Why public silence from Dept. of Public Health on 3 meningitis deaths?

fieldingduranmeningitis
April 3, 2014

Op-ed by Ryan Gierach, West Hollywood, California

When the press release went out yesterday announcing that the LA County Department of Public Health had changed their recommendations on gay men, men who have sex with men and those with HIV/AIDS getting meningitis vaccines, nearly every news organization ran with what was disgorged without question, parroting Public Health’s headline.

Dr. Jonathon Fielding oversees the Los Angeles Department of Public Health. He is due to retire soon.

Dr. Jonathon Fielding oversees the Los Angeles Department of Public Health. He is due to retire soon.

“LA County Urges Vaccinations After Spike In Meningitis Cases Among Gay Men” or “County urges vaccinations against meningitis for gay men,” predominated, while each also noted that the department had found, for the first time, a “cluster” of infections located in and around WeHo’s gay men with HIV.

The presser was informative, telling the press that four of the people were gay men who either lived or played in WeHo or NoHo, that three of the four gay men were HIV positive and that vaccines were suggested and readily available.

The press dutifully reported what DPH wanted thethem to, even unto simply copying and pasting it onto their web site with a cursory mention of last year’s non-cluster cluster (that’s not Public Health’s problem; laziness is the  problem).

You see, none of the local media, apparently, asked how many of the eight cases of meningitis died. Public Health somehow neglected to include that information in their press release. We noticed the absence of that information and gave their Public Information Office a call, and we got two disturbing responses.

First, the department begrudgingly reported three invasive meningococcal disease (IMD) deaths from among the eight person cohort. Two of the deaths were of men who were HIV positive. The ages of the three who died are also similar—27 or 28, while the fourth, who survived, is 50.

Why would they not ret vital information, especially in light of last year’s community stakeholder meeting at which Dr. Jonathon Fielding promised to do so?

Attorney and WeHo resident was felled by meningitis a year ago. At that time the gay community received promises of more transparency and more open cooperation from the LA County Dept. of Public Health.

Attorney and WeHo resident was felled by meningitis a year ago. At that time the gay community received promises of more transparency and more open cooperation from the LA County Dept. of Public Health.

Secondly, and certainly more disturbing, is the refusal to provide one essential piece of data 7 so that the public can make I Indecisions about their health and risks taken during sexual activity.

The LA County Department of Public Health is apparently keeping private the number of gay men who died from meningitis unless you can pry it from them.

3rd District County Supervisor Zev Yaroslavsky, or at least his health writer, seems to have an in with Jonathan E. Fielding, MD, MPH, Director of Public Health and Health Officer, because inside Zev’s blog entry on the subject yesterday is the only media mention we found of the fact that the three deaths did, indeed, occur among those four infected men who have sex with men.

From the public health point of view, the fact that they are all MSM, mostly HIV positive and live or play in WeHo/NoHo indicates strongly that this is an actual “cluster,” in epidemiological terms, in comparison with last year’s disconnected and disparate incidences.WeHo council member John Duran raised a clarion call last year when Brett Shaad's case came to be known. He says that promises made then by Dr. Fielding regarding openness have been broken.

WeHo council member John Duran raised a clarion call last year when Brett Shaad’s case came to be known. He says that promises made then by Dr. Fielding regarding openness have been broken.

The dread disease, which can strike, leave you in a coma and kill you within days, received a great deal of attention last year when Brett Shaad fell into a coma and died suddenly and inexplicably.

But public health officials did not find a congregation of infections, an epidemiological nexus of contagion, last year. This year, however, four cases in the possible cluster involving men who have sex with men and three of the men lived or socialized in West Hollywood or North Hollywood.

We saw a near-panic when DPH reported that of the 13 confirmed cases between November 2012 and April 2013, one death was initially connected to a gay man. The next day, however, DPH disclosed AIDS Healthcare Foundation (AHF) to that another gay man had died – in December – of meningitis.

Days later news that a third during that period had expired fanned the flames of resentment against a public health agency by their private and government partners – chief among them the City of West Hollywood and the AIDS Healthcare Foundation.

Michael Weinstein, founder and president of AHF thinks the department is covering up deep flaws in the way the largest public health system in the country doles out treatments and public information. “It’s the same old thing,” he told WeHo News. “They come to the table late and don’t share information with us.”

John D'Amico, WeHo's mayor Pro Tem, would like to have had the information given to Zev's reporter, calling it potentially useful. On the other hand, he said he understood how cautious public health departments must be to not exaggerate.

John D’Amico, WeHo’s mayor Pro Tem, would like to have had the information given to Zev’s reporter, calling it potentially useful. On the other hand, he said he understood how cautious public health departments must be to not exaggerate.

West Hollywood council member John Duran said that withholding the news of the number of deaths and, “even worse, not telling us how many of those deaths were gay men or HIV positive men,” disables everyone combatting the spread of the infection.

Soon-to-be-mayor of WeHo John D’Amico also called for greater transparency while adopting a wait and see attitude. “We need as much information as we can get to make health decisions,” he said, “not only law makers but individuals and healthcare providers. Transparency is vital to that.”

He also acknowledged the sensitivity of the department’s mandate – to watch, warn, assist and not cause unnecessary angst. “The Department of Public Health must inform us truthfully about what we face; they have a responsibility not down play it, but also a responsibility to avoid causing panic.”

Council member Jeffrey Prang said, “We need good hard information so that we can act wisely as a city to protect our constituents’ health.”

The Department of Public Health received these questions from WeHo News in three E mails:

I am informed that three of the eight cases of meningitis confirmed this year died.Please provide the following data:

  • When did the deaths take place?
  • Where did the deceased live?
  • Was Public Health aware of this uptick among gay men before the recent meningitis presentation at Plummer Park?
  • How many of three deceased identified as gay?
  • Is there a more precise commonality among the gay men such as an event, nightclub or party.

After repeated calls, the public information office at Public Health had still not answered the “questions not already addressed on Supervisor Yaroslavsky’s site, and when an explanation for the press release’s missing data was requested, WeHo News received none, nor did an inquiry with Dr. Fielding about the missing info on the presser pan out before deadline (if he does eventually respond, I’ll publish it in a separate article).

Termed-out 3rd District LA County Board Supervisor Zev Yaroslavsky's reporter evidently had cachet enough with the PIO to get the straight skinny.

Termed-out 3rd District LA County Board Supervisor Zev Yaroslavsky’s reporter evidently had cachet enough with the PIO at DPH to get the straight skinny.

People in County, City and non-government organizations dedicated to the public health are all shaking their heads, mystified about the possible reasoning for attempting to withhold the important data. Doing so leads people to believe that there is something to hide, that somehow Public Health failed in its mission and doesn’t want to discuss what might be a very uncomfortable topic. Perhaps they simply don’t value a relationship with the press, or see how transparency can help them in fulfilling their mission.

What is clear is that only one reporter, for Zev Yaroslavsky’s office, rated a quick return call to questions about the number of deaths and who among the cohort died. I’ll give everyone else in town the benefit of the doubt and presume they, as did Zev’s reporter and I, inquired but failed to hear back and didn’t want to embarrass anybody by saying anything about it  (it’s a really huge beneficence, so take advantage of it).

Why would the Public Health Department stonewall the press? Do they really believe that Zev’s readership, impressive as the content and the site’s numbers might be, reach more West Hollywood gay eyes than WeHo News or Frontiers?

While one government official said on background that this year’s response by DPHG was an improvement over last year’s, “This year’s situation is worse [from the gay and HIV/AIDS community’s perspective] and they aren’t providing contextual details about the cluster.” That source went on to express frustration that the department is not as forthcoming as they promised to be last year.

Michael Weinstein, impatient at the response by Public Health in 2013, announcing that AIDS Health Care Foundation would offer free meningitis vaccinations. WeHo council member John Duran looks on.

Michael Weinstein, impatient at the response by Public Health in 2013, announcing that AIDS Health Care Foundation would offer free meningitis vaccinations. WeHo council member John Duran looks on.

And frankly, from my perspective it’s mind boggling that the LA County Department of Public Health could act so ineptly. Yes, I wouldn’t advocate running screaming through the streets proclaiming the end of civilization because of meningitis; for gosh sakes, we gays already guaranteed a quick Armageddon when we got the right to marry.

But I and those to whom I spoke about this do believe that there is some room for DPH to grow in communicating with their constituents – actually, their patients – as all growed up adults like them.

Dr. Fielding, you are not far away from retirement, and have a long, respected and formidable career you leave behind. Let this foolish kerfuffle be your last, or better yet, talk openly to the press and let’s leave well enough alone.

For you readers:

Symptoms to watch for.

Symptoms to watch for.

Keep in mind that, while meningitis is infectious, but not easily transmitted. Passage of the bacteria can not be spread by casual contact, such as being in the same room with someone who is infected or using the same door knob, and is less infectious than the flu.

The bacteria responsible for the disease are spread by “very close exposure to sneezing and coughing or direct contact with saliva or nose mucus,” according to the CDC. “The disease is usually found in families, especially among impoverished families with small children who pass mucus and saliva back and forth.

Meningitis can be treated with antibiotics but because it progresses quickly, watchfulness, “immediate diagnosis and treatment is imperative,” according to the news release. Symptoms include high fever, stiff neck and “altered mental status.”

The shots listed below are free; I'm guessing there's an extra charge to get poked in any place other than in your arm.

The shots listed below are free; I’m guessing there’s an extra charge to get poked in any place other than in your arm.

Vaccinations are being offered everywhere gay or HIV men hang out, in WeHo, Hollywood and at Vermont and Fountain and hip LA. Here’s the list.

Go get a shot; this year it’s important.

AIDS Healthcare Foundation, which led the way to vaccinations last year, will also be offering them at their Men’s Wellness Center located at 1300 North Vermont Avenue, Suite 407, Los Angeles. For more information, please call (866) 339-2525 or visit www.aidshealth.org.

 

The L.A. Gay & Lesbian Center offers meningococcal vaccine at its McDonald/Wright Building, located at 1625 North Schrader Boulevard, Los Angeles.

It also offers free meningococcal vaccine at The Spot, located at 745 North San Vicente Boulevard, West Hollywood. For more information, please call (323) 860-5855 (McDonald/Wright) or (323) 993-7440 (The Spot) or visit www.lagaycenter.org.

The Saban Community Clinic offers free meningococcal vaccine at its Hollywood-Wilshire Health Center, located at 5205 Melrose Avenue, Los Angeles. For more information, please call (323) 769-7800 or visit www.sabancommunityclinic.org.

In West Hollywood, the MinuteClinic at CVS/pharmacy, located at 8491 Santa Monica Boulevard, offers meningococcal vaccine for a fee, though the MinuteClinic will accept health insurance coverage. For more information, please call (866) 389-2727 or visit http://www.minuteclinic.com/CA/Los-Angeles/West-Hollywood.aspx

For more information regarding invasive meningococcal disease and vaccination, please visit www.cdc.gov/meningococcal and http://publichealth.lacounty.gov/acd/Mening.htm.