Disaster/Pandemic preparedness

[LMonty911]

I was looking the the other Disaster/Pandemic thread that Florida1 started. She mentioned that after the hurricanes, that they had problems getting basic supplies and food stores were often closed for weeks after the storm.

That concerns me. I wonder in case of disasters like hurricanes, earthquakes and pandemics if the nurses who work in the area have problems like that. I'd be worried about leaving my family if there was no heat or electric. After loosing electric in the ice storms in the Carolinas a few years back, my husband bought us a generator. I try to keep enough gas stored so that I could run that and maybe have an extra tank of gas for getting back and forth to work, if things were shut down. I never want to wait in the cold on those gas lines again; or have to risk driving around to find necessities!

What disasters have you been through? What lessons did you learn about what things would make life easier if it happens again to you? What can we learn from your experience, and how can we prepare for so we dont have to go through th esame problems you did?

Where there any sepcial tricks or issues that came up that helped you at work? Any special problems that nurses in disasters face?

I have a confession- my home first aid kit is pretty anemic right now :) DH burned his hand prety badly at work last week. I hadnt checked my kit in awhile, and was shocked to see how low I was on some stuff. I only had one roll banfage and had to make a run to WallyWorld the next day! If the stores were shut or the roads iced in or otherwise impassible that would have been an issue. Maybe not life threatening- but its a small example of how not being well prepared can be a problem.

I'd have been so embarrased to admit to hubby I couldnt take care of it, or come thru when he needed me to.

What do you do to prepare? I'm going to restock my kit, and get some more OTC stuff to keep on hand too. What else should I be thinking about?

Laura

[indigo girl]

With permission from Effect Measure:

WHO's pep talk and fighting bird flu

Category: Bird flu * Birds * China * Pandemic preparedness * Public health preparedness * WHO

Posted on: December 17, 2007 7:14 AM, by revere

With everyone on tenterhooks over the confusing outbreak of human

bird flu cases in Pakistan and the first reported case in Burma (aka

Myanmar), WHO is taking the opportunity to give its member nations

a pep talk about swift reporting. Since there is evidence the reporting

might not have been so terribly swift in that case, one must assume

they consider this a "teachable moment" rather than an exemplar:

The World Health Organisation (WHO) on Sunday praised Asian countries

for swiftly reporting the latest bird flu cases after Pakistan and Myanmar

were hit by a resurgence of the disease. Asia-Pacific spokesman

Peter Cordingley said prompt notification was helping keep the virus in

check after Pakistan announced its first human death and Myanmar

revealed its first human case.

"People have learned that hiding cases just makes things worse,"

Cordingley told AFP [Agence France Presse].

This month China, which has previously been accused of withholding

information, reported its 27th bird flu death and Indonesia, the worst

hit country, reached 93.

Outbreaks have also been reported among poultry in Germany and

Russia as bird flu, which has killed more than 200 people worldwide

since late 2003, re-emerges. (Agency France Presse)

Getting countries to report promptly will remain a struggle. There are

lots of reasons for delay, many of them specific to particular geographic

regions, political realities and functioning infrastructure. In the Pakistan

and Myanmar cases things could have been much worse but they could also

have been better. Maybe it wouldn't have made a difference but the principle

is clear and WHO is trying to punch it home. WHO has had its own

credibility problems, of course. Maybe this is a good time to give them a pep

talk, too. More transparency, please.

But there is a curious coda to the WHO news story (a story WHO

clearly wanted told, so we assume they also want this part told, too).

Cordingly observes that flu season was upon us, that birds got the flu,

too, even before humans, and because of wild bird migration and human

caused poultry movement (legal and illegal) bird flu will continue to

spread unless ... unless what?

"This virus will continue. We cannot fight it on a public health front, it

depends on how farmyards and chickens are raised and that is a long-term

fight," he said.

What's the take home lesson here? What does it mean to say we

"cannot fight it on the public health front"? Vaccines for humans and poultry

are surely weapons on the public health front. More importantly, however,

public health and social service systems are the public health front.

I would think an essential message here would be that along with trying

to stop a pandemic emerging from the current panzootic of avian

influenza, an effort that is likely to fall short, we should be preparing

for the consequences of a pandemic.

That means turning our attention to the global, national and local public

health front. Or am I missing something?

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.

[indigo girl]

Failure to Participate Will Have Consequences

http://afludiary.blogspot.com/2007/12/what-we-have-here-is-failure-to.html

Seven states have failed to purchase any of the federally subsidized

antivirals, that are a hugh part of the nation's pandemic preparedness plan.

The seven states that have declined to purchase tamiflu are: Colorado,

Connecticut, Florida, Massachusetts, Mississippi, North Dakota and

Rhode Island. On a personal note, I am working in Ct, living in RI, and I am

moving to Florida. Am I surprised? No, but I can see that it is time for some

phone calls to the press, and for holding govt and health departments

accountable earlier rather than later.

How does your state measure up to protecting its citizens?

The Trust For America's Health has issued it's fifth annual "Ready or Not? Protecting the Public's Health from Disease, Disasters, and Bioterrorism" report, and its findings are not encouraging.

Among the key findings:

Thirteen states do not have adequate plans to distribute emergency vaccines, antidotes, and medical supplies from the Strategic National Stockpile.

Twenty-one states do not have statutes that allow for adequate liability protection for healthcare volunteers during emergencies.

Twelve states do not have a disease surveillance system compatible with the Centers for Disease Control and Prevention's (CDC) National Electronic Disease Surveillance System.

Seven states have not purchased any portion of their federally-subsidized or unsubsidized antivirals to use during a pandemic flu.

Seven states and D.C. lack sufficient capabilities to test for biological threats.

[indigo girl]

From a newspaper in Georgia, some good advice, not enough advice maybe,

but it's a start:

http://www.macon.com/197/story/223637.html

Authorities at the Division of Public Health and the North Central Health District of Georgia know all too well the danger of a widespread influenza pandemic and encourage all 13 counties in the district to be prepared for that possibility.

Their mission is to work with local agencies, businesses, schools and churches to have a coordinated community plan in place to avoid the overwhelming effects such as those experienced in this country during the 1918 Spanish Flu Pandemic.

Historically, pandemics - defined as epidemics over a widespread geographic area - have caught the world by surprise, giving communities little time to prepare for the abrupt increases in illness and even death that characterize these events and make them so disruptive.

Currently the spread of the H5N1 avian influenza virus - often referred to as bird flu - is enhancing the worldwide warning. Circumstances have been unfolding in areas of Asia over the past year that make conditions favorable for another pandemic.

Every household should have a disaster kit. Consider gathering the following items that would help in caring for someone with the flu: thermometer, disposable gloves, acetaminophen, ibuprofen, bleach, soap, tissues, paper towels, hand sanitizer, surgical masks for each member of the household, sugar, baking soda, salt and salt substitute.

The final four items on the list are used to treat dehydration for someone over the age of 12. Combine 1 quart of water, teaspoon of baking soda, teaspoon of table salt, 3 to 4 tablespoons of sugar and teaspoon of salt substitute.

Mix well and flavor with lemon juice or sugar-free Kool-Aid. The electrolytes in the solution will help reduce dehydration.

[indigo girl]

I should have posted this on New Year's Eve when it was written, but I was too

worn out from lack of sleep. Hopefully, I will not be working nights much longer.

Gratefully posted with the permission of the editors of Effect Measure.

This is an excellent and thoughtful commentary given from

experienced public health docs.

The reformat was done to help simplify understanding:

Pandemic influenza subtypes: end of the year musings

Category: Bird flu * Birds * Epidemiology * Infectious disease * Pandemic preparedness * Public health preparedness * Surveillance * biology

Everyone seems to have an opinion about whether bird flu will be the next terrible global pandemic. In current parlance "bird flu" means human infection with the highly pathogenic avian influenza/A subtype H5N1. There is no doubt that this is the 800 pound gorilla in the global health room at the moment, but not because it is more likely to become a pandemic (NB: pandemic by definition is a globally dispersed sudden increase in infection among humans; the same situation for animals is called a panzootic, and it is plausible to say we have an H5N1 panzootic for birds now). On the basis of biology humans are potentially susceptible to influenza viruses, although only the H1, H2 and H3 subtypes circulate or have circulated in human populations. But a handful of human infections have also been reported from H5, H7, H9 and H10 subtypes, although except for H5 the infections have been relatively mild. Out of 103 cases of the non-H5 subtypes there has been only one fatality (H7N7, one fatality with 88 non-fatal cases), whereas the current official tally for H5N1 gives 213 deaths in 346 cases (61%). Which is why the H5N1 gorilla weighs 800 pounds. This influenza/A variant is a remarkably virulent virus. Is it the most likely virus to cause the next influenza pandemic?

Recall the terminology here, as it makes distinctions that are important. A virus is pathogenic for a host if it is capable of infecting the host cell and cause disease in the host. So there are two criteria for pathogenicity: it can infect the cell; and the host organism gets a disease. This last criterion is vague. The "disease" state might range from very mild or hardly noticeable to fatal. The underlying idea is that the infection was in some sense parasitic, i.e., the virus reproduced itself with the host cell machinery at the expense of the host. That cost might be tiny or catastrophically large, but it wasn't neutral or beneficial (symbiotic). The degree to which the cost of the typical infection is on the serious side is the virulence of the virus. Virulent viruses are by definition pathogenic, but in addition they cause serious disease. By this terminology the H7, H9 and H10 are human pathogenic viruses that aren't very virulent (the most frequent disease symptom was conjunctivitis, "pink eye," in the Netherlands H7N7 outbreak of 89 cases).

There is a bit of special usage in the flu world here, which we should also clear up.

The avian version of H5N1 exists in two main forms that differ in virulence, called confusingly low pathogenic and high pathogenic.

To be consistent with the terminology used in the rest of infectious disease epidemiology they are both pathogenic viruses, one of low virulence, the other of high virulence. The standard test for high path was to see if it killed chicks. These days it is more common to look at a genetic feature, the presence of extra basic amino acids at the cleavage site of the hemagglutinin protein.

What bearing do these distinctions have on which of those influenza subtype is likely to become the next pandemic strain? None, really. They are all subtypes to which humans have had little prior exposure so there is no pre-existing immunity to the main antigen (the one designated "H"). It could also be a subtype not listed as having caused human infections, like an H6 or an H13. The thing that will decide whether a new subtype becomes pandemic, in addition, is whether it is easily passed from person to person, as is "ordinary" seasonal influenza (currently certain H2 H1 and H3 subtypes). This is still given by yet another term, transmissibility. On that list of non-H1 to H3 subtypes pathogenic for humans the most transmissible was H7N7, so on those grounds one might expect this to be the next pandemic. Why aren't we more worried about it? Because a pandemic of "pink eye" is not the same thing as a pandemic that has a 60%+ case fatality ratio (CFR), the way H5N1 does. For comparison, the horrendous 1918 flu had an estimated CFR of under 3%.

All of these influenza subtypes mutate with ease. Most mutations are bad for the virus (in the sense that the mutated virus replicates less well than the unmutated version). So ease of mutation isn't going to tell us which is the next pandemic subtype. We also don't know the features that make an influenza virus easily transmissible. There are likely multiple combinations of features that can do this (i.e., many roads to the same end), but we don't know what they are. We don't know how these subtypes interact when they circulate simultaneously. For example, if another N1 is circulating, does this make it less likely a second N1 virus coupled with a different H will also gain a foothold? How likely are they to infect a host simultaneously? As if these questions weren't themselves of key importance, we also don't know the relationship between transmissibility and virulence. They are logically and biologically independent in general, but changes that affect transmissibility might also affect virulence. Because we don't know any of these things (and lots more besides), it is not possible at the moment to quantify the probability of one or another (or any) subtype to "go pandemic." Experts can make judgments ("subjective probability") based on evidence, but at the moment the evidence isn't strong enough to narrow the huge range of plausible judgments. The best we can do is make some assumptions, for planning purposes. Those assumptions are the source of most of the contentious arguments over the adequacy or lack thereof about pandemic preparedness.

Because perseveration is a characteristic and privilege of the aged, we will repeat again in this last bird flu post of 2007 what we have been saying here since late 2004. The best way to prepare for an influenza pandemic is to do those things which make for a robust community, especially building and strengthening the public health and social service infrastructure. This is like repairing the roof on your dwelling. It will help protect against heat, cold, rain, sleet or snow. It won't keep you safe from an asteroid or a nuclear attack. A strong public health system also won't protect you from a pandemic with a 30% attack rate and 60% CFR. But it will help with a hell of a lot of other things, including many of the most plausible candidate influenza pandemic viruses.

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.

[indigo girl]

CIDRAP on the US vaccine-allocation "draft guidance"

How vulnerable are we when it comes to the supply chain?

When it comes to medical supplies, we are in serious trouble:

http://crofsblogs.typepad.com/h5n1/2008/01/cidrap-on-the-u.html

The Centers for Infectious Disease Research and Policy at the University of Minnesota has been a vocal and aggressive advocate for pandemic preparation. On December 31 CIDRAP released its Comments on the Draft Guidance on Allocating and Targeting Pandemic Influenza Vaccine. Dr. Michael Osterholm is the lead author...

...we believe that HHS and DHS must determine a priority list of critical products and services that, should they be unavailable during a pandemic due to disruptions in international trade and travel, will result in significant morbidity and mortality.

For example, in the health care delivery system during the next pandemic, regardless of where routine and influenza-related patient care takes place or how many health care providers actually come to work, we will need even more drugs such as antibiotics; medical devices and other products such as needles, syringes, IV bags, gloves, and masks; and routine laboratory and diagnostic tests.

Yet today most of these products have supply chains and production locations outside of the United States.

[indigo girl]

Important information from CIDRAP:

PROMISING PRACTICES FOR PANDEMIC PLANNING

Toolkit provides guidance on home care for the sick

http://www.cidrap.umn.edu//cidrap/content/influenza/panflu/news/jan0208homecarepp.html

As healthcare facilities become overwhelmed during pandemic influenza, many of the sick may have to receive care elsewhere, including at home. The "Stay at Home Toolkit for Influenza," developed by health officials in Maryland's Montgomery County, offers the public practical guidelines on how to nurse ill household members.

The simple guide, from the Montgomery County Department of Health and Human Services Public Health Services, highlights prevention and caregiving with outlines on what people should or should not do when assisting those sick with the flu.

Rachel Abbey and Betsy Burroughs of the county's Advanced Practice Center (APC) for Public Health Emergency Preparedness and Response compiled the toolkit and said the idea developed following suggestions from other public health officials about the necessity for home care guidelines.

"During a pandemic, in order to deal with surge, we would need residents to take care of sick people," said Abbey, a program specialist at the APC.

[indigo girl]

Santa Clara County Home Treatment for Pandemic Influenza Guide

Kudos to the Santa Clara County Public Health Department for providing this

document, and thanks to flutrackers.com for pointing it out. This is really

excellent, and will save lives. Downloading this is highly recommended:

http://www.flutrackers.com/forum/showpost.php?p=121634&postcount=1

About Pandemic Flu

Pandemic flu or pandemic influenza is a worldwide outbreak of a

new flu virus for which there is little or no immunity (protection)

in the human population. Scientists and health professionals are

concerned that the flu virus that has been reported in birds - called

avian flu - will develop into the next human pandemic.

When a new pandemic flu spreads it creates a public health emer-

gency. This emergency will be different than other emergencies we

have faced before - it will last longer, make more people seriously ill

and may cause more deaths than any other health crisis in our time.

While we cannot stop a pandemic from happening, it is important

to plan ahead. As many as one (1) in four (4) people could get sick

during a pandemic, with many of these people getting seriously ill.

Because so many people will be sick, the services and supplies that

we count on every day may not be readily available. That means

each individual and family should have emergency supplies like

food and water, as well as other supplies they'll need to take care of

their loved ones at home.

...It will be important for you to stay informed, read and

listen to the news, and check the Public Health Department's Web site

at http://www.sccphd.org for home isolation and other important

instructions.

Home Preparation is Important

Since so many people will be sick during a pandemic, it is likely

that families will need to take care of their loved ones at home.

When caring for an adult or child who is sick during a pandemic, it

will be very important to be prepared.

You need to have the right supplies and medicines on hand. You

need to know how to care for a sick family or household member

including how to isolate (or separate) them at home, how to treat

their symptoms and when to call for medical advice. You will also

need to know how to control the spread of the disease in your

own home.

Please remember, most people will survive the pandemic flu. But it

is important to be prepared so that you give the best care to your

family and household members who may get sick during a pan-

demic. The information provided in the following pages will help

you prepare so that you will be better able to care for your loved

ones at home.

[indigo girl]

More about the Santa Clara County Home Treatment for Pandemic Influenza Guide

http://afludiary.blogspot.com/2008/01/home-pandemic-guide-available.html

[indigo girl]

From SophiaZoe's blog:

A Prime Directive Forgotten

http://birdflujourney.typepad.com/a_journey_through_the_wor/2008/01/a-prime-directi.html

After much personal reflection I have come to the conclusion that my "bucket" contains a requirement for me to keep at this--whatever this is, irrespective of its effectiveness. And, although I am suffering an acutely felt abandonment of muse, I am an optimist at heart, an optimist that hears the clarion call of responsibility. Even if my responsibility isn't to save the world, I feel it is my responsibility to continue to "speak", to continue to chip away at the crumbling stone statue reflecting Narcissus in the hopes that the flower of understanding will take root and receive enough sustenance to bloom. Presumptuous? No doubt. I am, admittedly, a rather presumptuous person.

[Ayrman]

I find myself wondering how many people who have bothered to read this thread have actually undertaken ANY sort of preps.

The federal government in particular, and to a lesser degree various state and local governmental bodies have been promoting preparedness for.... well, for whatever, up to and including an infectious disease pandemic, for several years now. But how many people have actually listened and taken the messages to heart?

Ayrman

[sharona97, BSN, RN]

I find myself wondering how many people who have bothered to read this thread have actually undertaken ANY sort of preps.

The federal government in particular, and to a lesser degree various state and local governmental bodies have been promoting preparedness for.... well, for whatever, up to and including an infectious disease pandemic, for several years now. But how many people have actually listened and taken the messages to heart?

Ayrman

Great question! I myself have followed tis thread for over a year and we are prepared! Aren't all nurses lol? Seriously, this is a real forseen danger and I agree with you. Where I live I have found at least 6 dead birds in the yard and caled the state hotline to report. What a joke. You can't even speak to someone.

Thank God for the OP.

[indigo girl]

Don't know where to go to get information on preparing for natural

disasters or other emergencies such as pandemic influenza? Here

is a link to a new preparedness site.

Congratulations on a job well done to those who contributed their talents

for a common cause, that of reducing morbidity and mortality:

This website boasts more than 30 small PDF files with preparedness advice that you can download. They are easy to read, illustrated, and chock full of solid advice.

http://afludiary.blogspot.com/2008/01/launch-of-getpandemicreadyorg.html