Disaster/Pandemic preparedness

indigo girl · Oct 1, 2007

indigo girl here you have the email you asked for
ttp://www.whcenter.org/body.cfm?id=555603

Thank you!

indigo girl · Oct 2, 2007

Senate Hearing Reminder

http://afludiary.blogspot.com/2007/10/senate-hearing-reminder.html

This week the Senate Committee on Homeland Security and Governmental Affairs will hold hearings on Pandemic issues.
It appears that these hearings will be available for viewing, live on the web at http://www.senate.gov/~gov_affairs/.
Today's hearing begins at 10:00am EDT

UPDATE after the hearing

Did anyone get a chance to hear or see this today? It will probably be

archived. I could not view it, but was able to listen.

Wow! They have done a lot, but their planning is based on 1918 numbers,

and not the current case fatality rate of H5N1.

They seem to be relying, for D.C. anyway, on federal assistance in a worse

case scenario. And, they are going to have the postal workers deliver

antivirals, house to house. Those workers want armed guards to

accompany them, but planners admit that there is no guarantee that

this can be done. They left it at that...

They talked about closing schools, but I felt that they seemed somewhat

reluctant to do so, talking instead about teaching students, parents,

and teachers what the symptoms are, and to seek immediate treatment.

So they kind of skirted around specifics about this.

The Committee Chairperson, I did not catch his name, asked about

the current seasonal flu vaccine and H3N2, but did not ask the right

question. He seemed concerned about the 1968 pandemic and that

this virus was the cause, worrying that it would cause more millions of

deaths. I thought that he was going to ask about the Brisbane strain,

and why it is not in the current seasonal vaccine that everyone is going

to be receiving, but no he did not go there.

There is much planning involving the hospitality industry because of

all the tourists.

The three areas, D.C., Va, and Md have agreements that citizens that

live near the boarders of each area can cross over and receive

vaccine (when available), and antivirals if available. It sounds like

they have enough antivirals for about 25% of the population.

Their planning includes university students and tourists/visitors if

they need to be treated since the population of this area will be increased

by these groups.

They addressed surge capacity for hospitals in several ways, and I have

to give them credit, they did really try to deal with this. They seem to be

counting on not everyone getting sick at the same time by using those

mitigation strategies, and the antivirals. They seem to be hoping for

assistance from the national guard and the military bases that are in the

area. They have agreements with other parts of their state areas to provide

beds, but admit to the fact that this may not be very realistic if all are hit

at once. They have mobil treatment centers. They have identified other

primary care facilities, that are not hospitals that they will use.

They did not specify what kind of places these would be. (I am thinking

nursing homes, assisted living, and wondering if they have told these

places which are mostly privately run for profit that they are included in this planning.)

Here is the archived audio. It is about 1 1/2 hours:

http://www.senate.gov/~gov_affairs/audio_video/100307video.ram

Mechi · Oct 2, 2007

http://www.google.com/search?q=hazmat&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a

Thanks ,did you ever assist to a Hazmat course in your hospital is mandatory.Read web site

indigo girl · Oct 2, 2007

U.S. Senate Committee on Homeland Security and Governmental Affairs

Ad Hoc Subcommittee on State, Local, and Private Sector Preparedness and Integration

Title: Pandemic Influenza: State and Local Efforts to Prepare

Date: 10/3/07

Time (EST): 2:30 PM

Place: Dirksen Senate Office Building, Rm. 342

Witnesses

Panel 1

RADM W. Craig Vanderwagen , Assistant Secretary for Preparedness and Response , U.S. Department of Health and Human Services

Dr. Tilman Jolly , Associate Cheif Medical Officer , U.S. Department of Homeland Security

Panel 2

Dr. Paul Halverson , Director and State and Health Officer , Arkansas Department of Health

Christopher Pope , Director of Homeland Security and Emergency Management , New Hampshire Department of Safety

Yvonne Madlock , National Association for County and City Health Officials

Go to this link at 2:30 PM EDT on 3 October 2007:

http://www.senate.gov/~gov_affairs/

If you can not view it, there is a way to listen to the hearing.

These next hearings are about what your local and state govt are going to do.

UPDATE

http://www.senate.gov/~gov_affairs/index.cfm?Fuseaction=Hearings.Detail&HearingID=488

You can listen to this testimony thru the archives or read each person's

testimony via PDF, but then you would miss the discussions.

The questions after the testimony is where much information

has been given out. You can only get this by listening via

the archive.

RADM W. Craig Vanderwagen answered some questions

about seasonal flu vaccine, and mentioned the severe flu season just

experienced by the southern hemisphere. There were questions about

H3N2 inclusion in the current flu vaccine that will be given out in the

northern hemisphere. They say that the current vaccine may not

give full protection given what has just occurred in the southern

hemisphere. I think that they are concerned about the Brisbane

strain not being included although they did not mention it by name.

They say that they are moving to a cell based rather than an egg

based technology for flu vaccines. This is a good thing if they can do it.

They prefer to work with US vaccine companies rather than foreign

companies naturally enough as access will be easier.

They say that they will have 26 million doses of prepandemic vaccine

that has a shelf life of 3 years. Not enough for everyone, unfortunately...

There was discussion about how to use the antivirals and who should

receive them.

I recommend looking at Dr. Halverson's testimony because what he has

to say is very relevant at the state level. There are real problems that

states will have to struggle with such as the expiration date for the Tamiflu

that can only be kept for 5 years. Reading his testimony, you

get a real feel for the difficulties of planning with a limited budget. He

comes across as a caring physician who really knows the problems that

his state will have.

http://hsgac.senate.gov/_files/StatementHalverson.pdf

indigo girl · Oct 4, 2007

http://www.senate.gov/~gov_affairs/index.cfm?Fuseaction=Hearings.Detail&HearingID=486

U.S. Senate Committee on Homeland Security and Governmental Affairs

Subcommittee on Oversight of Government Management, the Federal Workforce, and the District of Columbia

Title: Forestalling the Coming Pandemic: Infectious Disease Surveillance Overseas

Date: 10/4/07

Time (EST): 2:30 PM

Place: Dirksen Senate Office Building, Rm. 342

Due to the evolving nature of infectious diseases, environmental changes, and the easiness of global travel, the nature of newly emerging disease is increasingly transnational and is disproportionately zoonotic (diseases that can be transmitted to humans). Thus, we need to detect not only emerging disease, but zoonotic disease outbreaks, which depend on establishing effective new partnerships between disciplines, institutions, and nations. There are a number of executive branch agencies with programs in place to help developing countries monitor the outbreak of infectious disease and to provide the U.S. with early warning of potential public health emergencies. These programs were most recently reviewed by the Government Accountability Office (GAO). This hearing will examine the results of the GAO report, assess the effectiveness of the U.S.-funded programs to assist other countries in monitoring emerging infectious disease and how those programs help the U.S. provide early warning of imminent public health threats, and work being done by the animal health community to identify emerging zoonotic disease.

indigo girl · Oct 6, 2007

Ordinary citizens can help become part of the solution at organizations such

as this one:

http://www.citizencorps.com/

There seems to be more helpful information aimed at preparing the

public for a possible flu pandemic. I have been seeing PSAs,

promoting awareness of the possibility of pandemic flu and how to

prepare, early in the AM when my patients have their televisions on.

The night supervisor at the LTC where I worked this past week in eastern CT,

brought in a flyer distributed at her local supermarket in a partnership

with the CT Dept of Public Health. She made copies of this flyer for the

night staff, and the dayshift supervisor made copies of the flyer for her

staff also. Their facility belongs to a corporation that has fitted their entire

nursing staff with N-95 masks, the only nursing homes in the state to do so

that I am aware of.

Here is what the flyer said, and the website address of the CT Dept of

Public Health information. This says a two week supply, and that is a good

place to start. I would aim for 3 months of supplies if you can, as a safer

option.

Flu Watch

Be Prepared For PANDEMIC FLU

Pandemic flu is a worldwide outbreak of a new strain of flu virus. During a flu

pandemic, millions of people could get sick, forcing stores and businesses to

close. In an emergency like pandemic flu, you may not be able to get the things

that you need when you need them most. That is why it is important to stock

your own supply of important items so that when you need them, they'll be there.

To be ready for pandemic flu, use this handy shopping list of items that you can

purchase here to create your own pandemic flu preparedness kit. Stock up

on a two-week supply of these items:

Food & Non-Perishables

Canned meats, fruits, vegetables, & soups

Protein or fruit bars

Vitamins

Powdered milk

Dried fruit

Bottled water (min. 1 gallon per person per day)

Staples (rice, flour, spices, etc.)

Crackers, snack foods

Dry cereal, granola

Peanut butter, nuts (if not allergic)

Canned juices

Canned or jarred baby food, formula

First Aid & Healthcare

Medicines for fever (acetaminophen or ibuprofen)

Antacid (for stomach upset)

Sterile adhesive bandages in assorted sizes

Cleansing agent/soap

Thermometer

Prescription & nonprescription medications

Anti-diarrheal medication

Laxative

Sterile gauze pads & rolled bandages

Disposable gloves

Antiseptic

Sanitation

Toilet Paper, towelettes, tissues

Alcohol-based hand wash

Feminine & personal hygiene items, diapers

Plastic bucket with tight lid

Soap, liquid detergent

Surgical masks, gloves

Plastic garbage bags, ties

Disinfectant or chlorine bleach

General Supplies

Paper cups, plates, plastic utensils

Battery-operated radio, extra batteries

Manual can opener, utility knife

Matches

Plastic storage containers

Scissors, needles, thread

Sterno

2 flashlights, extra batteries

Small canister fire extinguisher

Aluminum foil & plastic wrap

Paper, pencil

Remember

Have a two-week supply of food & water for any emergency.

Keep your preparedness kit in an easy-to-carry, waterproof container.

Store your kit in a convenient place known to all family members.

Change your stored water supply every six months. Replace your stored

food every six months.

Ask your physician or pharmacist about storing prescription medications.

For more information on pandemic flu, visit http://www.ct.gov/ctfluwatch or call 2-1-1

indigo girl · Oct 7, 2007

Financial Sector Seriously Plans for Pandemic

An article on the federal exercise in planning for pandemic

for the critically important financial sector,

(https://allnurses.com/forums/2417343-post151.html)

The test ends this Thursday:

http://www.buffalonews.com/145/story/178966.html

(hat tip PFI/pixie)
...Banks and insurers must have "business continuity" plans in place for a wide range of emergencies...The flu efforts have been under way for two years, since November 2005.
The exercise-the largest ever of this type in the United States-is designed to simulate as best as possible the conditions that companies would face when the virus hits America.
At its core, the test expects about 25 percent of a company's staff to be absent the first week, and almost half the second.
"What we're trying to do is recreate as much as we can what would happen should a pandemic eventually reach America," said Louis W. Pietroluongo, deputy New York state...
... Rather than affecting just a limited geographic area or even a single building, a pandemic would hit the entire country. ]And it would last for 12 to 18 months, in multiple waves, instead of a few minutes or hours.
Employees also are being actively cross-trained in multiple functions, and companies are identifying key people to fill critical roles. And significant work is already automated.
Many companies like M&T, Citi and KeyBank are considering whether employees can do work from home to avoid exposure, and are assessing whether they have enough Internet "bandwidth" to handle such an increase in Web traffic. Indeed, that's become a major question.
"It's such a great unknown," said M&T's Shaw. "We've never pushed the limit of the Internet to this point where we know what this would do to us."

KeyBank officials are looking at whether they could handle more activity through call centers, online banking, and ATMs, since many routine activities can be done remotely, said spokesman William Murschel.
Billittier said some banks have talked of closing branch lobbies to minimize physical contact.
Pietrolongo said companies also need to maintain building security to keep sick people from coming to work, and might need to provide cafeteria service around the clock. And they have to consider the psychological impact on workers.
HSBC, with its global reach in 83 countries and territories, has gone a step further. After seeking advice from leading experts on avian flu, the company is purchasing and stockpiling the anti-viral drug Tamiflu that has been recommended by the World Health Organization. The drug would be available to all employees and, where possible, could be purchased for their family members.
The financial services industry is among the most advanced in planning, because it's highly regulated and those regulators want to ensure the nation's financial system remains intact.

sharona97, BSN, RN · Oct 7, 2007

Dear Indigo Girl,

I did a CEU last year on the Avion flu and in the read there was discussion about also safe proofing your home with stuffing certain vents ,etc. I have since lost track of the CEU booklet. Have you haerd of these kinds od precautions as well as those you have already listed?

Thanks

Sharona

indigo girl · Oct 7, 2007

I have never heard of those type of precautions, sharona, but I would very

much appreciate any info on CEU booklets or classes if you should recall where

you obtained that information. Useful and up to date information for healthcare

workers is sorely lacking. I keep waiting for some organization to step up to

the plate such as CIDRAP is doing for business groups. Of course,

big business can afford the fees that are being charged for these

seminars, and most healthcare workers can not.

Most individual preparedness info seems to focus on stockpiling what a

family would need for 3 months as well as the CDC Mitigation Strategies

that the govt is relying so heavily upon to try and limit the numbers of

people being exposed at one time. They know that they can not prevent

the disease from spreading, but will try to limit the number of cases

occurring simultaneously by implementing these strategies. Here is an

earlier post about this:

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

indigo girl · Oct 7, 2007

Thanks for the PM, sharona. I appreciate the sharing of resources.

indigo girl · Oct 8, 2007

Schools

One of the stickiest, and most controversial aspects of pandemic planning is

deciding whether or not to close the schools once a pandemic has been

declared, and has hit the country. It appears that this will be a local

decison, but may be based upon CDC or other govt guidance. There is no

hard and fast rule.

Kids spread viruses to themselves and to their families. It is a given. What

will mothers decide to do? Are most moms aware that the govt planning

is based on a 2% case fatality ratio (CFR) in line with a worst case scenario,

based on what happened in 1918? Are most moms aware that the H5N1

virus should it, in fact, become the next virus to go pandemic, currently

has a case fatality ratio (CFR) of 62%? Somehow, I have to doubt that this

fact is being very well publized. Maybe it because they do not know if

in fact H5N1 will cause a pandemic. But, govt planners do know the current

CFR, and they still plan for a 2% CFR as the worst case scenario.

Why is that?

Govt planners and some health authorities believe that as a virus begins to

infect more people that it will attenuate, meaning that it will become less

virulent in order to perpetuate itself, and infect more people. Is that true?

Did SARS do that? Is Ebola doing that? Is HIV doing that? There are very

few virologists that are saying that H5N1 will become less virulent.

Is anyone familiar with the phenomenon of "passage"?

From The Great Influenza by John Barry:

"In 1872, the French scientist C.J. Davaine was examining a specimen of blood

swimming with anthrax. To determine the lethal dose he measured out various

amounts of this blood and injected it into rabbits. He found that it required ten

drops to kill a rabbit within forty hours."

He did this through twenty five rabbits, and found out that the virulence

increased with each passage.

"After tweny-five passages, the bacteria in the blood had become so virulent

that less than 1/1,000,000 of a drop killed".

That is passage. So every time the virus has a chance to infect another human

being, (we presume, after it has achieved the ability to become more

transmissible to humans), it should become more virulent rather than less so.

Why should we presume that it would attenuate? It certainly does not have to do so.

Why are most virologists not saying that this virus will become less virulent?

What about the actual changes that some of the bird flu strains already have made,

such as the ability to infect the upper respiratory tract of humans?

This is not even mentioning some of the other worrrisome changes that have

occurred in some strains of bird flu such as Tamiflu resistance.

Planning, especially when it comes to closing schools, one would hope would

err on the side of caution simply because there is no vaccine and not enough

antivirals. Realistically, what is more important, keeping kids in school or

keeping kids healthy and alive? Remember the case fatality rate for bird flu

now stands at 62%. That is a fact that just is not going away, no matter

how much of the govt and local planning is based on 2%, if H5N1 is

what we will be dealing with.

http://www.modbee.com/local/story/87347.html

(hat tip PFI/pixie)

About 200 school nurses and district administrators from Stanislaus County gathered Thursday to discuss how to keep schools in business during a pandemic flu outbreak.
Unlike flu season, which happens every year, a pandemic flu outbreak happens about three times a century and can sicken one-third of the population. History has shown that adults younger than 35 are disproportionately affected by pandemic flu.
Stanislaus County Deputy Fire Warden Mike Wilkinson estimated about 40 percent of students would be absent from school at the peak of a pandemic outbreak, which could last 18 months.

Why they would even try to keep schools open during a pandemic, if it is a highly virulent virus such as

avian flu, should remain the question.

http://abcnews.go.com/WNT/AvianFlu/story?id=1724801

indigo girl · Oct 9, 2007

This could be important. There may be some cross protection from H5N1 by

receiving a seasonal flu vaccine nasally rather than via a subcutaneous injection according

to this recent study in mice. Unfortunately, mouse studies is all we have to go by, but it is something

to think about. We are talking about Flumist, but there may be more to it than just getting Flumist.

Will post more as we get a better picture of what they are saying.

http://www.journals.uchicago.edu/JID/journal/issues/v196n9/38072/brief/38072.abstract.html?erFrom=-5403067790995666563Guest

Results. Compared with noninoculated mice, those inoculated intranasally manifested cross-reactivity of mucosal IgA and serum IgG with H5N1 virus, as well as both a reduced H5N1 virus titer in nasal-wash samples and increased survival, after challenge with H5N1 virus. Subcutaneous inoculation did not induce a cross-reactive IgA response and did not afford protection against H5N1 viral infection.
Conclusions. Intranasal inoculation with annual influenza vaccine plus the Toll-like receptor–3 agonist, poly(I):poly(C12U), may overcome the problem of a limited supply of H5N1 virus vaccine by providing cross-protective mucosal immunity against H5N1 viruses with pandemic potential.