Total coliform colony forming units in 100 mL of sample, 5 of which were fecal coliform, all 5 proving to be E. Coli. There were 47 enterococcus colonies per 100 mL, probably due to water fowl at the sampling point.
The next sample was interesting, the Nitrate level dropped to 0.436 mg/L, but no measurable nitrite or phosphate. This was near Dyke Park. Total coliform levels were still at 20 CFU's per 100 mL with 14 being fecal coliforms, all confirming as E. Coli. Enterococcus bacteria levels were at 14 CFU's per 100 mL.
The last sample was only a short distance from the outfall (50 meters) and was a surprise.
phosphate was measurable at 0.389 mg/L
nitrite nitrogen was measurable at 0.004 mg/L
and Nitrate was 0.823 mg/L
total coliform CFUs/100 mL by membrane filtration (m-Endo) 90
fecal coliform CFUs/100 mL by membrane filtration (m-TEC) 25
enterococcus CFUs/100 mL by membrane filtration (m-EI) 35
Escherichia coli CFUs/100 mL by membrane filtration (m-TEC) 20
These are the results down stream of the best sewage treatment plant in the area.

Beaches

How long have I studied Stamford water quality at the beaches? 30 years? May be, but I really got down and dirty with it 20 years ago. This is the run off from all the rain cleaning urban streets and storm systems and hopefully providing food for creatures to eat because out there in the Sound a mile out there is nothing!
The unsettled weather, the 3 inch rain and the other thunder storms all around us has cause the water to have a lot of unusual bacteria organisms, none over limit to allow me to close them, but I would tell you to be careful going into the water. Wash off after.
We have not seen that mystical white Styrofoam type stuff, "Sewage grease" that I believed would be there from the 3 inch rain, but the weather has been very unsettled and may have broken it all apart in the near waters.
The next four or five days promise to be nice weather and that maybe enough to settle every thing down.
From the info I get from beach net, the indicator bacteria (and a pathogen in its own right) will come out of wet sand during this unsettled weather. it has not been numbers I worry greatly about and certainly not in numbers that would allow me to shut down bathing on a Fourth of July weekend, but caution is urged.

Observations on the Sound

Art Glowka and I started the first of many surveys yesterday. This was taken a mile south of Westcott cove in 80 feet of water. It was a slightly subsurface sample and the water temperature was 63 F out there. The sky was slightly overcast, so there was no direct sun.
He wanted me to look for the nutrients I can do, I got curious.
Samples were taken at 5, 7, 9 and 11 AM at the same location.
There was no reactive phosphate or nitrite-nitrogen.
The nitrate nitrogen varied between 0.525 mg/L to 0.629 mg/L.
The Secchi dish reading was between 4 and 5.
That is not a lot of nutrient and the nitrogen level is consistent with what everyone else has found.

Now for me.
the pH varied between 8.17 to 8.25
There were no indicator bacteria in any sample.
No total or fecal coliform and no enterococcus species.
There were a few non-coliform bacteria growing on the total coliform plate, they are not significant except that they a aerobic bacteria.
Turbidity varied between 1.32 to 1.64 NTUs.
The sample would be considered very clean.

Conversations with a true environmentalist

I have posted several times about the man I consider the "Patron Saint of Long Island Sound", mostly because he is so active in just so many aspects of the Sound.
He stops in the lab every now and then and just talks.
Today he started with me and how i am doing. Progressed on the legal work to deal with the East River tidal flow.
Lamented on the way the EPA's Long Island Sound office is stonewalling any requests to really look at the biology of the Sound.
Discussed how the good fishermen were having trouble finding the schools of peanut bunker that should be very prevalent this time of year.
These are juvenile Menhaden, which used to be a major commercial fish from Long Island Sound.
We went on to discuss taking samples on Nitrogen levels down from treatment plants when the Sound becomes calmer and doing a particle differentiation to see what size the plankton is now. Last grab sample showed everything to be still very small, below what the normal zooplankton want.
Talked about maybe Mike Pavia running for mayor of Stamford (I think that would be a very good thing).
We finished with a quick thing on the Scofieldtown park.
He is very knowledgable, good man to know,

Pandemic revisited

Not much on the news? No scary news stories? Why not?
The Information in a nutshell is that the US has had 20,000 plus cases and 87 deaths and it is not flu season!
Here is the release:

FluView Influenza Activity Update

· Influenza illness, including illness associated with the pandemic influenza A (H1N1) virus, is ongoing in the United States .

· As of June 19, 2009, 21,449 confirmed and probable infections with pandemic influenza A (H1N1) virus have been identified by CDC and state and local public health departments with 87 deaths.

· During week 23 (June 7 – 13, 2009), the June 19 FluView Report shows that influenza activity overall decreased in the United States; however, there are still higher levels of influenza-like illness than is normal for this time of year and pandemic H1N1 outbreaks are ongoing in parts of the United States, in some cases with intense activity.

· 11 states in the U.S. are reporting widespread influenza activity ( Arizona , Connecticut , Delaware , Hawaii , Maine , New Jersey , New York , Pennsylvania , Rhode Island , Utah , and Virginia ); 6 states and Puerto Rico are reporting regional influenza activity; 13 states and the District of Columbia are reporting local influenza activity; and 20 states are reporting sporadic activity.

· It is very unusual for this time of year to still be having so many states reporting regional and widespread activity.

· Pandemic H1N1 viruses now make up approximately 98% of all subtyped influenza A viruses analyzed by the U.S. WHO/NREVSS collaborating laboratories.

· Overall, the nationwide level of outpatient visits to providers for influenza-like-illness is below the national baseline, but one of the 10 surveillance regions reported an influenza-like illness percentage above its region-specific baseline (Region II).

o This was in Region II, which includes New Jersey , New York , Puerto Rico , and the U.S. Virgin Islands.

o Increases in ILI in region II likely represent an increase in influenza activity in large cities in that region, such as New York City, which is experiencing community outbreaks of pandemic H1N1.

· Influenza-like illness decreased during week 23 in six of 10 regions compared to week 22.

· The proportion of deaths attributed to pneumonia and influenza (P&I) was slightly above the epidemic threshold.

· One influenza-associated pediatric death was reported and was associated with pandemic influenza A (H1N1) virus infection during Week 23.

· Since September 28, 2008, CDC has received 71 reports of laboratory confirmed influenza-associated pediatric deaths that occurred during the 2008-09 influenza season, six of which were due to pandemic influenza A (H1N1) virus infections.

· It’s uncertain at this time how severe this H1N1 pandemic will be in terms of how many people infected will have severe complications or death from pandemic H1N1-related illness.

· It is likely that localized outbreaks will continue to occur over the summer and that we will see pandemic H1N1 virus, illness and death during the upcoming U.S. flu season in the fall and winter.

· The real uncertainty is how widespread and severe the pandemic H1N1 virus will be during the 2009-2010 influenza season in the United States .

· We are still learning about the severity and other epidemiological characteristics of the pandemic H1N1 virus and are watching the Southern Hemisphere very carefully to see how pandemic H1N1 affects their influenza season, which is just beginning.

· This information is important and will be taken into account when making recommendations with regard to vaccine and other preventive measures in the fall.

Enhanced Influenza Surveillance in the Southern Hemisphere

· The Centers for Disease Control and Prevention (CDC) is working closely with countries in the Southern Hemisphere to enhance surveillance for influenza viruses circulating in the Southern Hemisphere, including pandemic H1N1 flu.

· The Southern Hemisphere is just going into its flu season now and how this virus behaves will give us some clues about what we can expect for the Northern Hemisphere.

· CDC is providing real-time, reverse transcriptase polymerase chain reaction (rRTPCR) reagents to all national influenza centers (NICs) in the Southern Hemisphere region and is working with the Pan American Health Organization (PAHO)* to increase laboratory testing capacities in South/Central America by supplying resources and training.

* PAHO is a regional office of the World Health Organization (WHO).

· In addition, CDC is providing to all NICs in the PAHO region a supplemental WHO Influenza kit containing reagents for identification of pandemic H1N1 influenza virus in the Hemagglutination Inhibition (HI) assay.

· CDC's Influenza Division has provided the necessary documents and forms with instructions for sending influenza virus isolates and specimens to CDC to 28 NICs in PAHO.

· As part of CDC’s efforts to enhance surveillance in the Southern Hemisphere, CDC has developed guidance for national laboratories within PAHO to send their most recent and representative influenza virus isolates to CDC more frequently: as often as every two weeks, if possible.

· The World Health Organization has offered to help countries ship influenza virus isolates and specimens to CDC for testing by supplying financial and logistical support.

· In addition to laboratory assistance, CDC has deployed two epidemiologists, one to Peru and one to Chile , to assist with planning enhanced surveillance activities.

· A recent mission to Chile , Argentina , and Bolivia has met with the ministries of health in each of those countries to map out a strategy for enhancing surveillance.

· CDC has provided $200,000 (U.S. Dollars) to the Central America Project in Guatemala to enhance surveillance for severe acute respiratory illness in five countries of Central America .

Summer Camp Guidance

· CDC has heard reports of pandemic H1N1 outbreaks in summer camps in the U.S.

· This is not surprising given the fact that children and young adults have been the most affected by the outbreak of pandemic H1N1 flu so far.

· CDC has developed guidance for day and residential camps in response to human infections with pandemic H1N1 influenza and posted this information on our website.

· It is important that camp staff members, parents and others are aware of, and use measures to protect themselves and also the public’s health by making plans for how to prevent and control outbreaks in camps and other places that children and young adults gather.

· CDC is recommending that the primary way to reduce spread of influenza in camps is to focus on identifying ill campers and staff as soon as possible, moving ill persons away from well campers, treating ill campers, educating campers and staff about good cough and hand hygiene etiquette, and educating camp facilitators and administrators about environmental controls that should be in place to encourage use of these practices.

· CDC is recommending that people who currently have or have had influenza-like symptoms in the previous seven days should not attend, work or volunteer in a camp until at least seven days AFTER their symptoms began or until they have been symptom-free for 24 hours, whichever is longer.

· Camp staff, volunteers, and campers should be aware of the symptoms of pandemic H1N1 flu and rapidly report to camp staff if they recognize any of them in campers or themselves.

· CDC is encouraging camp administrators and facilitators to work with parents to plan ahead for what to do in the event that their child becomes ill while at camp.

· Camps should work with local public health authorities to develop plans for addressing potential camp outbreaks and establish an open line of communication.

· Hand washing facilities, including running water and soap, should be available to all campers and staff. Everyone should be reminded to use good hand hygiene (hand washing and appropriate use of alcohol-based gels) and good cough etiquette (covering coughs and sneezes).

· Aspirin or aspirin-containing products should not be given to any person 18 years old or younger with a confirmed or suspected case of influenza, due to the risk of Reye’s syndrome.

MMWR: Novel H1N1 virus infections among healthcare personnel

· On June 19, 2009 the Morbidity and Mortality Weekly Report (MMWR) published a report entitled “Novel Influenza A (H1N1) Virus Infections Among Healthcare Personnel ─ United States , April – May 2009”

· As of May 13, 2009, CDC had received information on 48 confirmed or probable pandemic H1N1 infections reported to have occurred in people who worked in the healthcare profession; 26 with detailed information.

· Of the 26 cases, CDC found that:

o 13 healthcare personnel (HCP) (50%) were deemed to have acquired infection in a healthcare setting which could have been from provider-to-provider (1) contact or patient-to-provider (12) contact.

o 11 healthcare workers (42%) were deemed to have been infected in the community.

o 2 HCP (8%) had no reported exposures in either healthcare or community settings.

· Two infected HCP were hospitalized, one of whom reported underlying medical conditions. Neither hospitalized HCP was admitted to the intensive care unit; neither died.

· None of the HCP with potential patient-to-provider transmission of pandemic H1N1 influenza reported adhering to all recommended infection control practices for all contacts with possible source patients.

· These findings cannot definitely establish whether these instances of patient-to-provider transmission were related to non-adherence to certain parts of personal protection equipment.

· Whatever the risk of infection to HCP, this report suggests that much of it exists in the outpatient setting, such as outpatient clinics and emergency rooms.

· Current CDC infection control recommendations for the care of patients with pandemic H1N1 infections include:

o Administrative actions such as exclusion of ill HCP from work

o The use of fit-tested N-95 respirators

o Eye protection

o Use of gloves and gowns

o Aerosol-generating procedures should be performed in an airborne infection isolation room with negative pressure air handling

· HCP were defined as employees, students, contractors, clinicians or volunteers whose activities involved contact with patients in a healthcare or laboratory setting.

· These case reports do not contain enough information to determine effectiveness of specific types of personal protection equipment to protect against infection of pandemic H1N1 infection.

WHO Declaration Phase 6

· On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6.

· Designation of this phase indicates that a global pandemic is underway.

· There are now community level outbreaks ongoing in other parts of the world.

· While U.S. influenza surveillance systems indicate that overall flu activity is decreasing in the United States , pandemic H1N1 outbreaks are ongoing in different parts of the U.S. , in some cases with intense activity.

· In the United States , this virus has been spreading efficiently from person-to-person since April and, as we have been saying for some time, we do expect that we will see more cases, more hospitalizations and more deaths from this virus.

· Because there is already widespread pandemic H1N1 disease in the United States , the WHO Phase 6 declaration does not change what the United States is currently doing to keep people healthy and protected from the virus.

· Thus, there is no change to CDC’s recommendations for individuals and communities.

· WHO’s decision to raise the pandemic alert level to Phase 6 is a reflection of epidemiological changes in other parts of the world and not a reflection of any change in the pandemic H1N1 virus or associated illness.

· At this time, most of the people who have become ill with pandemic H1N1 in the United States have not become seriously ill and have recovered without hospitalization.

· In the United States , we have been preparing for this for some time.

· And we are actively and aggressively implementing our pandemic response plan.

· Phase 6 is an indicator of spread and not of severity.

· It’s uncertain at this time how serious or severe this pandemic H1N1 pandemic will be in terms of how many people infected have severe complications or death related to pandemic H1N1 infection.

· There were three influenza pandemics in the last century and they varied widely in severity.

· The 1918 pandemic killed tens of millions of people.

· The 1957 pandemic is thought to have resulted in at least 70,000 deaths in the United States .

· Deaths from the 1968-69 pandemic were about the same as for seasonal influenza.

· This pandemic certainly poses the potential to be at least as serious as seasonal flu, if not more so.

· Because this is a new virus, many people will not have immunity to it and illness may be more severe and widespread as a result.

· We are still learning about this virus and expect that, like all influenza viruses, it will continue to change.

We are taking action:

· The Federal Government is mounting an aggressive response to this newly declared pandemic.

· CDC’s goals during this public health emergency are to reduce transmission and illness severity, and provide information to assist health care providers, public health officials and the public in addressing the challenges posed by this newly identified influenza virus.

· To this end, CDC continues to update guidance.

· Visit the CDC website at http://www.cdc.gov/h1n1flu/ for more information or call 1-800-CDC-INFO.

· Everyday, we learn more about this virus and what we learn will continue to inform the actions that we take in response.

· We are aggressively taking early steps in the vaccine manufacturing process, working closely with manufacturing and the rest of the government.

· Vaccines are a very important part of a response to pandemic influenza.

· CDC isolated the pandemic H1N1 virus, made a candidate vaccine

· virus, and has provided this virus to industry so they can begin scaling up for production of a vaccine, if necessary.

· There are many steps involved with producing a vaccine and we are committed to going forward with the NIH, and FDA, BARDA, and the manufacturers of influenza vaccines, to see about developing full scale vaccine production.

· Where possible, we are taking parallel steps to speed up the vaccine process.

· If things go well, and we develop a full scale production, it would be several months until the vaccine were available.

· So vaccine is an important tool for the future.

Pandemic Severity

· Influenza pandemics can range in severity, mainly in terms of the number of people that have severe illness and die.

· Pandemic severity may also change over time and will differ across regions of the world, in different countries and even within different communities within a country.

· Pandemic disease severity will vary depending on several factors: a nation’s ability to provide health care to their people, the availability of antiviral medications to treat those who are sick, differences in how the disease affects people in different age groups, and the effectiveness of efforts to reduce person-to-person transmission of influenza.

· An evaluation of pandemic severity should be based on local circumstances for this reason.

· A pandemic severity index helps pubic health officials to match the timing of the spread and severity of the outbreak with the appropriate use of public health and community resources to minimize the number of people who get sick and the number of people who die.

· WHO has a three point scale to determine pandemic severity: mild, moderate and severe.

· At this time, WHO has indicated this seems to be a moderately severe pandemic.

U.S. Pandemic Severity Index (PSI)

· CDC developed the U.S. Pandemic Severity Index (PSI) to describe the severity of a pandemic in terms of illness and death.

· The U.S. PSI scale is based on the case-fatality ratio; the likelihood of people dying from the disease.

· The PSI scale ranges from Category 1 to Category 5 and is comparable to the U.S. hurricane severity index.

· Category 1 is the least severe and Category 5 is the most severe.

· At the current time, CDC estimates that the pandemic situation in the U.S. would be equivalent to a pandemic severity index of 2. (This would be most similar to the 1957 influenza pandemic, however, it’s uncertain how the current situation will evolve over the coming months so it’s not possible to make a predication about deaths at this time.)

· CDC will re-evaluate the classification of the Pandemic Severity Index should there be evidence that the pandemic has become more severe.

· The PSI will be adjusted based on that evaluation and appropriate guidelines and recommendations provided.

· CDC emphasizes that unnecessary weight not be given to the numeric categorization of the pandemic.

· According to the U.S. PSI:

o A category 1 pandemic has the following:

§ Case fatality ratio of less than 0.1 percent

§ Excess death rate of less than 30 per 100,000 people

§ Illness rate of 20-40% of the population

§ Less than 90,000 potential deaths (based on 2006 U.S. population)

§ Similar to a more severe seasonal flu year in the United States

o A category 2 pandemic has the following:

§ Case fatality ratio of 0.1 percent to less than 0.5 percent.

§ Between 90,000 and 450,000 deaths in the U.S. (based on 2006 U.S. population)

§ Excess death rate of between 30 to less than 150 per 100,000 people

§ Illness rate of between 20 and 40 percent.

§ Similar to 1957 pandemic.

o A category 5 pandemic has the following:

§ Case fatality ratio of greater or equal to 2 percent

§ Excess death rate of more than 600 per 100,000 people

§ Illness rate of 20-40% of the population

§ Greater than or equal to 1.8 million potential deaths (based on 2006 U.S. population)

§ Similar to the 1918 pandemic

· The importance of identifying a category of severity is only to help guide the public health interventions recommended for individuals and communities.

· The PSI scale helps public health officials match the range of public health intervention efforts to the severity of a pandemic.

For a Category 1 to 3 pandemic:

§ Ill adults and children are asked to stay home voluntarily.

§ If someone in the household is sick, well adults and children do not need to stay at home.

§ School and child care dismissal is not generally recommended, but may be considered depending on the local impact of the disease.

§ Workplace and Community adult social distancing efforts (e.g., encouraging teleconferences instead of meetings, reducing density, meaning the number of people crowded into an enclosed space, in public transit and the workplace, postponing or canceling selected public gatherings, encouraging people to telework, or take staggered shifts) are generally not recommended.

o For a Category 4 to 5 pandemic

§ Ill adults and children are asked to stay home voluntarily.

§ If someone in the household is sick, well adults and children should stay at home too.

§ School and child care dismissal is recommended for up to 12 weeks.

§ Workplace and Community adult social distancing efforts (e.g., encouraging teleconferences instead of meetings, reducing density, meaning the number of people crowded into an enclosed space, in public transit and the workplace, postponing or canceling selected public gatherings, encouraging people to telework, or take staggered shifts) are recommended

Declaration of Phase 6 and Travel

· At this time, CDC does not recommend against travel to any country.

· CDC will continue to monitor the pandemic H1N1 situation around the world and will provide recommendations to U.S. travelers based on the changing situation.

· Travelers should check the CDC travelers’ health website (www.cdc.gov/travel) for information related to this outbreak, as well as for health information on the prevention and management of flu.

· Travelers should also check the website of the embassy of the country to which they are traveling for the latest updates on entry or exit screening procedures which may impact their travel.

· CDC recommends that ill persons postpone travel both for their protection and that of other travelers.

Public:

· So far, most people who have been ill with this virus have recovered.

· We are monitoring hospitalization and death rates.

· At this point, whether you are tested and actually diagnosed with pandemic H1N1 is less important than what you do if you become sick.

· It’s possible that this summer, people around you may get sick and you may get sick.

· Certainly in the fall, with our flu season, people around you will be getting sick and you may get sick.

· Be prepared to stay home for a week or so if you are ill.

· Most people infected with this virus so far have experienced the regular symptoms of flu (fever, cough, body aches, and a significant number of people have reported vomiting and diarrhea).

· For people who are critically ill, we do have antiviral medications in our arsenal against flu.

· The priority use for influenza antiviral drugs at this time is to treat severe influenza illness.

· Influenza antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza viruses, including swine influenza viruses.

· There are two influenza antiviral medications that are recommended for use against swine influenza. These are oseltamivir (trade name Tamiflu ®) and zanamivir (Relenza ®).

· Influenza antiviral drugs work best when stated soon after illness onset (within two 2 days), but treatment with antiviral drugs should still be considered after 48 hours of symptom onset, particularly for hospitalized patients or people at high risk for influenza-related complications.

· You have a role in protecting yourself and your family.

· Stay informed. Health officials will provide additional information as it becomes available. Visit www.cdc.gov

· Everyone should take these everyday steps to protect your health and lessen the spread of this new virus:

o Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

o Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.

o Avoid touching your eyes, nose or mouth. Germs spread this way.

o Try to avoid close contact with sick people.

o If you are sick with a flu-like illness, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.

o Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.

o If you don’t have one yet, consider developing a family emergency plan as a precaution.