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Avian Influenza Daily Digest
September 17, 2008 14:00 GMT
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Article Summaries ...
Regional Reporting and Surveillance
Togo takes safety measures to control spread of bird flu
9/16/08 Togolese government website republicoftogo.com--The alarm was given at the beginning of September by the agriculture ministry. The concern of the authorities was well-founded. The massive death of poultry in the village of Agbata (Lakes prefecture) is well due to the presence of bird flu virus (H5N1).
Regional Reporting and Surveillance
USA: Agencies to sample waterfowl across Montana
9/17/08 AP--State and federal wildlife crews will be sampling ducks, geese and other birds across Montana as part of a national effort aimed at providing early detection of the bird flu.
Regional Reporting and Surveillance
China reopens to most US poultry; beef still banned
9/17/08 Reuters--China has agreed to lift a bird flu-related ban on U.S. imports of poultry products from six states but remains closed to all imports of U.S. beef, U.S. trade officials said on Tuesday.
Regional Reporting and Surveillance
New Zealand: LPAI found in wild ducks
9/17/08 NZ News--Wild mallard ducks in New Zealand have tested positive for a "low pathogenic" form of bird flu. The virus, known as LPAI H5N, is closely related to viruses found in the past and has been here for some time, Ministry of Agriculture and Forestry (MAF) biosecurity staff said today.
Regional Reporting and Surveillance
Science and Technology
Cost-Effective Antiviral Strategy Could Halve Pandemic Deaths
9/15/08 Medical News Today--Treatment with the oral antiviral oseltamivir combined with post-exposure prophylaxis (PEP) of people exposed to infected individuals could be one of the most cost-effective strategies for reducing illness and death during an influenza pandemic according to recent modeling research published in Value in Health by Beate Sander et al., University of Toronto, Ontario, Canada.
Antivirals
Scientists Working To Protect Northern Ireland From Bird Flu
9/17/08 Medical News Today--Queen's University Belfast scientists are involved in two international projects aimed to protect Northern Ireland's agri-food industry from Bird Flu and African Swine Fever, a disease which kills pigs.
Science and Technology
Pandemic Preparedness
The reality of pandemic planning: I've hit the 'wall' but I'm not giving up
9/15/08 CIDRAP Business Source--Special feature alert: Welcome to CIDRAP Business Source, a subscription service from the University of Minnesota designed to help businesses prepare for public health threats. This commentary by infectious disease and preparedness expert Michael T. Osterholm, MPH, PhD, Editor-in-Chief, appeared in the Sep 11 Osterholm Briefing. In view of the importance of Dr. Osterholm's message to all organizations and individuals, we're making this column available to the general public. We encourage you to explore our content-rich site for additional context and commentary. Michael T. Osterholm
Pandemic Preparedness
PlanFirst Webcasts on Pandemic Influenza
9/17/08 PandemicFlu.gov--On March 13, 2008, the U.S. Department of Health and Human Services launched PlanFirst, a regular Webcast series on pandemic planning. The goal of the PlanFirst Webcasts is to help states, local communities, employers, faith-based and civic organizations, and families and individuals learn more about pandemic planning. September Webcast
Pandemic Preparedness
Few remember millions killed in Spanish flu outbreak 90 years ago
9/16/08 Canadian Press/Branswell--The Allied Forces were gaining hard-earned ground in the late summer of 1918, carving a path that would shortly lead to an armistice for the First World War.
Pandemic Preparedness
Full Text of Articles follow ...
Antivirals
Cost-Effective Antiviral Strategy Could Halve Pandemic Deaths
9/15/08 Medical News Today--Treatment with the oral antiviral oseltamivir combined with post-exposure prophylaxis (PEP) of people exposed to infected individuals could be one of the most cost-effective strategies for reducing illness and death during an influenza pandemic according to recent modeling research published in Value in Health by Beate Sander et al., University of Toronto, Ontario, Canada.
The objective of the study was to analyze, from a US societal perspective, the potential economic impact of a number of key mitigation strategies that may be considered in the event of a pandemic.
Combined targeted antiviral treatment / PEP is a cost-saving strategy and the most effective single approach for mitigating pandemic influenza. The addition of school closure provides greater benefit. Although this remains cost-effective from a societal perspective, school closure will most likely be an attractive strategy when transmission / mortality rates are high.
This analysis is the first economic evaluation to be performed using a dynamic model to predict influenza transmission, the model being based on a "typical" American community of 1.6 million individuals. The study evaluated the use of 16 alternate strategies based on the use of oseltamivir for both treatment and post-exposure prophylaxis (PEP), the use of pre-vaccination in 70% of the population, the use of school closure to reduce the spread of disease and the absence of any intervention.
Without intervention, the authors predict that an influenza pandemic would result in ~50% of the population being infected with a mortality rate amongst infected individuals of ~1.3% and an overall economic impact to society of ~$190 per capita. To a greater or lesser extent, all of the interventions studied reduced illness attack rate, morbidity and mortality. However, the combined use of oseltamivir for treatment and PEP was shown to be the most effective single approach, reducing the number of individuals infected by ~50%, the mortality rate by ~60% at the lowest cost to society ($120 per capita). Extrapolation of these results to the broader US population (300 million) would indicate that such an intervention could result in the prevention of 81 million infections and 2.4 million deaths in the event of an influenza pandemic. Further significant improvement in disease transmission and mortality (reduced by ~88% and ~92% respectively in comparison with no intervention) can be gained by the addition of school closure to this approach but at a substantially higher overall cost to society (~$2,700 per capita).
"The World Health Organisation provides a strong recommendation for the use of oseltamivir for the prevention of avian flu in people who have been in contact with someone who is known, or suspected of being infected with the virus," commented Professor Ira Longini, Professor of Biostatistics and Mathematics at the University of Washington, Seattle, USA. "This research suggests that a similar approach may also be an effective strategy in the event of an actual pandemic outbreak, especially as it is unlikely that a vaccine fully matched to the strain will be available in the initial wave of a pandemic."
Value in Health (ISSN 1098-3015) publishes papers, concepts, and ideas that advance the field of pharmacoeconomics and outcomes research and help health care leaders to make decisions that are solidly evidence-based. The journal is published bi-monthly and has a regular readership of over 3,000 clinicians, decision-makers, and researchers worldwide.
ISPOR is a nonprofit, international organization that strives to translate pharmacoeconomics and outcomes research into practice to ensure that society allocates scarce health care resources wisely, fairly, and efficiently.
Pandemic Preparedness
The reality of pandemic planning: I've hit the 'wall' but I'm not giving up
9/15/08 CIDRAP Business Source--Special feature alert: Welcome to CIDRAP Business Source, a subscription service from the University of Minnesota designed to help businesses prepare for public health threats. This commentary by infectious disease and preparedness expert Michael T. Osterholm, MPH, PhD, Editor-in-Chief, appeared in the Sep 11 Osterholm Briefing. In view of the importance of Dr. Osterholm's message to all organizations and individuals, we're making this column available to the general public. We encourage you to explore our content-rich site for additional context and commentary.
Michael T. Osterholm
September 11, 2008 (CIDRAP Business Source Osterholm Briefing) ? Like marathon runners or long-distance swimmers, I hit the "wall" this week when it comes to pandemic preparedness planning?big time. It wasn't pretty. And while I am not giving up, recent events certainly gave me pause. So, I'm changing my strategy?and sharing it with you.
What brought me to this place
Yesterday, our presidential campaign devolved into "lipstick and pigs" nonsense, and it became so clear to me that no politician can get elected today by telling the electorate the painful truth: We're not prepared for our future, and we're not going to do much to get prepared. True preparedness requires sacrifice, and, frankly, as a nation we're mostly too "in the moment" to consider sacrificing for the future.
Here are two non-pandemic examples that call for sacrifices:
* Paying more at the pumps. We should be promoting $7 a gallon gas to reduce consumption and create the incentives for alternate fuel development. Yes, it would be painful, but in the words of STP CEO Andy Granatelli, "You can pay me now, or you can pay me later."
* Looming burden of entitlements. This past Sunday, Peter Peterson, the highly respected senior chairman of the Blackstone Group, published a two-page letter in the New York Times, describing America's $53 trillion black hole?the sum of our government's current liabilities and unfunded entitlement promises. More than $41 trillion of this hole is related to Medicare and Social Security entitlements for the soon-to-come-of-age baby boomers. This amounts to more than $455,000 per American household. No national or state candidate has the courage to tell this story because it would mean she or he would have to promise "future pain" under her or his watch. No tax cuts?instead, major tax increases! (And by the way, this situation won't go away if we just ignore it. Instead it will smother our kids in their adulthood years and future generations.)
So you tell me: Will the honesty and vision to do what is necessary to prepare for the next pandemic come from any of our current or newly elected leaders or even from our business leaders?
And what of pandemic planning?
For more than 15 years, I've spent a good deal of my professional heart and soul trying to convince a distracted world that there are two public health threats that require us to make special efforts to prepare for them. Both bioterrorism and pandemic influenza have the potential to wreak havoc in our world far and beyond the direct cost of illness and death.
We need look no further for evidence that a bioterrorism event can have such an impact than when we recall what letters filled with anthrax spores did to our country in 2001. Of 22 human anthrax cases, 5 people died?a number that, while tragic, hardly puts this event on the same scale as massive public health concerns. And yet the resulting fear and even panic almost shut down the US Postal Service. Imagine what an aerial release of anthrax spores across an entire US city would do both in terms of deaths and our national psyche.
An influenza pandemic, regardless of whether it's mild, moderate, or severe in terms of human illnesses and deaths, has every potential to bring the global just-in-time economy to a screeching halt. As I've detailed in these columns before, such an impact will result in many collateral deaths from the lack of availability of critical drugs, food, and even clean drinking water.
Why now?
So, if I've made it my professional mission to promote preparedness for these two potential catastrophic events for so many years, why I am hitting the wall now? It's not because we haven't had some successes.
I'm actually impressed with efforts that we have made in the US during the last 7 years to better prepare to deter, detect, and respond to bioterrorism events. We now have:
* Extensive caches of new and effective smallpox vaccine and antibiotic stockpiles that can be brought to communities quickly for the treatment of up to 10 million people potentially infected with anthrax or plague
* Better systems for quickly detecting releases of these infectious agents by terrorists
But these pale in comparison to efforts to prepare us for the next pandemic. Pandemic influenza, unlike a local or regional terrorist attack, will quickly overwhelm our preparedness efforts to date.
As I've detailed on numerous occasions, to be genuinely prepared for the next pandemic we need the public health version of a Manhattan Project to develop, produce, and distribute an influenza vaccine effective against most strains of flu virus for the entire global population. And we need to anticipate the impact of suddenly halting the global just-in-time economy so we can plan accordingly.
Both of these efforts are enormous in scope and I believe are doable with (1) a commensurate political and private-sector commitment to medical research, science, business leadership, financial resources, and human ingenuity and (2) a real sense of urgency.
I'm hitting the wall because I've finally come to the conclusion that, as a nation, we don't have and can't find either the political will or private-sector commitment needed to address our pandemic preparedness challenges of today. To make matters worse, other national governments and their private-sector enterprises are not making meaningful progress in preparing for the next influenza pandemic, either. In the US, we have a national pandemic influenza plan, but it doesn't even begin to address the disastrous implications of a collapsing global just-in-time economy.
Yes, I know that you as planners have tried your best to prepare your organizations?including developing pandemic plans and perhaps even exercising them. But you, better than anyone, also understand the challenges that can't be addressed because they are out of your control. In many instances, your management hasn't given you the support you need to move your plans past the first draft.
A new order of business
So, where do we, where do I, go from here? I can't give up preparing for the next pandemic if for no other reason than my duty to ensure the safety and security of my kids.
What I am doing is changing my approach. In upcoming columns, I will focus on what we can do to better prepare for the collateral damage of the next pandemic, rather than on preparing for the pandemic itself.
This approach may sound like a subtle difference, but in the public health world, such a shift is like knowing when it's not possible anymore to prevent a disease outbreak, so we choose to focus our energy and resources on limiting the impact of the outbreak. In a long-distance competition, it's the same as mustering the physical and mental wherewithal to break though the "wall" so you can get to the finish line. In the world of business, it's what Jim Collins calls in his book, Good to Great, the Stockdale Paradox?combining the courage to face the brutal facts with the unwavering belief that you can and will prevail.
Helping you prevail
So here's my plan. I will address the following topics in upcoming columns:
* Electricity. What must we do to ensure that our communities don't lose electricity during the next pandemic, and if they do, what should our plan be?
* Critical life-saving drugs. To be sure, we will run out of drugs that have nothing to do with preventing or treating pandemic influenza. So, what can your organization do now to prepare for the 5% or more of your workers or their families who won't be able to get their life-saving insulin?
* Food. Finally, I'll address why we'll see major food shortages within hours of the official declaration that the pandemic has begun. What can you do now to be better prepared?
Bottom line for business
In short, I am no longer counting on any substantial or meaningful pandemic preparedness efforts that require major national leadership or significant financial investment. I believe that's far more than we can expect among our get-elected-at-any-cost "leaders." Though I've hit the "wall," I'm not stopping my efforts to prepare or giving up my belief that we'll get through this catastrophe. After all, my efforts, your efforts, are about our kids, all kids, and their future. For that alone I could never give up.
Pandemic Preparedness
PlanFirst Webcasts on Pandemic Influenza
9/17/08 PandemicFlu.gov--On March 13, 2008, the U.S. Department of Health and Human Services launched PlanFirst, a regular Webcast series on pandemic planning. The goal of the PlanFirst Webcasts is to help states, local communities, employers, faith-based and civic organizations, and families and individuals learn more about pandemic planning.
September Webcast
Join us on September 25, 2008, at 2:00 pm ET, for our Webcast on individual preparedness.
Every sector of society is responsible for preparing now for an influenza pandemic. Even families and individuals have a role in planning for an influenza pandemic. The media buzz around ?bird flu? has died down but the H5N1 virus has not. We must continue to prepare our Nation for a flu pandemic.
To help citizens learn more about pandemic flu and the steps they can take now to plan for a pandemic and to protect their loved ones, the U.S. Department of Health and Human Services invites you to participate in this important discussion.
Speakers
* Admiral Joxel Garcia, Assistant Secretary for Health, U.S. Department of Health and Human Services
* Dr. Richard Benjamin, Chief Medical Officer, American Red Cross
* Harlan Dolgin, Co-chair, PandemicPrep.org, St. Louis, Missouri
* Tim Woerther, Co-chair, PandemicPrep.org, St. Louis, Missouri
No registration is required. Email your questions for the Webcast panelists before and/or during the program to hhsstudio@hhs.gov. Please include your first name, state and town.
Before the Webcast, please ensure that your system can access the live stream. Test Your Video Player
Regional Reporting and Surveillance
Togo takes safety measures to control spread of bird flu
9/16/08 Togolese government website republicoftogo.com--The alarm was given at the beginning of September by the agriculture ministry. The concern of the authorities was well-founded. The massive death of poultry in the village of Agbata (Lakes prefecture) is well due to the presence of bird flu virus (H5N1).
Analyses done in Ghanaian's and Italy's laboratories confirmed the presence of the virus. The H5N1 can be transmitted to human being even if the phenomenon is limited for the moment (235 deaths in the world since 2003).
"Safety measures have been taken to avoid a spread and we invite the population to be very cautious", indicated the ministry of health on Monday.
The ministry recall the complete ban of poultry importation in Togo and continue to maintain controls at the port, in the markets and border posts with Benin, Burkina and Ghana.
Regional Reporting and Surveillance
USA: Agencies to sample waterfowl across Montana
9/17/08 AP--State and federal wildlife crews will be sampling ducks, geese and other birds across Montana as part of a national effort aimed at providing early detection of the bird flu.
Rose Jaffe is the avian influenza project coordinator for the Montana Department of Fish, Wildlife and Parks in Bozeman. She says FWP and the U.S. Agriculture Department's Animal and Plant Health Inspection Service will collect 1,600 samples statewide this fall and early winter.
The samples will be gathered at areas where waterfowl congregate, such as hunter check stations and national wildlife refuges.
Jaffe says the birds will be collected in land traps, sampled and released unharmed. The data will then go into a national database created to track avian influenza information.
Regional Reporting and Surveillance
China reopens to most US poultry; beef still banned
9/17/08 Reuters--China has agreed to lift a bird flu-related ban on U.S. imports of poultry products from six states but remains closed to all imports of U.S. beef, U.S. trade officials said on Tuesday.
The breakthrough on poultry products, as well as an agreement to convene in-depth technical talks on the impasse over beef, were announced at the end of high-level U.S.-China talks at the Richard Nixon presidential library in Yorba Linda, California.
China also agreed to adhere to a more streamlined process by which U.S. makers of medical devices obtain approval for imports of their products to China and to step up efforts to prevent contamination of its own pharmaceutical exports, U.S. officials said.The two sides further pledged closer cooperation on steps to combat piracy of intellectual property and the sale counterfeit goods in China.
The lifting of restrictions on U.S. poultry imports from six states - New York, Pennsylvania, Connecticut, West Virginia, Rhode Island and Nebraska - takes effect immediately, said U.S. Agriculture Secretary Ed Schafer.
But the ban will remain in place for now against poultry products from two other states - Arkansas and Virginia. For some of those states, China's poultry import ban has been in effect for years.
China imposed the bans in states where a "low-pathogenic" strain of avian influenza, or bird flu, was detected - a restriction that U.S. officials said runs contrary to the standards of world agricultural authorities.
The so-called "low-path" bird flu strains are widely seen as posing no threat to public health because they cannot be transmitted to humans, the officials said.
The United States exported $600 million in poultry products to China during the past year.
HEALTH-CARE PRODUCTS
But U.S. Commerce Secretary Carlos Gutierrez said two of the most significant agreements pertained to trade in health-care products - accords to clamp down on tainted drugs exported from China and to follow simpler procedures for testing of U.S. medical products bound for China.
U.S. exports of medical devices last year totaled roughly $860 million.
Taken as a whole, the various agreements are especially important in light of the current economic slowdown and turmoil rattling financial markets, Gutierrez said.
With China heavily invested in the United States, Beijing has a great stake in the success of the U.S. economy, he said, adding that Chinese Vice Premier Wang Qishan, leader of Beijing's delegation, "wants to make sure that our trading relationship is on firm ground and firm footing."
"There's no question that added a bit of an extra push, and extra sense of urgency ... to the meeting," Gutierrez told reporters at the end of the daylong talks.
China has become the third-largest export market for U.S. goods, taking in a record $65.2 billion last year. But imports from China jumped to a record $321.5 billion over the same period, rattling U.S. manufacturers and prompting calls from Congress for the White House to take a tougher stance against "unfair" China trade.
In another favorable development for U.S. business expansion in China, Beijing announced over the weekend a 50 percent reduction in the amount of capital required for foreign companies to enter China's huge telecommunications market.
But a big breakthrough on the touchy issue of U.S. beef imports alluded negotiators at the talks in Yorba Linda, an annual forum known as the U.S.-China Joint Commission on Commerce and Trade.
Like many countries, China closed its market to U.S. beef after the first case of mad cow disease was found in the United States in December 2003. The Bush administration hailed China's conditional agreement in April 2006 to reopen its market but more than two years later, that still hasn't happened.
U.S. officials said two sides agreed to a new round of technical discussions on beef safety in the near future.
Science and Technology
Scientists Working To Protect Northern Ireland From Bird Flu
9/17/08 Medical News Today--Queen's University Belfast scientists are involved in two international projects aimed to protect Northern Ireland's agri-food industry from Bird Flu and African Swine Fever, a disease which kills pigs.
Working with colleagues from other EU-member states and the Far East in the FLUTEST project they are providing improved diagnosis and early warning systems for bird flu.
Meanwhile, local researchers in the AFRISK project are working with 16 partner institutes around the world including Africa and the Far East to provide new ways of detecting African Swine Fever (ASF) and reduce the risk of the disease being imported into EU member states.
Gordon Allan, an Honorary Professor at Queen's who is also a Principal Scientific Officer in the Agri-Food and Biosciences Institute (AFBI), is leading researchers from both institutions in the European Commission-funded projects, which have each been awarded £130,000.
Professor Allan said: "Both of these viruses pose a significant threat to the agri-food industry in Northern Ireland and rapid detection of the viruses in any suspect infected animals is an important step in controlling and eliminating potential outbreaks of the disease."
Bird Flu, (Avian Influenza) which has killed millions of birds across the world, is a constant threat to the poultry industry in Northern Ireland while African Swine Fever, a disease which kills pigs, has recently spread across Europe.
Although it has killed hundreds of people, Bird flu is not considered a large-scale threat to humans as it cannot pass easily from one person to another.
ASF is no longer confined to sub-Sahara African states, and recent outbreaks have been recorded in Sardinia, Georgia, Armenia and southern Russia.
Global warming and climate change are thought to be increasing the spread of the disease in Europe.
Professor Allan explained: "It is important to the agri-food industry on the island of Ireland that researchers, both North and South of the border, continue to participate in these large EC-funded projects.
"These multinational collaborations enable locally-based scientists to input expertise but they also gain considerable information from partners around the world on how to successfully fight the increasing threat to our local industry.
"Infectious diseases do not recognise borders and multinational collaboration is the only effective way to combat their spread."
Regional Reporting and Surveillance
New Zealand: LPAI found in wild ducks
9/17/08 NZ News--Wild mallard ducks in New Zealand have tested positive for a "low pathogenic" form of bird flu. The virus, known as LPAI H5N, is closely related to viruses found in the past and has been here for some time, Ministry of Agriculture and Forestry (MAF) biosecurity staff said today.
It is different to high pathogenic (HPAI) form of the bird flu virus. MAF official Andre van Halderen said that strains avian influenza viruses which did not cause disease were present in wild bird populations, and the find was "not unexpected".
Sampling of healthy wild birds took place at seven locations across New Zealand in February as part of avian influenza surveillance. A total of 1241 samples were collected from mostly mallard ducks and some migratory bird species in Paparoa, the mouth of Kaituna River, Lake Aniwhenua, Reparoa, Napier, Temuka and Invercargill.
"The risk of HPAI "bird flu" reaching New Zealand is unchanged and remains low," Dr van Halderen said.
Avian influenza viruses are naturally present in many species of wild birds, especially water fowl such as ducks and geeseand shorebirds, including migratory waders.
HPAI virus causes severe disease that spreads quickly, causing sudden death in birds, but LPAI viruses may cause mild illness or no clinical disease in birds.
Since 1975 over 5000 samples have been taken from wild birds in New Zealand. A small number of low pathogenic avian influenza viruses, including those of the H5 or H7 subtype, have been found in healthy mallard ducks. New Zealand has never had a case of HPAI.
Pandemic Preparedness
Few remember millions killed in Spanish flu outbreak 90 years ago
9/16/08 Canadian Press/Branswell--The Allied Forces were gaining hard-earned ground in the late summer of 1918, carving a path that would shortly lead to an armistice for the First World War.
As those armies battled over the blood-soaked fields of Europe 90 years ago, another enemy was on the move. This adversary didn't choose sides. It didn't restrict itself to Europe. It didn't spare civilians.
By the time it was through rampaging around the globe, this assailant - the Spanish flu - had killed between 50-100 million people, several times more than had lost their lives in the soon-to-be-concluded War to End All Wars.
Yet despite the scope of the death and illness, the fear and social disruption, the history books made little mention of what is now viewed as the deadliest outbreak of infectious disease in recorded history.
"If I hadn't researched and written a book myself, I'd want to go look it up in the Encyclopedia Britannica to find out whether it really happened or not," historian Alfred Crosby said in a recent interview from his home on Nantucket Island.
Crosby's 1976 account of the event - America's Forgotten Pandemic: The Influenza of 1918 - sank the first spade in what has turned into a historical and scientific excavation of the Spanish flu.
"For me, that's the most mysterious thing about it," Crosby says. "The vagaries of the virus, we'll understand them eventually. And we'll understand how flu epidemics work.
"But we're never going to understand: How the hell did we have something that killed millions and millions of people and then we said 'Oh, well' and went on to the World Series or something?"
Most of us would have had a relative - an aunt, a grandfather, a great-grandmother - who was sick with the Spanish flu.
If we'd asked or if they'd offered, they could have told stories of a taxing time, when gymnasiums morphed into crowded makeshift hospitals, when undertakers ran out of coffins, when the Stanley Cup playoffs were shelved - the only time that happened until the NHL lockout of 2004-05.
Recounting the details now, the story seems like bad science fiction - 30,000 to 50,000 dead in Canada. If a similarly virulent outbreak occurred now, between 186 million and 372 million people around the world would die, and between 112,000 and 186,000 Canadians would succumb.
Today such a catastrophe would be non-stop news. Consider the SARS outbreak of 2003: the disease infected just over 8,000 people and killed fewer than 800, but rivalled the start of the war in Iraq for top-of-the-newscast status.
Heather MacDougall, a historian at the University of Waterloo, has studied Canadian newspaper coverage of the time.
"The press was heavily self-censored because the war was still on. And when you look at the news stories, the rhetoric of the stories is that this is just another battle that we have to fight. Except it's against disease, not against the Germans."
