Today I took a day off from work to try and get a few things done that are hard to cram into a small window of time either in the evenings or on a Saturday. It was just a normal sort of list of things, involving repairing a freezer door, dealing with a car service issue, taking the dog to the vet for his annual exam, and having a locksmith come to the house to fix a broken deadbolt lock. The idea was to take one day off and deal with everything that needed to be done.

It was all going to be smooth until the freezer door replacement part didn't show up on the truck yesterday. And the voicemail alerting us about that didn't reach me as a message until after 10:00 pm last night. And the repair guy still hasn't called me back although I paged him so we can reschedule.

It's all a small inconvenience, but it calls to mind how many things in life we makes plans about. We plan our careers. We may plan our relationships. Our retirement strategies. Whatever your thing is, I am sure that at some point you planned it out in your mind, how you wanted it to go even if the outcome was not something you could control.

I recently taught a course at UNC in Chapel Hill, or at least a portion of a course I share with some other guest lecturers. My assignment has the students write a paper explaining how they think they would respond to a given disaster scenario. The course is part of a Disaster Management Certificate program. One student wrote a paper that had the most elaborately articulated plan for organizing a response I have ever seen. It was a tour de force of confidence that any situation could be easily managed if you just had the right plan in place to handle it. I cautioned the student to remember a saying the Marines have: Don't Fall In Love With Your Plan. It often won't work out.

The poet Robert Burns had a more eloquent way of expressing the same thing, and through serendipity today I was reminded of that. I'm not saying that we shouldn't make plans, but I do think we need to hold on to a measure of humility when we do it. And, I may say, allow for the possibility that something unexpected but even better than we planned could happen too. It might not happen, but then again, who knows?

Here's the Burns poem. You'll recognize the key phrase when you read it, even if you've never read it before. Imagine a Scottish accent when you read it.

To A Mouse

Wee, sleekit, cowrin, tim'rous beastie,
O, what a panic's in thy breastie!
Thou need na start awa sae hasty
Wi bickering brattle!
I wad be laith to rin an' chase thee,
Wi' murdering pattle.

I'm truly sorry man's dominion
Has broken Nature's social union,
An' justifies that ill opinion
Which makes thee startle
At me, thy poor, earth born companion
An' fellow mortal!

I doubt na, whyles, but thou may thieve;
What then? poor beastie, thou maun live!
A daimen icker in a thrave
'S a sma' request;
I'll get a blessin wi' the lave,
An' never miss't.

Thy wee-bit housie, too, in ruin!
It's silly wa's the win's are strewin!
An' naething, now, to big a new ane,
O' foggage green!
An' bleak December's win's ensuin,
Baith snell an' keen!

Thou saw the fields laid bare an' waste,
An' weary winter comin fast,
An' cozie here, beneath the blast,
Thou thought to dwell,
Till crash! the cruel coulter past
Out thro' thy cell.

That wee bit heap o' leaves an' stibble,
Has cost thee monie a weary nibble!
Now thou's turned out, for a' thy trouble,
But house or hald,
To thole the winter's sleety dribble,
An' cranreuch cauld.

But Mousie, thou art no thy lane,
In proving foresight may be vain:
The best laid schemes o' mice an' men
Gang aft agley,
An' lea'e us nought but grief an' pain,
For promis'd joy!

Still thou are blest, compared wi' me!
The present only toucheth thee:
But och! I backward cast my e'e,
On prospects drear!
An' forward, tho' I canna see,
I guess an' fear!

Robert Burns

Why the New Flu Matters

Take a look at this image. It isn't all that much to look at, but that is what the influenza virus looks like up close and personal. This photo comes courtesy of the Public Health Image Library at the Centers for Disease Control and Prevention. And this little bugger is what has had most of us in my profession running on high alert since the end of March.

I am a the Food Borne Disease epidemiologist for the State of North Carolina Division of Public Health. But before that, I was a general infectious disease epidemiologist with the Texas Department of Health in Austin, Texas. There I worked as much on respiratory diseases like tuberculosis, Legionnaire's disease, and influenza as I did on enteric pathogens like cryptosporidium, salmonella and E. coli. In the late 1990s I was the influenza surveillance coordinator for the State of Texas. So when this novel strain of influenza (H1N1) popped up, I was extremely interested. And, as it turned out, I was also on call that first weekend it hit in the U.S., and wound up working as part of our response team on this issue for the past several weeks.

I know that a lot of people think the hype over novel influenza this past month was overblown, and I have read the same snarky comments that everyone else has about this all being much ado about nothing really important. That could not be further from the truth. And for everyone who thinks this has all blown over, I'm sorry, but this has not even started yet for us here in the U.S.

For the past several years, we in public health have been sounding warning bells that the world is overdue for an influenza pandemic. Pandemics are world-wide epidemics of disease occurring simultaneously or in close succession, caused by the same organism. Very few pathogens are capable of causing pandemics. Influenza is one that not only can, it does. In the past century there have been three major pandemics: 1918, 1957, and 1967. Most of us don't remember them, although I was 3 years old in 1967 and lived through it. The worst one of course was 1918 when more than 40 million people died world-wide. We really don't know how many people died, because there are no accurate records from that era for places like India and China.

Pandemic influenza is caused when a novel virus emerges, usually due to reassortment of genetic pieces from a combination of influenza viruses that can infect both humans and animals. There are many different kinds of influenza viruses. When a host organism gets infected with two or more virus strains at the same time, the genes can get scrambled and a new virus emerges. That creates what is known as a shift virus, which is different from the genetic drift we see with influenza from one annual epidemic to the next one. With drifting viruses, the changes from one year to the next are subtle and can be mild. People who have been exposed to a prior version of the virus may have partial immunity, and they don't get as sick. Herd immunity from the general population keeps the numbers of newly infected people down as well.

Shift viruses are different. With shift viruses, everyone on Earth is susceptible to them. No one has the benefit of prior infection, so the numbers of new cases are likely to be higher. Sometimes the illnesses can also be much worse. The annual influenza epidemic in the U.S. infects anywhere from 5%-20% of the population. With shift viruses, we can expect the numbers to be higher--but not until next flu season, when this virus should return as the dominant strain causing illness in the U.S. Right now the new virus is a minor player. Next year, this one is likely to steal the show.

For the past several years the World Health Organization has tracked a different new influenza virus, the avian influenza H5N1 virus. That one is a bad actor, with a 60% mortality rate. But it does not transmit easily from person-to-person, and even though we have tracked it since 2003, so far it has only caused 424 confirmed human infections with 261 deaths (as of May 15, according to WHO). That is after six years. This new influenza H1N1 has caused 8,480 confirmed cases in 39 countries with 72 deaths since March 2009. (As of May 17, according to WHO). It is less than two months into this virus. It is moving much more easily, and since everyone is susceptible, it should become well established. This one is not going away and it has already taken flight.

So, yeah, we have been overdue for a pandemic for a long time. It is looking like we will soon have one on our hands, if we don't already.

Sweet

Ok, so in my last post I got a few things wrong. Seven teams from the ACC and Big East made the Sweet 16, and five of them are from the Big East. The ACC flamed out below the big guns of UNC and Duke. Also, Duke advanced past the second game, which I didn't think they would do based on recent tournament appearances. And yeah, my bracket is a mess, although I've only lost one Final Four team so far.

Of the teams still playing basketball, there are many of the usual suspects still here. Most of the teams have McDonald's All Americans on them and seven of the head coaches still here have won national championships before. Gonzaga is here (again), and Kansas, Memphis, and UNC from last year. There are some surprises (Arizona? Really?) but no Cinderellas.

This next four days will give us the best basketball feast that we get all year. Lots of great teams, and some will have heart breaking losses. One thing to remember is that 49 teams went home last weekend. Twelve more will lose this weekend. After Sunday, there will only be four left. And before it is over, all but one will lose. It is the greatest two weeks in all of college athletics, and I can't wait to see what happens next.