Parademic Notes Week Ending 161016

#(161016)

1. Disaster Intelligence; 2. Near Poverty; 3. Past and Present; 4. ; 5. Gambler’s Fallacy; 6. Watchlist Item - Siberian Anthrax; 7. Resilience; 8. Music - Cancer; 9. Hidden - Pandemic; 10. Destruction Narratives; 11. Historical Books; 12. Cultural Differences; 13 Medical Slang; C⁴.

-1. Recently I had a few requests for a white paper I wrote a couple of years ago “Disaster Intelligence (DISINT) and Medical Intelligence (MEDINT)” from another forum I belong to. Given that it is 1.2 MB I will not publish it here. ¶ DISINT, like Parademic, is intended as a living document, with some updated to it on Parademic. ¶ An earlier version, with a Defense Support to Civil Authorities (DSCA) orientation was published in 2008 for the Military Intelligence Professional Bulletin “Synthesis: intelligence Support for Disaster”. Copies of it are  at FAS page 47, and at Free Library. ¶ There is a large body of material available on Disaster Intelligence ranging from Virtual Operations Support Teams (mapping and open source monitoring) to Non Government and International Organizations (NGO/IGO, though they rarely use the word Intelligence), and government agencies (typically with an law enforcement investigative/terrorist orientation). ¶ If anyone is interested in a copy (unlikely as most of the current traffic are people I already know) you can request it via comments. Do cite the date and stub number to assist me in knowing what you are requesting. ¶ Update: wrote the above on Monday and have had more requests and questions than I anticipated. Unusual that there was so much interest. The only current disaster is Hurricane Matthew 2, while larger more destructive events have happened before this, such as Ebola that was more what the white paper was designed for.

-2. It is known that poverty exacerbates the impact of a biodisaster, if not being the cause of the  biodisaster. The following looks like a good additional tool where households that suffer parademic consequences such as inability get to work, loss of job, sick people at home, lack of food and water would add to these numbers of a vulnerable population. Many Families Living one Emergency Away From Poverty. Online tool complements a United Way report that shows hundreds of thousands of people who aren’t below the federal poverty line still struggle to make ends meet.

-3. Another contradiction to the idea that biodisasters of the past would not have a one to one correspondence to modern conditions of transportation speed and distance, population density, modern public health. On the other hand humans remain humans. Medieval Cities Not So Different from Modern European Cities, sharing a population density to area relationship, a regularity in human settlement patterns across space and time. ¶ With their agrarian societies and simple market economies, these seem very different from modern European urban centers. Life in 14^th century cities centered around hierarchical institutions such as the crown, guilds, and churches. Today, companies, technologies, and a global economy dominate our lives. 160821-3A, 160214-4 Megacity, 150322-45 Zipf↓.

↕4. Local 10 News Photojournalist Denied Zika Testing at Hospital. Despite all of the warnings from health authorities about the mosquito borne Zika virus, unless someone is a pregnant woman, he or she might have a hard time finding someone to test them for Zika, even if they are exhibiting symptoms. Done as a story for outrage junkies. This does not explain why the refusal is a problem or why there is a policy. There could be lack of lab capacity, erroneous interpretation, lack of funding, not understanding that the cause of pregnancy is semen which can carry Zika. Researchers Obtain First Zika Sequence Isolated from Semen. #Book The Journalism of Outrage: Investigative Reporting and Agenda Building in America.

            -4.1. Why Scientists Are Keeping an Eye on a Little Known Virus. The Problem with Calling Mayaro 'the Next Zika'. Scientists have ample reason to keep an eye on a mosquito borne virus called mayaro, but when the media rushes to declare it the next Zika epidemic, the result may do more harm than good. Mayaro has been circulating in Latin America for decades, but little is known about the virus. 160918-4.5↓.

            -4.2. This brings up a conundrum. If a state or municipality chooses to cut back funding that would have mitigated a public health problem, misused funds intended for other purposes, were an obstacle to health programs, should the next higher jurisdiction have to pay (at higher cost) for the negligence. Obviously people can’t be allowed to die or maimed if there is a means to save them, that people should not suffer to due to negligence of others. Maybe there should be a requirement for repayment, while those that have prepared and are still overwhelmed should  get some “discount” for their previous efforts 160828-4↓. Florida Governor: We’re Still Waiting for Zika Money. Zika Virus: Mosquitoes Now Spreading the Disease near Miami's Little River Neighborhood, Florida Declares New Area of Zika Transmission in Miami. A summary of state public health authority is in Improving State Efforts to Prepare and Respond to Public Health Emergencies.

-5. The Gambler's Fallacy. A Severe Pandemic Is Not Overdue - It's Not When but if (2007). We have no grounds for confidence that a severe pandemic is imminent. Our communications shouldn't imply otherwise. ¶ Medical historians tell us there have been nine influenza pandemics in the past 300 years. So one every 30 to 35 years or so, or roughly three per century, is everybody's best guess about the future frequency of influenza pandemics. ¶ But extrapolating from nine cases is far from a sure thing. Scientists wouldn't be all that shocked if pandemics started coming more frequently or less frequently. And even if the average remains three per century, it's only an average. The 21^st  century could still give us just one pandemic—or five. Global Rise in Human Infectious Disease Outbreaks (2014) [Chart]. The “Not If, But When” Fallacy: Active Shooter Preparedness  may distort how certain organizations perceive emergency preparedness. This common expression leads to inaccurate threat perceptions and can result in neleaders becoming complacent. Emergency managers should be aware of this potential odd pairing of a sense of inevitability with complacency, and be prepared to counter it. Though its true that biodisasters are inevitable, there is no relation with frequency, recency, or being “over due” to indicate when. For one thing the duration of biodisasters are too long with repeating waves to have clear ends and beginnings. ¶ Each of the above links are different framings and datasets. Leading to different conclusions. The predictability of a bioevent is not based on probability but the aggregate of circumstances. Message Framing: It’s How You Say it That Matters. 10↓.

            -5.1. This could be considered a gambler’s fallacy. Mumps Outbreak Continues to Grow in Arkansas. The number of suspected mumps cases in Arkansas is growing. As of October 11, there were 427 mumps cases under investigation. That is the largest number of cases reported in the past 15 years. This outbreak has students without the disease staying at home. Arkansas's Department of Health warns parents to take advantage of a vaccine that can protect their child. That still makes some parents nervous.

            -5.2. Modeling the Economic Burden of Adult Vaccine Preventable Diseases in the United States. Low rates of vaccine uptake lead to costs to individuals and society in terms of deaths and disabilities, which are avoidable, and they create economic losses from doctor visits, hospitalizations, and lost income. To identify the magnitude of this problem, we calculated the current economic burden that is attributable to vaccine preventable diseases among US adults.  Approximately $9 billion. Unvaccinated individuals are responsible for almost 80 percent, or $7.1 billion, of the financial burden. I believe that it is less than 20% of the population that is unvaccinated (some of whom for medical reasons cannot vaccinate), which reminds one of Pareto’s principle that 80% of problems are caused by 20% of the people. When Adults Forgo Their Immunizations, it Costs the Nation Billions in Care.

-Quote. “Never tell your problems to anyone...20% don't care and the other 80% are glad you have them.” – Lou Holtz

-6. In some cases I don’t include additional items about a topical stub but list them as ADDED to the original stub in case the topic becomes pertinent again, or there is a request for more information about a topic. In this case I was continuing to follow the Anthrax in Siberia. Beware of Action That Would Put Age Old Tundra Nomadism at Risk in Yamal. Russia Plans to Kill a Quarter Million Siberian Reindeer amid Anthrax Fears. Reindeer to Be Culled in Russia’s Far North Due to Anthrax Outbreak. Killing Reindeer to Stop Anthrax Could Snuff out a Nomadic Culture. This indicates my original speculation was in fact true, that this was annihilation of a culture under the guise being humane, or an unintended consequence of humanitarian efforts. 160911-6.3, 160821-1, 160807-7.1↓. In fact we see a similar narrative about humanitarian aid in the aftermath of Matthew in Haiti which was also a watchlist and an ADDED item. The Haitians have cause to suspect aid because it introduced cholera in the 2010 Earthquake and conditions have not improved since then. Who Can Haitians Trust to Deliver Hurricane Aid. Anger Flares in Storm Hit Haiti as Aid Trucks Leave Many Empty Handed. 161009-5.1↓. Haitians Blame Fatal Crash on U.N. Peacekeepers as Storm Aid Anger Grows. Looting Near U.N. Base in Haiti; Ban Promises More Aid. What You Need to Know If You'd like to Help Post Hurricane Haiti, you run the risk of making things worse for those you're trying to help. [Cartoon, Cartoon, Cartoon, Photo, Photo, Photo]

            -6.1. Matthew will not only increase the continuing disaster that is Haiti, but exacerbate Cholera, and increase famine which will also increase Cholera, A Decade of Crop Loss from Hurricane Matthew in Haiti. It’s 2016. Here’s How Hungry the World Is. More than 21 percent of the developing world is in “serious” need of food.

-7. Though not the official emergency management definition Community Resilience (2, 3), in the context of biodisaster resilience is the ability to identify, control and contain the events and resist slipping into a parademic. Understanding Community Resilience in the Context of National Health Security. Conclusion page 25. Collective physical and psychological health of the population before an event can affect its resource needs and length of recovery period. ¶ Understanding of community norms and expectations also has an impact on the quality, content, and effectiveness of risk communication. ¶ Disasters really exist at the local level, engaging individuals, groups, and organizations together in a robust and integrated way helps build community assets and fosters resilience in the face of disasters and undue stress on the social environment. ¶ Social connectedness is important for health security because social networks can be used for information and resource exchange before, during, and after an event. ¶ Further, these networks are essential for restoring the community, both structurally and at the “human” level ofrecovery. A Healthy Society Is a Disaster Resilient Society, IFRC Framework for Community Resilience. Studies such as America’s Top Fears 2016, What Do Americans Fear and Social Reality Index, indicate that US Society, at this time, though not the worst in the world, would not be particularly resilient to biodisaster or resistant to deleterious parademic. This is not because of a lack of consensus and homogeneity in beliefs, but the inability to cooperate with those of different beliefs. It does appear however that fear of “disease” has become higher.

-Quote. “It is no measure of health to be well adjusted to a profoundly sick society.” –  Jiddu Krishnamurti

-8. A New London Musical Will Change the Way We Think about Cancer. Well chosen language can be a powerful medicine, and song and dance may be the right way to deliver it. A Pacifist’s Guide to the War on Cancer [Video, Video, Photo] People are likely to use violence and journey metaphors to describe their experience of cancer. Perhaps unsurprisingly, that experiences of serious illness can be deeply individual and fluctuating. Expressions varied from person to person, and even from week to week. Metaphor is seen by most people studying it as not just a linguistic but also a cognitive phenomenon. If you give people different metaphors for the same topic, they reason about it quite differently. Collective Symbolic Coping with Disease Threat and Othering: a Case Study of Avian Influenza, Othering and Being Othered in the Context of Health Care Services, Distancing Disease in the Un-Black Han Chinese Politic

Othering Difference in China’s HIV/AIDS Media. This social phenomena of making something non-human, an enemy, may be to provide a sense of remoteness from oneself, and if remote then less of a threat, or a threat that can be destroyed without mercy. See Othering, Stigma, War On/Against, The Other. Remorta (remote+morta/mortality).

            -8.1. 15 Years Ago: Anthrax Refuse to Change Their Name After BioTerrorism Scare. There’s no way to overstate the unease and turmoil felt in the United States in the wake of the terrorist a  ttacks of Sept. 11, 2001. It was further exacerbated one week later when news outlets and politicians randomly began receiving letters containing anthrax spores, which, when inhaled, have the ability to cause severe illness and death. Paranoia was at an all time high, and for a period, there was focus on the metal band Anthrax by the mainstream media. [Photo, Poster]

-9. Illustration of a hidden/ignored pandemic. Tuberculosis Kills Three People a Minute as Case Numbers Rise. At 1440 minutes in a day that would be 4320 each day, 29240 a week, 1520480 a year. Contrasted against 7,500,000,000, dispersed geographically and over time (Deaths today

111,528 Population Growth today 154,793) this seems hardly significant.

-10. The collapse of society, apocalypse, end of the world narratives associated with biodisaster (or the historical forces of nature, act of God(s)) are a theme in Parademic. This is largely about how these a priori narratives influence (if not determine) behavior in the face of such disasters. These are often times a negative response that increases the harm. These narratives are very old, and yet have not changed is some key ways. Towards a New Interpretation of the Myth of the Destruction of Mankind, The World Is Always Doomed. Confirmation Bias (Part One):

How to Counter Your Audience’s Preexisting Beliefs. When your message is actually of interest to your audience, they’re likely to be testing that message against what they already know and believe and feel – and confirmation bias will rear its ugly head. 5↑.

            -10.1. Man and Disease: The Black Death. Beginning in 1347 and continuing for a full five years, a devastating plague swept Europe, leaving in its wake more than twenty million people dead. Today its repercussions may be felt in the resistance to AIDS seen in some European populations. By any measure taken, the Black Death was world shattering and shows how even the smallest of things, the microbial world, can at times steer the course of human civilization. ¶ It also paved the way to extreme behavior. Staring down their mortality, many people gave into lewdness and revelry, while others turned to religion and extreme piety. ¶

Wherever the cry of "Plague!" was heard, despair manifested itself and not just in art and literature but also in bizarre social phenomena, one of which was flagellants. Professional self torturers who went from town to town, the flagellants scourged themselves for a fee to bring God's favor upon a community hoping to avert the bubonic plague – according to Medieval logic, the Black Death was a punishment for sin, and its atonement must be paid in real, physical terms – flagellants served, then, as a means for people to buy that remission from sin at the price of migrant "whipping boys". In these more rational times the narrative is now more in the nature of  Beware the Living and Humans are the Real Monsters. This narrative could lead to expectation that a biodisaster will become a collapse of society with people in severe violent competition with each other. This could  result in bands of people attacking and stealing from each other at a time when cooperation* is what is needed for survival.

            *Cooperation and collaboration, like other things, shouldn’t start at the beginning of a disaster but well before. This is not limited to individuals but countries, sectors of society and organizations. FBI: We Need to Collaborate with Industry on Bioterrorism, WMD and if I might add they also need to consider their role and who they need to work with in a natural outbreak and other types of biodisaster as a hallmark of parademic is exploitation and crime, many of which will cross jurisdictions. National Association of County and City Health Officials, Potential Hurricane Matthew Phishing Scams, FBI-CDC 2016-17 Training Announcement: Criminal/Epidemiological Investigation. Pandemic Vaccine Planning: Pharmacy and Public Health Collaboration Overview & Meeting Summary. USU’s CGHE* takes part in Georgetown University’s Pandemic Influenza Tabletop Exercise. *the Uniformed Services University (USU) of the Health Sciences Center for Global Health Engagement (CGHE), a DoD agency. HHS Office of Emergency Management ASPR has a list of other useful organizations to link to.

            -10.2. Mark on your calendars Aug. 21, 2017. There will be a total eclipse of the sun, and prior to that there will be “end of the world” predictions.

-11. #Books. Top of the Heap: Adia Benton is an occasional listing of books of medical anthropology interest, created by various anthropologists. I’m almost done with Randy Packard’s A History of Global Health. Packard lays out a straightforward account of why, at different points in time, international health and colonial public health largely focused on disease specific programs, rather than on the social determinants of health. I suspect it’d be a wonderful book in an introduction to global health course. Marion Moser Jones’s The American Red Cross from Clara Barton to the New Deal is a historical account of how humanitarian concepts like neutrality emerged. Too bad that those who developed the idea of neutrality did not understand the belligerents are threatened by those who want to be neutral, to help all, to remain apart (and implied above) conflict. The idea is that any assistance to a potential enemy needs to be neutralized. From a belligerent perspective, bent on winning or they will not survive, people are other for or against you. Anthropologists in Global Health Experiments.

            -11.1. When Poison Was Everywhere. A new book explores how and why arsenic found its way into wallpaper, bread, and baby carriages in Victorian times. Bitten by Witch Fever [Cover].

-12. A quick example of how differences in culture means differences in how one provides health care. Medical Spanish - Spanish for Healthcare. This includes having different theories of disease, such as mal aire which is related to the early medical theory of miasma, not the more modern germ theory. #Website Science Museum's History of Medicine, Brought to Life looks worthwhile to explore. Topics are all parademic related ones and include: Belief and medicine, Birth and death, Controversies and medicine, Diagnosis, Diseases and epidemics, Hospitals, Public health, Science and medicine, Surgery, Technology and medicine, Medical traditions

Treatments and cures, Understanding the body, War and medicine. Geert Hofstede's Dimensions of Culture and Edward T. Hall's Time Orientations, Dimensionalizing Cultures: The Hofstede Model in Context .pdf. C⁴.1 item 6↓.

-13. Private SNAFU Learns about Malaria (Video). Malaria was a major risk for American troops during World War II. The US Army enlisted the help of Theodor Geisil (Dr Seuss 150920-21Quote, 150802-30Quote, 150531-E.20.1, 140702 PID Humor.2.10Quote, 130421-47.4, 130324-44.1, 130224-7↓), to produce educational booklets and pamphlets. They also turned to moving pictures to educate the troops.  Private Snafu was featured in a catalog of 26 SNAFU training films based on characters originally developed by Theodore Geisil and Phil Eastman and produced by Warner Bros, Looney Tunes and Merrie Melodies. SNAFU is an informal, but widely understood, military acronym. During the same time period, in more polite company, the good private’s name was changed to Snuffy (or Airman Snuffy), adopted from a movie and cartoon of the period. Term is most commonly used in the sense of “making something Snuffy (idiot) proof. There are similar medical slang terms to make things patient proof, or for patients who do not follow instructions, and for those who keep appearing for medical help but don’t need it. These are ingroup terms and should not be used if one is not considered medical, and never outside the group.

_↓^↑C⁴. Crisis and Emergency Risk Communication (CERC) Corner [Logo]. Have noted that most communication advice is directed not on the message itself, but getting the message through the non-acceptance of others, and the messages of others. Managing Multiple Messengers. Various stages of crisis bring together many players, agencies, organizations, and partners. It’s important to understand how the roles of other messengers may affect your agency’s message. These agencies and groups often have distinct missions, capabilities, and resources. Although their tasks may be unique, they will sometimes overlap with those of your agency. Differences in communication include: Planning, Preparedness, Training, On the scene assistance, Consequence management, Coordination, Communication. [Cartoon, Cartoon, Cartoon, Billboards, Meme]

-Quote. “The biggest problem in communication is the illusion that it has taken place”. – Contested

            - C⁴.1. 6 Tips to Consider in Crafting Disaster Communication Materials. Agree or disagree with it but know this: what we are doing now doesn't seem to be working.

1. Trying to prove something that someone believes is false may simply harden their beliefs.
2. Prevention is an easier sell than preparation.
3. Preventing future losses is more compelling than preparation.
4. Simplify message as much as possible.
5. Have them write down what they intend to do.
6. Different groups/cultures respond to different messages. 12↑.

            - C⁴.2. NACCHO is pleased to announce the release of the National Health Security Strategy (NHSS) Strategic Messaging Guide. This tool can be used by local health department (LHD) staff to easily create and communicate messages about national health security to media outlets, policymakers and the public. The messages found in this guide were generated by utilizing the National Health Security Strategy and Implementation Plan, field expertise, and feedback from LHD staff. The messages can be edited and expanded to reflect specific LHD activities and effectively demonstrate the importance of national health security.