Disaster/Pandemic preparedness

indigo girl · Jul 24, 2007

AMA Launches New Disaster Journal:

Disaster Medicine and Public Health Preparedness

http://www.ama-assn.org/ama/pub/category/17711.html

The new quarterly, peer-reviewed journal is the first comprehensive publication emphasizing public health preparedness and disaster response for all health care professionals.
"Disasters are unplanned, but the response shouldn't be," said Ron M. Davis, MD, AMA President-Elect. "Whether disasters are natural or man-made, infectious disease pandemics or terrorist attacks, physicians, health care professionals and public health workers must be prepared to respond to emergencies and aide in the recovery efforts that follow. We can't predict when a disaster will strike, but as first responders, we can better prepare ourselves and others to protect the health and safety of our patients and citizens."

indigo girl · Jul 25, 2007

http://afludiary.blogspot.com/2007/07/fairfax-county-virginia-gets-it.html

Fairfax County, just outside of Washington D.C., is heavily tied to the Federal government. It is a largely upscale bedroom community for the Nation's capitol. Many of the residents either work for the Federal government, or for government contractors.
This week, county officials are doing a mass mailing to 440,000 households in the county of a 17 page pandemic home care booklet. As you can see from this article, they aren't mincing words.
Home care will be essential
Hospitals won't be able to cope
There is a `high possibility' a pandemic could occur
People need to prepare.

Local health professionals expect a staff decrease of about 40 percent during a pandemic, Hanfling said.
The problem is exacerbated by a worldwide shortage of health care professionals, Addo-Ayensu said.
The answer is teaching people to care for themselves at home as much as possible, especially during less severe phases of a flu, Hanfling said.
The 17-page pamphlet, called "Caring for Yourself and Others: Seasonal and Pandemic Influenza," was mailed with grant money the health department received from the Centers for Disease Control and Prevention.
It outlines ways for people to protect themselves, both during the annual flu or something bigger, with information on self care, when to seek medical attention and emergency information.
"Caring is preparing," Hanfling said.

indigo girl · Jul 25, 2007

Here is the Fairfax Country pamphlet that was mailed out to the public:

http://www.fairfaxcounty.gov/emergency/pandemicflu/county_influenza_guide_july_2007.pdf

Kudos to the public health officials of that county for giving out this information, and enabling their citizens to prepare.

This is what the people need to know. No beating around the bush with this

info. The only advice that many of us would change is the suggestion to store

2 weeks worth of goods. It is not in alignment with the projection of pandemic waves occurring over periods of weeks, and the possibility of more than one wave of infection.

But, it's a start.

Planning for pandemic flu is not just a government issue. Residents have a
responsibility to prepare themselves and their family. This reference guide will
help you understand influenza; learn how to protect yourself and others from
catching the flu and how to limit its spread; find out how to manage illness in
yourself and others; determine when to seek medical care; and know what to do
to prepare yourself and family for a pandemic or other emergencies that might
disrupt our community for an extended time.

indigo girl · Jul 26, 2007

It is worth looking back at the CDC Mitigation Strategy. This link is to an earlier

discussion about the CDC Press Conference giving their plan to use what worked

in 1918 against the Spanish Flu. With no vaccine and limited amounts of antivirals

we are going to have to do this. Notice the hurricane model being used to indicate

the severity levels of influenza outbreaks:

https://allnurses.com/forums/2047151-post10.html

indigo girl · Jul 29, 2007

Fear of Fear:

The Role of Fear in Preparedness...

And Why It Terrifies Officials

by Peter M. Sandman and Jody Lanard

http://www.petersandman.com/col/fear.htm

(hat tip : writangl at effect measure)

The authors are risk communicators. This is not a new document, but it is

still pertinent.

I am reminded of this document every time someone makes a comment about

scaring the public, or says that the pandemic influenza information is all about fear.

And I am thinking, well yeah...

indigo girl · Jul 30, 2007

From Effect Measure with permission of the editors:

The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.

Pandemic planners and the wisdom of crowds

Category: Bird flu * Pandemic preparedness * Public health preparedness

Posted on: July 29, 2007 3:13 PM, by revere

There is an apocryphal story of a politician during the Revolution of 1848 desperately running after a crowd in Paris's Jardin du Luxembourg. "I'm their leader," he cried. "I must follow them!" A couple of years ago most national pandemic planners were occupied with procuring stockpiles of antivirals, worrying about the lack of a vaccine and reassuring people that they had the matter under control if a pandemic were to strike. No one believed them and they knew they were whistling past the graveyard, but the poverty of vision was amazing. There has been much progress since then. Now there is open talk about the need and potential efficacy of non pharmaceutical interventions, or as the jargon has it now, "community mitigation guidelines." Whatever you call it, the objective is to reduce contact through measures of social distancing (closing schools, theaters, etc.). So the planners are getting there. Now a just published survey in CDC's journal, Emerging Infectious Diseases, shows the public was there long before the planners.

Some 3500 subjects in Europe and Asia were asked which of the following responses would be most likely in the event of a pandemic:

Avoid public transportation

Avoid going out for entertainment

Limit shopping to the essentials

Take leave from work

Keep children out of school, even if it remains open

Limit physical contact with friends and family

Avoid seeing doctors, even when sick from something unrelated to flu

Stay indoors at all times

CIDRAP has an excellent summary of the study. Here's some of it:

A recently published survey of Europeans and Asians showed that, when faced with an influenza pandemic, most would avoid mass transit and limit shopping to essentials, and many would avoid other public places, including restaurants, theaters, and the workplace.

The study, published online Jul 20 in Emerging Infectious Diseases, found that "avoidance of public transportation was consistently reported across the region as the most likely precautionary behavior," with about 75% of respondents choosing that option.

Reactions to other risk-avoidance measures varied by region. For example, 79% of Europeans would likely avoid places of entertainment such as cinemas, restaurants, and theaters, while only 33% of Asians said they would. And 52% of Asians said they would stay home from work, compared with 35% of Europeans. (CIDRAP News)

The responses didn't seem to be conditioned on whether the pandemic was mild or severe. And the survey was done in late 2005, before the time when planners were seriously discussing these kinds of social distancing policies. People were already someplace it would take planners another year to get to.

I am not inclined to give much weight to the specific differences or levels for the various responses. This is a hypothetical question and not quantitatively transferable to what would happen in a real event. What it does show, however, is that a substantial proportion of people have a good idea of what they might do in the way of spontaneously altering their behavior. While political leaders and planners wring their hands over what the criteria will be for closing schools (a Draconian measure with huge economic and social implications for most communities), the decision will most likely be made by people without reference to what the planners think. The governor or prime minister or provincial leader will officially close the schools when students and teachers stop showing up.

This isn't an argument for not thinking about what should trigger a school closure. But it is an argument for shifting the major effort away from trying to figure out what the trigger will be to planning to manage the consequences. Similarly for the effects on trade, commerce and travel.

People will vote with their feet. And the leaders will follow the crowd. Both should think ahead about what this will mean.

indigo girl · Jul 30, 2007

Banking/Finance/Insurance Industries to Conduct Pandemic Drill

This sounds voluntary, and is being promoted by Dept of Homeland Security.

They are very interested in critical infrastructure protection.

http://continuitycentral.com/news03385.htm

(hat tip monotreme/PFI)

indigo girl · Aug 2, 2007

York, Pa officials Urge 90 Days of Pandemic Preparation

http://afludiary.blogspot.com/2007/08/york-pa-officials-urge-90-day-pandemic.html

Government officials have been urging people to prepare for a pandemic for more than a year. The `standard' advice has been to have a 2-week supply of food and water in every household. Many, including myself, have expressed the opinion that 2-weeks simply won't be enough in a severe pandemic.
Some local health departments have broken ranks with the Federal government, and have advocated more than 2-weeks. There is a move afoot at the federal level to try to change the recommendation to `at least 2-weeks', and I suspect we may see that subtle, but important change soon.

"It isn't just pandemic influenza that people should think about being prepared for," said Dr. David Hawk, director of the York City Bureau of Health. "There's always threat of a terrorist attack, a nuclear event, power outage or blizzard."
In the 1918 influenza pandemic and again in 1957 and 1968, the people most likely to get sick were not the very young and very old, but those of working age -- those who would normally keep electric plants and water treatment facilities operating. Planners believe that pattern could happen again and possibly disrupt services that are usually taken for granted.
The mantra: Prepare now to save lives later.
Smith volunteers for Hampton-based Community Awareness and Preparation, which attempts to help residents prepare for pandemic and other disasters.
Canned goods, powdered milk and stacks of bottled water -- three gallons a day per person is recommended for drinking, washing and cooking -- also should be included in one's emergency stockpile if possible. Smith said access to food, electricity, water and gasoline could be limited.
Look at 90 days: She demonstrated a makeshift cooking device comprising a cookie-cooling rack, four votive candles and a 4-inch tall square frame. It would work in a pinch should residents become housebound. She and other health officials recommend preparation for a 90-day span, which would cover the first wave of flu.
Hawk reiterated that pandemic is a matter of when, not if. He cited the Spanish flu pandemic of 1918, which claimed between 20 million and 100 million people, according to estimates from the Centers for Disease Control and Prevention. That pandemic is now recognized as the worst in history, especially when compared to pandemics in 1957 and 1968 that killed 1 million each.
That's why Hawk and numerous others urge those who are able to prepare to do so now to help reduce stress on a system that will be unable to assist everyone.

"People live day to day and paycheck to paycheck," Hawk said. "They can stock up incrementally, spend $10 a week until they have an adequate supply."

indigo girl · Aug 8, 2007

Study: Quarantines Work Against Pandemics

To put it very simply, this is our official US policy for dealing with a pandemic influenza situation in the 21st century. Our situation is not much different than in 1918. We have very little antiviral medication, and an extremely limited amount of an untried vaccine of which most of us will never see.

Please understand that this is it. This is all that we've got for protection for

our entire population.

There is no other national plan, hence the need for individual families to prepare by stockpiling food, water and medicine for at least a three month period. Three months is considered to be the length of time for each pandemic wave to hit a community with two or even three waves expected in approximately one year of time.

These mitigation strategies are based on the following study being published in JAMA.

http://www.flutrackers.com/forum/showpost.php?p=95067&postcount=1

The new report, published in the Aug. 8 issue of the Journal of the American Medical Association, analyzed the public-health measures taken by 43 U.S. cities, all with populations greater than 100,000, during the six months between Sept. 1918 and Feb. 1919. Markel found that cities that early on adopted "old-fashioned," non-pharmaceutical interventions — such as school closures, social-distancing in the community and workplace and quarantine — and "layered" multiple interventions at once for a long period of time fared better than other cities, with slower rates of infection and lower rates of death.
... "This study gives us real reason for optimism, that even reaching back to a time where there were no antiviral medications and no well-matched vaccines to fight a pandemic, the things communities did in terms of traditional public health tools — isolation, quarantine, social-distancing, canceling schools — made a big difference and have a lot of potential to mitigate the severity of a lethal disease pandemic."
That's good news, considering that the U.S. has purchased only 26 million doses of the newly licensed H5N1 flu vaccines, enough to cover 13 million people...
Researchers compare layering interventions to layering Swiss cheese: if the holes are vulnerabilities, with enough layering you'll end up with a solid block of prevention.
Though Markel's study has just been published, it has already been rolled into policy. The Department of Health and Human Services and CDC finished their analysis of the study's data last December before incorporating it into the Community Strategy for Pandemic Influenza Mitigation, a collection of guidelines for use by individuals and communities issued by the agencies in February. The guide offers help in coordinating and implementing a strategy to protect communities from the front end of an epidemic and to keep them afloat until the appropriate pandemic-strain vaccine can be delivered to them — which officials estimate will be four to six months after the first case is identified

indigo girl · Aug 9, 2007

Physicians Practice for Pandemic

Many patients will be seen by their private physicians rather than the ER. It

makes sense for these docs to prepare for this:

http://www.greeleytrib.com/article/20070808/NEWS/108080103

(hat tip fluwiki)

To deal with pandemic flu, the office changed its operations entirely. First, they had to run with 30 percent fewer staff members, who would presumably stay at home with flu-stricken family members, children who were unable to attend closed schools or who were sick themselves. Those who came to work were screened for symptoms every day.
Several other measures were implemented to keep the disease from spreading. Upon driving up to the clinic, a triage nurse stopped patients at the parking lot entrance and questioned them about symptoms. Those obviously suffering from the flu were sent to another health center. Those with questionable symptoms were given a mask and a number and told to drive around the back and wait in their cars for a nurse, who was fully clad in protective gear, to take them to an isolation room.
Budensiek and his staff worked closely with Jon Surbeck, director of public health preparedness for Weld. Surbeck is well aware of the myriad variables that come with pandemics and said that's what made the exercises imperative in the planning process.
Through their preparations, Budensiek recognized that a pandemic would affect more than just office operations, though. The staff saw that under the stress of the Asian avian flu, they may not meet insurance company timelines for billing and reimbursement. In that case, the office's cash flow would be impacted. Budensiek already has applied to his bank for an emergency credit line in real life, to be prepared for just such an incident.

indigo girl · Aug 10, 2007

NIH Scientists Target Future Pandemic Strains of H5N1 Avian Influenza

http://www.flutrackers.com/forum/showpost.php?p=95325&postcount=2

...they have developed a strategy to generate vaccines and therapeutic antibodies that could target predicted H5N1 mutants before these viruses evolve naturally. This advance was made possible by creating mutations in the region of the H5N1 hemagglutinin (HA) protein that directs the virus to bird or human cells and eliciting antibodies to it.
“While nobody knows if and when H5N1 will jump from birds to humans, they have come up with a way to anticipate how that jump might occur and ways to respond to it.”
“Now we can begin, preemptively, to consider the design of potential new vaccines and therapeutic antibodies to treat people who may someday be infected with future emerging avian influenza virus mutants,” says NIAID Director Anthony S. Fauci, M.D. “This research could possibly help to contain a pandemic early on.”
Influenza viruses constantly mutate...vaccines are most effective against the highly specific strains that they are made from. This makes it difficult to predict how effective a vaccine made today will be against a virus that emerges tomorrow.
Dr. Nabel and his colleagues started their project by focusing narrowly on mutations that render H5N1 viruses better able to recognize and enter human cells. Bird-adapted H5N1 binds bird cell surface receptors. But these receptors differ slightly from the receptors on human cells, which in part explains why bird-adapted H5N1 can infect but not spread easily between humans.
They focused specifically on genetic changes to one portion of the H5 protein — a portion called the receptor binding domain. They showed that as few as two mutations to this receptor binding domain could enhance the ability of H5N1 to recognize human cells.
...these mutations change how the immune system recognizes the virus....they discovered one broadly reactive antibody that could neutralize both the bird- and human-adapted forms of an H5N1 virus.
... their findings should contribute to better surveillance of naturally occurring avian flu outbreaks by making it easier to recognize dangerous mutants and identify vaccine candidates that might provide greater efficacy against such a virus before it emerges.
“Insight into the structure of the avian flu virus has enabled us to target a critical region of HA that directs its specificity. Such a structure-based vaccine design may allow us to respond to this future threat in advance of an actual outbreak.”

This makes perfect sense. It has been obvious for quite some time that everything hinges upon the receptor binding domain (RBD) in humans.

This is why it has been so frustrating that information regarding viral sequences has been secretive. WHO affilitated labs frequently do not release this information. They have been hoarding viral sequences for quite some time despite a hugh outcry from other scientists.

Additionally, it has become even more critically important that access to viral samples from recent victims is necessary. How else to ascertain if these dangerous viral changes have occurred in those countries experiencing outbreaks, outbreaks that may be exported elsewhere if they fail to contain the spread of this disease?

indigo girl · Aug 10, 2007

Avian Flu Diary comments on this new study from the National Institute of Allergy and Infectious Diseases in Maryland and the Emory University School of Medicine in Atlanta from the previous post, and notes some very valid concerns about vaccine production, and the will to do what needs to be done.

http://afludiary.blogspot.com/2007/08/before-we-start-popping-champaign-corks.html

...there is a goodly gap between most of these discoveries and actually having a vaccine in hand that can fight a pandemic.
Assuming that these scientists have found an antigen that would work across a variety of H5N1 mutations, we would still need to manufacture and deliver a vaccine to billions of people.
Our global manufacturing capacity for vaccine is very limited. Distribution is another bottleneck. It would take a commitment of billions of dollars, some serious global cooperation, and several years, to overcome those obstacles.

Yes. Unfortunately, all of the above is absolutely true.