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HSPH investigators help lead H1N1 research and response

[Fall 2009]

Catching the flu before it catches the world

As a new influenza pandemic this spring set off alarms in the global health community, Harvard School of Public Health scholars helped illuminate the crisis and lead a practical response. In a widely readNew York Times op-edDean Julio Frenk described how the Mexican government’s sharp surveillance system—backed by prompt government interventions—alerted the world to the novel H1N1 virus and contained its initial spread. Professor ofEpidemiology Marc Lipsitch lent his epidemic modeling skills to the U.S. Centers for Disease Control and Prevention (CDC) and published two timely scientific papers on the topic. And Associate Professor Atul Gawande teamed up with the World Health Organization (WHO) to create a concise influenza patient-care checklist for beleaguered hospitals.

Frenk—Mexico’s former minister of health—praised Mexico’s initial response to the epidemic. After Mexico’s disease surveillance system picked up a minor but troubling trend in flu cases in April, “An immediate investigation led, within a few weeks, to the isolation and full genetic sequencing of the microbe causing the illness,” he wrote in the Times (“Mexico’s Fast Diagnosis,” May 1, 2009). The charge that the government hadn’t acted quickly enough, he added, “fails to take into account the real-life complexity of recognizing and responding to an unexpected public health emergency.” Frenk consulted with officials in Mexico in April as the outbreak began to jump across continents. Impressed by how Mexican scientists had quickly spotted H1N1 against a background of standard seasonal flu and had promptly alerted global authorities, he wrote, “Their fast action gave other countries the warning they needed to screen for the new virus.”

MODELING AN EPIDEMIC
While Dean Frenk was in Mexico, Lipsitch lent his infectious-disease modeling skills to the CDC in Atlanta. He worked with agency scientists to judge the severity and transmission rate of the virus. His collaborators included faculty colleagues and students at HSPH, and colleagues at Hong Kong University, the Netherlands National Institute for Public Health and the Environment, and Imperial College London.

Coincidentally, just before the epidemic emerged, Lipsitch had completed a paper that described how dipping into small reserves of second-line flu drugs such as Relenza could hedge against resistance to stockpiled first-line treatments such as Tamiflu. PLoS Medicine published the paper online May 19. In a separate May 27New England Journal of Medicine article, Lipsitch and colleagues described steps needed to prepare for the upcoming flu season in the Northern Hemisphere-from capitalizing on university and private-sector expertise to amping up government surveillance.

HELPING HOSPITALS PREPARE

Gawande, who led a team that developed a surgical checklist now used in operating rooms worldwide (“A Simple Checklist that Saves Lives,” Harvard Public Health Review, Fall 2008), responded to a WHO request for similar influenza H1N1 guidelines. Twelve hospitals around the world, including one in Mexico, joined in reaching clinical consensus on the checklist and in quickly bringing the guidelines into operation. HSPH doctoral student Martin Lajous, a medical doctor from Mexico, acted as a go-between with Mexican hospitals.

By May 15—barely five weeks after Mexican authorities started investigating the first wave of cases—the WHO published the checklist. The two-page swine flu document lists recommended medical procedures from the time a patient arrives at a clinic until the discharge and after. For medical personnel, the first two procedures are “put on medical/surgical mask” and “clean hands”—commonsensical actions that are shockingly ignored in modern health care, according to a 2006 study in Michigan on which Gawande had based part of his research.

MEDIA AVALANCHE
Doctoral student Lajous also helped Assistant Dean for Communications Robin Herman in working with Spanish-language media as an avalanche of media requests from around the world hit the HSPH Office of Communications. Reporters were most eager for Dean Frenk’s perspective on the epidemic as the former Mexican health minister, and the dean participated in dozens of interviews in the first few weeks after the outbreak became known.

CELL PHONE SURVEYS
Collaborating with a major cell phone company in Mexico, Lajous helped draft a survey to pinpoint the outbreak’s earliest cases. The company, Telefonica, then sent to its customers both the survey and a message from the Mexican minister of health. Lajous and colleagues are now analyzing the data, which could offer insights into how cell phones might enhance public health surveillance and response—not only for pandemic flu, but for any fast-spreading emerging disease.

Larry Hand is associate editor of the Review.