about the bird flu......

Multicollinearity, BSN, RN · May 8, 2006

A previous poster mentioned boosting your immune system in preperation. Ironically, the stronger your immune system, the more likely you are to have a bad outcome with avian flu. It's similar to the flu of 1918. Grandparents and grandchildren buried the generation in between. Those with the strongest immune systems were the most likely to die. This is because with Avian flu and the 1918 flu, the viruses prompt an immune response with a flood of chemicals in the lungs called a cytokine storm. You literally drown in your own lungs. The young and old tend to fare better because their immune systems aren't robust enough to mount the cytokine storm attack and flood the lungs. Ironic isn't it? Researchers have hypothesized that prednisone may be helpful if given right away to 'turn down' the immune system and reduce the cytokine storm.

Of course the young and old with lesser immune response are more vulnerable to secondary infections after the initial flu infection. Still, statistically speaking, those with the strongest immune systems are the most likely to die. This is what happened in 1918, and what researchers say will happen with H5N1 Avian flu.

barbshortt · May 8, 2006

Multicollinarity-

You are absolutely right - the cytokine storm is the most dangerous outcome of this avian flu (H5N1) and the 1918 pandemic (which was simialr in structure to H5N1, but not exact). Currently, this virus is not able to be transmitted easily between humans(there have been a very few family clusters in Vietnam) - but that is the big question....will it be able to continue mutating so that H-H transmission is accomplished. No one can say for sure either way, but Health and Human Sevice Secretary Leavitt has been making visits to every state int he country to make the case for preparation. he has essentially said that the time to prepare is now, and that you cannot count on the federal government to rescue you with supplies, meds, etc.

Whether or not to report to work is a hard and personal decision that everyone will have to make. Thousands of infected people will flock to ER's which will be overcome quickly. Supplies, and especially respirators, will be unavailable in a very short time. Once a nurse (or any other healthcare worker) makes the decision to go in to work, they may have to remain there so as not to infect their families or others on returning home - quarantine has already been sited as the most likely was to treat and prevent spread of the flu. I can't even begin to imagine the social chaos this would ignite - parents separated from kids, the elderly in nursing homes, prisons,. Not to mention, the regular pts who would need attention - pregnant women, dialysis pts, emergencies, and on and on.

My kids are grown, but are still foremost on my mind. Would my skills not be better utilized taking care of my own family (that is if I am not ill myself) and neighbors with old fashioned home care, then working in my regular unit (oncology) possibly transmitting disease myself. I still have not worked out the ethical side of these questions - just mulling it over.

Right now, in the human cases, the mortality rate is a bit over 50% (not just pregnant women). There is no vaccine, and no possibility of one until the virus actually mutates to a H-H form. Tamiflu may provide some protection, but is not in nearly enough supply for everyone in the country. Healthcare workers, first responders, police, fire personnel, and "some political leaders" (really, that is what the quote os from the HHS director was!), will be protected first, but again, think of what this may mean by way of your family's care.

I am glad to finally see some nurses address this issue, and would hope that we never have to face such difficult moral dilemmas. But, I think if this virus becomes pandemic, then we also have to think about preserving the medical infrastructure for the post-pandemic period.

indigo girl · May 9, 2006

I have read, but, do not remember where, that Tamifu, even if you can get it (it's on back order), is not going to be much help. And, truthfully, has not been that helpful to my patients in the nursing home who came down with flu (despite being vaccinated!!!). That's just the way it looks from here.

I have read that Sambucol which was developed by an Israeli virologist, has been tested against bird flu and found to be effective. I do not know that this is correct. I use this myself against cold viruses and found it to shorten and lessen the severity of colds dramatically. I have asthma and allergies. URI's used to be common for me. This is an old folk wisdom remedy (elderberry extract), just one example of strengthening the immune system.

Yes, those who had the stonger immune systems died in 1918. But, what else can you do? It makes sense to try something that is specific for viruses, doesn't it? I would also look at increasing Vit C if I got sick, to bowel tolerance (diarrhea). There are other things you can do, but everyone should research for themselves.

We cannot take care of others if we are sick ourselves. I think that if this really happens, you should plan for a breakdown in services. Nurses with children are probably not going to come in (there wil be no guarantee that

the caregivers for their children, that they have planned for, will not be ill). And, yes, basic things like utilities may be effected by the illness of public workers. And, the distribution of food also may be effected.

John Barry's book, "The Great Infuenza" is sobering. You can not imagine a world like that. People riding a streetcar, and several of them dead at the end of the ride (did they even know they were ill?).

Well, it does not sound as if the current bird flu is in this league. However, if scientists want us to pay attention, I suspect we should. It does not cost much to have some sort of plan for your family even if it seems unlikely to happen. We know that bird flu is in Africa, Great Britain, and China, just not on this continent yet (that we know of). It is spread primarily by water fowl and poultry. Carnivorous animals such as foxes, dogs, and cats that capture infected birds have contracted the virus and died. As far as I know, owners of these animals have not been infected yet. I see stronger leash laws coming for pets.

General E. Speaking, RN, RN · May 10, 2006

The pandemic of 1918 killed between 20-40 million people- very scary indeed. The question isn't IF another pandemic will occur but WHEN.

I'm not sure if I would feel obligated to go to work, but I agree with the other poster who mentioned that should her child need medical attention she would want someone there to care for them. Maybe I would feel obligated...

Makes me very uneasy to think about it. I have started a disaster kit. Buying things with long expiration dates, stocking up on water and what-not's. I live near the coast and had the unfortunate pleasure of dealing with the massive evacuations around the Houston/Galveston area last year. Hurricane season is upon us so I have supplies if needed.

Kelly_the_Great · May 10, 2006

Has anyone thought of the possibility that if indeed the situation becomes extreme, that the govt. my resort to extreme measures?

What I mean to say is, we may not have a choice as to whether or not we show up for duty, we may be forced to do so.

General E. Speaking, RN, RN · May 10, 2006

Has anyone thought of the possibility that if indeed the situation becomes extreme, that the govt. my resort to extreme measures?
What I mean to say is, we may not have a choice as to whether or not we show up for duty, we may be forced to do so.

medical personnel will be needed, whether we want to go or not...

zacarias, ASN, RN · May 11, 2006

The threat of a bird flue pandemic is very scary indeed, but I always think about this: If the virus mutates so that it can go from human to human, it also could mutate to a less lethal form. Mutations occur and can help the organism do its job better or take out all it's figurative teeth.