Disaster/Pandemic preparedness

[indigo girl]

An Aussie vet heads for Vietnam

http://crofsblogs.typepad.com/h5n1/2008/07/an-aussie-vet-h.html

This story is a great example of what needs to be done to prepare

globally for the next pandemic. Send help where it is needed now.

The hot zone countries gain by having the expertise of vets trained

in public health measures. The non infected countries gain by

having scientists gain first hand experience dealing with avian influenza.

Mutual assistance and cooperation wins out over censorship any day.

The Waverton resident left for Vietnam this week to work on public health

measures to control bird flu and other animal-to-human transmissible

diseases.

She will be working with a World Health Organisation (WHO) team to try to

influence government policy on the avian influenza strain that has ravaged

poultry flocks in Europe, Africa and Asia.

She said the disease had already caused widespread culling of chickens and

ducks, affecting the livelihood and food sources of Asian families.

What an opportunity! But all countries should be shipping their vets and

public-health experts into the hot-zone countries, to listen, learn, and lend

a hand. Their experience would be invaluable for all concerned.

[indigo girl]

Pandemic Issues For Home Health Providers - Pt 1

There are many communities that have very little home health

coverage at this present time. For example, in eastern Connecticut

there is so little home health care available currently that most folks

recovering from total knee replacements who could have done fine

at home, had to go to nursing homes with skilled rehab for their care.

If they had lived in Philadelphia, they might have received home care

instead.

Expectations for home health agencies during a pandemic do not

include caring for flu victims unless they are already home care patients.

That is not a possibility. There are not enough agencies and staff

providing care now, and there will be even fewer staff providing care

during a pandemic.

So what will be the role for home health during a pandemic?

Optimistically, it looks like the govt might be expecting them to fill

in the gaps, caring for people being discharged home from the hospital

early in order to free up beds. If anyone would take the time to read

your state's pandemic plan, you might see that this anticipated role

has been the plan all along. The real question that needs to be

answered is, how will they do more with less? If that question can

not be answered, than the plan is useless and can not be implemented.

No matter how you look at it, those discharged patients are not likely

to get much care.

http://afludiary.blogspot.com/2008/07/pandemic-issues-for-home-health.html

...this report identifies two primary receivers of home health care

during a pandemic.

Those medical and surgical patients, not hospitalized because of the

pandemic, who are well enough to be discharged early from hospitals to

free up hospital beds for more severely ill patients.

Patients who become or already are dependent on home health care

services (predominantly elderly persons with chronic disease) and will

continue to need in-home care during the influenza pandemic whether

or not they become infected with the influenza virus.

Accordingly, the home health care industry will be asked to handle their

current patient load, plus the addition of surgical and medical patients

discharged early in order to free up hospital beds during a crisis.

This at a time when their own ranks may be severely depleted due

to absenteeism.

[indigo girl]

pandemic issues for home health providers - pt 2

http://afludiary.blogspot.com/2008/07/pandemic-issues-for-home-health_12.html

who will pay for all of this in advance of an actual event?

i can see these agencies becoming leased by the govt or commandeered

during an event in progress as that may is the only way they will stay

afloat and provide at least some of the care envisioned in this report.

it is probably the only way that they will be supplied also.

`.... supplies specifically needed for surge patients

and supplies for surge and existing patients that are not usually

provided, such as food, water, or medications.'

finally, agencies need to ensure that their workforce has the essential

protective equipment needed to safely care for patients, including

niosh-certified n-95 filtering face-pieces or higher rated respirators

as feasible.

the assumption that during a pandemic, supply lines will continue as

normal, is seriously in dispute. there are good reasons to believe we

could see prolonged shortages of many goods, including disposable ppe's

such as masks, gloves, and gowns.

pandemic issues for home health providers - pt 3

http://afludiary.blogspot.com/2008/07/pandemic-issues-for-home-health_13.html

surveys indicate that a significant number of health care workers may

be unwilling to report to work during an infectious disease-related

emergency.

the new york city survey cited above indicated that less than half (48

percent) of the workers would be willing to report to work during an

infectious disease outbreak...

the most commonly cited reasons that workers gave for not being willing

to respond to an emergency included fear and concern for their own and

their families' health and well-being (31.1 percent and 47.1 percent

respectively).

[indigo girl]

Booster vaccination may help with possible future avian influenza pandemic

http://www.eurekalert.org/pub_releases/2008-07/idso-bvm071608.php

New evidence suggests that a booster vaccination against H5N1 avian

influenza given years after initial vaccination with a different strain

may prove useful in controlling a potential future pandemic. The study

is published in the August 1 issue of The Journal of Infectious Diseases, now

available online.

...as the virus continues to mutate into genetically distinct lineages, or clades,

the problem arises as to whether vaccines based on an older clade will be

effective against newer versions. The new study is the first to report that

giving one dose of a newer-clade vaccine to those who were vaccinated

previously with older versions is more effective than giving only doses of the

newer vaccine to unvaccinated subjects.

The results not only support the booster technique, but also show that even

though the virus had mutated since the initial vaccination, using it to boost

an earlier vaccine is more effective than simply vaccinating subjects with the

most current vaccine. These findings are important given the fact that

influenza viruses are mutating constantly.

"These results suggest that one strategy for pandemic control could

involve prevaccination of some segments of the population prior to the

emergence of a pandemic so that effective protection could be achieved

with a single dose schedule if and when a pandemic emerges," the

authors wrote.

In an accompanying editorial, Gregory A. Poland, MD, of the Mayo Clinic

College of Medicine, noted that some are already looking to begin such

prevaccination primers against H5N1 influenza. For example, Japan is

planning to immunize health care workers starting in 2009, and the U.S.

Department of Defense is offering a vaccine to those in high risk

specialties.

"determining who should receive these vaccines, when, and in what

order and under what circumstances deserves widespread debate,"

As of mid-June, 60 percent of the more than 380 human cases have

been fatal, and half a billion birds have died or been culled to prevent the

spread of the disease.

(hat tip flutrackers/ironorehopper)

[indigo girl]

HHS Guidance on Allocating And Targeting Pandemic Influenza Vaccine

Please understand, once a pandemic is declared, they are saying that it

will take 20 weeks for a vaccine targeted to the specific flu strain occurring to

be ready to roll. That's 5 months to begin vaccinating the available amounts

of vaccine going first to the most at risk population which is prioritized by

factors such as age, occupation, pregnancy, and this is modern medicine

at its finest which is why we should be concerned.

http://afludiary.blogspot.com/2008/07/hhs-guidance-on-allocating-and.html

Today we have the long-awaited release of the HHS's (Dept. Health and

Human Services) guidance on pandemic vaccine allocation called

Guidance on Allocating and Targeting Pandemic Influenza Vaccine.

...a targeted pandemic vaccine won't begin rolling off the production lines

for 20 weeks, and then, only in limited quantities.

... the availability of a strain specific vaccine for a pandemic will be extremely

limited during the first six months, and possibly longer, into a pandemic crisis.

Anytime you have to prioritize who will receive a potentially life-saving vaccine

first - and who will have to wait - there will controversy. No plan is likely to

please everyone.

[indigo girl]

Some State Preparedness Messages

Just looking at how some states have tried to prepare their citizens,

it becomes obvious that the next pandemic is not only expected, but that

there is real concern that it will not be mild as in 1957 or 1968. The very

fact that a highly virulent bird flu virus currently is present in birds on three

different continents, and that it has jumped species to infect mammals

including humans increases that risk.

Here is a video from California, a state that is at the forefront of the

preparedness effort. Human to human transmission of H5N1 was unknown

in 2006 hence the remarks that it had not happened yet. That has since

changed, and some suspect more frequently than is publicly acknowledged

as the existence of clusters of cases in places such as Indonesia and Pakistan

might indicate.

Secretary Leavitt of HHS is telling it like it is. Pandemics are part of our

biological history. They have always occurred, and they always will.

Nothing can change this fact, not modern science, not Big Pharma, and not

modern sanitation. Our only defense is to be prepared as best as we can.

http://www.youtube.com/watch?v=RXtmjTXm2Ng&feature=related

Will edgy messages be enough to get the public's attention as in the

PSAs mentioned in the following link?

http://afludiary.blogspot.com/2008/08/reaching-for-2x4.html

[indigo girl]

Florida pandemic flu drill dead-on with projections (so to speak)

http://tinyurl.com/5h3cp8

Commentary on a recent pandemic flu exercise in Florida from

Scott MacPherson, CIO of the Florida House of Representatives.

This exercise involved a case fatality ratio of only 2%. If it is

the H5N1 virus that we are hit with, it's current CFR is over 60%.

Something, unpleasant to consider, but should be kept in mind.

Exercises never use this figure...

...the issue of 16,000 new orphans arose during the simulation. How will

Florida cope with 16,000 new orphans? The answer was not forthcoming.

And that is fine for now: As long as the question is asked in a public

setting, the answer can come later. Just get someone thinking about that

and get back to him quickly.

Equally comforting in its bluntness was the estimate of 100,000 Floridians

dead from pandemic influenza. That is in line with HHS projections for a

2% case fatality rate. Eighteen million Floridians, at a 30% attack rate,

with a 2% CFR ..... right on line with the scenario. There was no attempt

to lower the CFR; no attempt at a happy ending.

Many eyes were opened during the exercise. According to the Miami

Herald, Governor Charlie Crist looked up at Fugate and asked, "Could this

really happen?"

Fugate's measured response: ''Unfortunately, that's what science tells us.

Do we want this to happen? Pray it never does. But we have to ask, what

if it did?''

[indigo girl]

Updates in Pandemic Planning for Japan

http://afludiary.blogspot.com/2008/08/japan-health-ministry-seeks-major.html

In another sign that global concerns over a pandemic have not lessened,

Japan's Health Ministry is seeking nearly a 10-fold increase in their

pandemic budget for 2009.

Japan's government has been very proactive in pandemic preparedness,

acquiring antivirals and pre-pandemic vaccines, while the private sector

in Japan has been less inclined to prepare.

http://afludiary.blogspot.com/2008/08/japan-plan-to-add-3600-ventilators.html

Plan To Add 3,600 Ventilators in Japan

... at least part of that funding (2 Billion yen) would go towards increasing

the number of ventilators (or `respirators', as this article calls them) in

medical districts around that nation.

[indigo girl]

Uncovering Influenza's Achilles Heel

http://afludiary.blogspot.com/2008/08/uncovering-influenza-achilles-heel.html

Basic research is where it's at. Some day in the not too distant

future, this research will pay off. I hope it is sooner rather than

later. We need to understand how influenza infects cells to

develop effective defense strategies against it.

This is a very important piece of work.

The researchers have determined the three-dimensional structure of a

site on an influenza A virus protein that binds to one of the human protein

targets, thereby suppressing a person's natural defenses to the infection

and paving the way for the virus to replicate efficiently. This so-called

NS1 virus protein is shared by all influenza A viruses isolated from

humans, including avian influenza, or bird flu, and the 1918 pandemic

influenza virus.

... the NS1 protein binds a human protein known as CPSF30, which is

important for protecting human cells from flu infection. Once bound to

NS1, the human protein can no longer generate molecules needed to

suppress flu virus replication.

[indigo girl]

Pandemic PPE for the Japanese HCW

First of all, I can not imagine working in this kind of get-up, but I

would wear it if I had it available and I were being exposed. And, second,

who is going to provide this? Not my hospital, since they already think

they've got everything under control for any eventuality. Running out of

O2? Not to worry, we will be resupplied by barges on our island fortress.

But what happens when the suppliers run out? No answer because the

planners have not considered it or maybe there is some other plan that

no one has mentioned...

Anyway, this is what Japan is doing for protective gear, and they are

also talking a lot about plans to inoculate staff with a prepandemic H5N1

vaccine so much so that it would appear that they are really going to do

follow through with these plans. This vaccine is in limited supply and is

based on an older strain of virus. No one knows if it will prevent infection

with the pandemic strain, whatever that may happen to be, but the thinking

is most likely that it will prevent mortality if not infection.

Quite a contrast between what is happening there and what is happening

here. Perhaps, actually knowing that bird flu has invaded in your country

more than once, and will most likely reappear again gives them the

necessary impetus to implement action in advance of a pandemic strain's

appearance. That, and the continued evolution of the H5N1 virus, as well

as the not so far away problem of Indonesia unremittingly hiding cases of

bird flu in humans though the last large outbreak scared even them enough

to call the WHO back in for help.

Sure, it's all based on a possible event, but history is full of these events

and there is no plausible reason to think that Mother Nature will stop

producing pandemic viruses no matter how sophisticated our modern

medical techniques and knowledge. We still can not prevent it from

happening though we are currently using many delaying tactics and

using our weapons effectively such as they are. Culling of sick or

potentially sick poultry, treatment of infected humans and use of the

Tamiflu blanket for those exposed to them or sick poultry, have been

successful thus far. We have had luck on our side when Tamiflu

resistant strains have occurred in that those strains have not been

more easily transmissible to humans yet. But, the very fact that this

resistance has occurred is why we should be thinking like the Japanese.

Human to human cases have occurred, and they will again because they

can. The concern is that some day, H5N1 will get it right, with a drug

resistant, easily transmissible strain,and then we will be dependent on

our mitigation strategies to protect our population with no vaccine, and

not enough of anything from PPE, to Tamiflu, beds, vents, O2, or even

antibiotics to treat the resulting cases of pneumonia. What are we

going to do then that we could have done now?

http://afludiary.blogspot.com/2008/09/what-well-dressed-hcw-will-be-wearing.html

[indigo girl]

The Downfall of Just in Time Delivery

http://afludiary.blogspot.com/2008/09/supply-chain-of-fools.html

One of the most effective voices urging that we take strong steps to

address supply chain issues during a pandemic- particularly for our

coal fired power generating facilities -is Dr. Michael Osterholm of CIDRAP.

He makes the case for other industries, including offshore

pharmaceutical manufacturing, PPE's, and other critical supplies as well.

If you have never listened to one of his presentations, I would urge you

to seek one out.

Next week Dr. Osterholm's presentation at the The Pandemic Threat:

Preparing an Organizational Response conference should be available online.

[indigo girl]

http://afludiary.blogspot.com/2008/09/reminder-hhs-telecast-on-personal.html

It is actually amazing that the govt is reaching out to give citizens

this information. Too bad they are not making more of an effort

to promote it. Hardly anyone will ever know that they are doing

this. If you really want to reach people, you have to be willing to

go the extra mile, and put the message where they can not help

but see it as in PSA's during prime time, bill boards, magazine ads...

Why not really do the job you say you are trying to do, which is to

educate? It kind of gives a mixed message when compared to what

they did to educate about AIDS or even to try to reduce cigarette

smoking. There is no question that the govt is serious about the

pandemic preparations to the tune of millions of dollars. They do know

that it is inevitable, just not how bad or when it will happen.

Contrasting what is happening here with what the Japanese are doing.

I best understand the difference in response by noting that Japan admits

to H5N1 outbreaks occurring in their country in the last few years. They

probably feel much more threatened because they are so much closer to

the problem. They know it is coming back, and they suspect that it is going

to be a serious problem at some point. The Koreans had a very difficult

time trying to stop it with the last outbreaks, and they are close by.

The latest in a series of PlanFirst Webcasts from the HHS is scheduled to

take place later this week, on September 25th, at 2pm EDT.

This month's broadcast will be on individual preparedness for a pandemic.

You may submit your questions via email prior to, and during the broadcast.