Disaster/Pandemic preparedness

indigo girl · Nov 25, 2007

Viral Tsunami

Commentary from Sophia Zoe's blog, as always informative, and thoughtful,

this time concerns itself with the possibility of only one wave of viral

infection instead of the multiple wave theory thought to have occurred in 1918.

As she notes, the UK planning has included a single massive wave of infection as part of its pandemic planning.

Unbelieveable, but who's to say what could happen? How do you plan

for an event of this magnitude?

http://birdflujourney.typepad.com/a_journey_through_the_wor/2007/11/vindicationof-s.html

indigo girl · Nov 26, 2007

One Community's Pandemic Plan

This is the scenario we would likely see during a pandemic outbreak with alternate care centers instead of hospitals, receiving flu victims.

http://www.heraldnet.com/article/20071125/NEWS01/711250066

(hat tip PFI/monotreme)

Hospitals in Everett, Edmonds, Monroe and Arlington would quickly be overwhelmed with sick people needing care.
A new disaster medical care plan from the Snohomish Health District's calls for:
Treating people who are moderately ill at home;
Setting up a call center staffed by nurses to help answer questions from the public;
Establishing seven sites in the county for people who need basic medical care;
And outfitting three large buildings in Arlington, Everett and Edmonds with medical staff and supplies to treat seriously ill patients who can't be treated in hospitals.
A critical part of the response will also depend on individuals and families being able to provide initial care at home, since more people would seek medical care than hospitals and health care clinics would be able to treat, he said.
That's one reason state health officials advised people earlier this year to begin stocking up on basic supplies that could be used in a pandemic.

These include nonprescription medications for fever (such as ibuprofen and acetaminophen), stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins. A thermometer, cold packs, blankets and humidifiers also are recommended.
...the three centers would be based at either a middle or high school in Arlington, the Comcast Arena at Everett Events Center, and Edmonds Community College.
They would care for people for two to five days, treating both people who are expected to recover and those expected to die.
These centers would provide oxygen and intravenous fluids for patients as well as 24-hour food service, a chapel, a morgue and rest areas for family caregivers.

indigo girl · Nov 27, 2007

Indonesia Says No to Sharing Virus Samples:

I am providing a link to Effect Measure, and encouraging reading the comments

following the link this time because they have some very important thoughts

to share. Dr. Woodson and Susan C are physicians very familiar with these

issues.

I have highlighted the comments of Susan C, a retired physician from the UK

because, I think that she had nailed it. This is the big problem.

http://scienceblogs.com/effectmeasure/2007/11/indons_supari_says_no_is_this.php

Well, there are lots of useful insights coming out of this meeting, and a lot of important issues that at least have gotten onto the table, to be dealt with more thoroughly.
But the bottomline is, this is NOT, has never been, a virus sharing issue. It is a vaccine-sharing issue.
Or rather a vaccine production capacity issue.
What the Indonesians want, is vaccines. Unless someone can find a way of getting them vaccines, they are not going to give. Everything else, is important, but is extraneous, IMHO.
Since the Indonesians don't have the $$$ to pay to build vaccine plants nor the expertise on their soil to get then going, they play the only hand they can get.
The only way to solve the impasse is to massively increase global production capacity AND at low cost. And that is only possible with new technology and abandon the egg-based system, which at the moment is being propped up by the mantra of 'increasing seasonal flu vaccine production capacity in order to meet the needs of producing pandemic vaccines'.
Well, guess what? The shortfall is so astronomical that only the most blinkered will continue to pretend that it is a viable goal.
As long as western governments, (and the WHO) continue this pretense that increasing seasonal flu vaccine capacity is the way to go, the system will continue to favor existing companies that dominate the seasonal flu market.
These big companies have the correspondingly big dollars to pay lobbyists to cover every single part of the US government that has any part to play in these decisions. And if these same companies happen to NOT be the front-runners for the most promising cell-based technologies? Tough luck for the whole world!!

indigo girl · Nov 29, 2007

Non-pharmaceutical interventions for a pandemic: getting it right (with Addendum from John Barry)

All of the links that follow including any commentary are worth reading.

Why bother? Because these NPI (non-pharmaceutical interventions) are

our main defense against a novel and very virulent disease that we have

no immunity to.

Consider the ages of those most at risk, those under age 40, and remember

that there is no vaccine, and not enough antiviral to treat everyone that

will get sick.

http://scienceblogs.com/effectmeasure/2007/11/nonpharmaceutical_intervention.php#more

Frankly, our one real hope is that all the other public health tools we have employed in past infectious disease epidemics will make a difference. These tools have largely tried to change individual and community-based behavior to avoid exposure to the infectious agent until after the epidemic has run its course. These are often referred to as nonpharmaceutical interventions (NPIs) and include familiar approaches such as isolation, quarantine, and social distancing. While all of us might believe that these measures will work, until recently very little evidence has been available concerning their efficacy in reducing either morbidity or mortality in an influenza pandemic. This is due in part to the infrequency of such pandemics (three in the last century) and an absence of systematic studies during those pandemics of our collective public health actions and their impact. (CIDRAP News)

indigo girl · Nov 29, 2007

It's Flu Season

http://afludiary.blogspot.com/2007/11/with-flu-season-upon-us.html

... seasonal flu will strike millions of people, and contribute to the deaths of tens of thousands over the next few months.

The emergence of the H3N2 Brisbane-like strain over the summer in the Southern Hemisphere, a strain not covered by this year's flu shot, provides an additional cause for concern.

indigo girl · Dec 2, 2007

San Francisco Archdiocese Pandemic Preparedness Plan

The good news is that they recognize that there is a threat. The bad news

is this plan is not realistic, and in actuality this plan will place many more

kids and their families at risk. I hope that parents will pull their kids out

of the schools at the first sign of a pandemic, and NOT let someone else

make the decision of whether or not it is safe for their child to go to school.

Having parents be proactive about this is critically important.

http://afludiary.blogspot.com/2007/12/going-their-way.html

At all levels of infection, infected children and staff are to stay home. If the level of infection rises above 30 percent of a school's population, the plan calls on principals to close the school and cancel all non-academic events.
Part of the plan includes a series of letters to be distributed to parents at various stages of a hypothetical pandemic. These letters are meant to calm fears and give instructions as the outbreak runs its course.

indigo girl · Dec 7, 2007

Flu Pandemic Would Cost Hospitals Billions

This essay is deeply disturbing. I hope that those who read it will understand

exactly what is at risk, and why 1918 as bad as it was, may not be as bad as

it could get. People really need to understand this because the cavalry is not

coming to the rescue this time. We have to depend upon ourselves. This does

not mean giving up because the task is too daunting. It means facing the

reality of a worse case scenario so that we can plan for it individually and as

a community. We are, in fact, a community, and as such we are powerful.

http://birdflujourney.typepad.com/a_journey_through_the_wor/2007/12/pandemic-accoun.html

Planning assumptions for a severe pandemic rarely account for anything worse than 1918. In fact, today is day two of a web dialogue on the US vaccine prioritization preliminary guidance, and the "PanFlu aware" who are participating are continually running up against the facilitators inability (or refusal) to step outside of the possibility that the next PanFlu could be worse, or even significantly worse, than the 1918 pandemic.
This steadfastness is in the face of WHO findings, multiple scientific papers, notable experts, and just plain common sense given available facts.
A human adapted H5N1 avian influenza is a "different beast" than the 1918 pandemic strain, which, via genetic reconstruction, was determined to have been wholly avian on a genetic level as well. We don't understand why H5N1 has such a frightful mortality rate, but just because we don't understand it doesn't make it not so.

indigo girl · Dec 8, 2007

Pandemic Crisis Simulation in Chicago

If it is H5N1 that we are dealing with, it will be a crisis unless it loses

some of its virulence.

Trust for America's Health has been working with many organizations

and meeting with stakeholders around the country to increase

awareness and help train leaders.

I wish that they would help train nurses as leaders also as we

will be intimately involved should this come to pass.

http://afludiary.blogspot.com/2007/12/chicago-officials-train-on-crisis.html

The effects of the computer-simulated flu pandemic kept getting worse and worse: highways and airports shut down, hospitals filled to capacity, pharmacies running out of medicine.
As the consequences of the virtual disease became direr, public and private officials taking part in an emergency-response drill Thursday got a taste of the high-pressure decisions they would have to make should such a disaster happen in Chicago.
About 100 employees of various city agencies and private businesses watched on projection screens as the officials decided how to respond to power outages, staffing shortages at police and fire departments and a lack of basic supplies at supermarkets.

indigo girl · Dec 12, 2007

Extrapolating the Unknown from What We Do Know

Sophia Zoe does not call her essay by this title, but I think that it somewhat

describes what she is trying to do. Do not read this if you do not want to

think too deeply. She is discussing the possibility of a pandemic outbreak

of H5N1, and whether the planning is realistic given what we know about

pandemics and the H5N1 virus Case Fatality Rate (CFR).

http://birdflujourney.typepad.com/a_journey_through_the_wor/2007/12/informed-seats.html

In order to qualify as a Viral Tsunami, by my definition, an influenza pandemic would have to have a high Clinical Attack Rate (CAR) and a high Case Fatality Ratio (CFR), as well as encompass a single wave of illness. There is strong belief that the CAR will be between 30-35% of the population and CFR will be no worse than ~2.5%. Because there is strong belief in this scenario as the upper limit of potentials, those figures represent the worst case scenario in so many plans. In addition, I must say, there are many plans that use numbers lower than these as their "upper limits".
CAR, a major component, utilizes a number known as R0, the basic reproduction number. From Wikipedia:
In epidemiology, the basic reproduction number of an infection is the mean number of secondary cases a typical single infected case will cause in a population with no immunity to the disease in the absence of interventions to control the infection. It is often denoted R0. This metric is useful because it helps determine whether or not an infectious disease will spread through a population.
If an infectious disease has an R0 of less than 1.0 it will burn itself out, if greater than 1 it will continue to spread if not mitigated. The UK PanFlu Framework assumes an R0 than they believe will range from somewhere between 1.4 and 2.2. It is useful to understand that at 2.0 cases will double every one or two days, at 4.0 they would quadruple, etc, on up the scale.
The assumptions of 1.4 - 2.2 R0 are frightful enough, to say nothing of difficult to address. The same assumptions assume community mitigation measures will have a significant effect on the CAR and R0, a very reasonable assumption. Modeling suggests the dramatic difference between a local outbreak with and without mitigation:
A lot rides on our plans, the actions we prepare ourselves to take, the plans our leaders civic and governmental leaders will institute on our behalf.
What if planning assumptions are wrong?

indigo girl · Dec 13, 2007

From the Medical Journal of Australia

A food “lifeboat”: food and nutrition considerations in the event of a pandemic or other catastrophe

http://www.flutrackers.com/forum/showpost.php?p=114958&postcount=2

Large catastrophes have caused the collapse of empires and civilisations.
Science and knowledge may help prevent some catastrophes, but urbanisation and narrowly concentrated food supplies, climate change and terrorism contribute to considerable risk. Viruses responsible for severe acute respiratory syndrome (SARS) and avian influenza A (H5N1) or “bird flu” are among the most immediately identifiable risks. The World Health Organization has stated that the risk scenario associated with an outbreak of pandemic H5N1 influenza should be considered more serious than was previously assumed.

Early self-isolation and social distancing measures are known to be highly effective. In the event of a lethal pandemic, emergency measures such as closing schools, staying home with family and friends, and avoiding contact with other people (until all have been immunised) will be instrumental in avoiding infection. People employed in essential services or occupations may be required to reside at their workplace for the whole period of the crisis. To achieve this type of isolation, sufficient food of adequate quality and quantity must be available.

The Australian Government and the Australian Food and Grocery Council (AFGC) have been planning for such a scenario for several years and have advanced plans in place (Russell Neal, AFGC, Canberra, ACT, personal communication). Nonetheless, the logistics and practicalities of household food stockpiling should be given greater media coverage...

http://afludiary.blogspot.com/2007/12/australian-food-lifeboat.html

indigo girl · Dec 13, 2007

Non-Pharmaceutical Interventions for Use During a Human Influenza Pandemic

U.S. Department of Health and Human Services,

Centers for Disease Control and Prevention

U.S. Agency for International Development

December 2007

I am providing this link to Flutrackers because this govt document keeps

disappearing for some reason. Sometimes it is there, and sometimes it

isn't. Clearly, it used to be there!

This is valuable information, and needs to be archived, and thankfully

Flutrackers has done this.

http://flutrackers.com/forum/showpost.php?p=112868&postcount=1

Response to a human influenza pandemic should include a wide spectrum of medical and non-medical interventions at local, national, and international levels to reduce morbidity and mortality and to mitigate the socio-economic consequences. However, there is uncertainty about the potential effectiveness of pre-pandemic vaccines against the future specific influenza strain causing the pandemic. There is also concern about the amount of time that will be needed to develop, manufacture, and distribute a vaccine that would be specific to the pandemic strain.
To help prepare the nations of the world for a possible global influenza pandemic, the U.S. Government is promoting the consideration of non-pharmaceutical interventions for use during an influenza pandemic, both domestically and internationally. We offer this condensed and adapted version of our national “community-mitigation guidance” – developed by the U.S. Centers for Disease Control and Prevention (CDC) within the U.S. Department of Health and Human Services (HHS),1 in accordance with recommendations of the Secretariat of the World Health Organization (WHO)2 – which provides information on key non-drug, non-vaccination measures that can mitigate the effects of disease during an influenza pandemic. We believe the core principles of community mitigation highlighted in this document are adaptable for use outside the United States – particularly in developing countries, which could suffer significant morbidity and mortality in the case of a human influenza pandemic. In addition, this document intends to articulate the principles in language the WHO can use to guide national and local governments as they create their own community-mitigation policies for a human influenza pandemic.

indigo girl · Dec 17, 2007

http://afludiary.blogspot.com/2007/12/who-warns-countries-to-be-vigilant.html

The World Health Organization warned Monday that countries should be on alert for bird flu because it is again on the move, with Pakistan reporting new infections and Myanmar logging its first human case.
"The key to the public health response is surveillance," said Peter Cordingley, spokesman for the WHO Western Pacific region in Manila. "If we do actually get to the cases with antivirals early on, the health outcome is a lot better."
The H5N1 virus often flares during the winter months. In some countries, like Indonesia, poultry outbreaks and human cases are reported year round, but many countries experience a flurry of activity when temperatures drop.
"It starts to pop at this time of the year, not just in this region where it's endemic, but it starts to appear in the West," Cordingley said. "Between now and April is a very dangerous time of the year."