Disaster/Pandemic preparedness

indigo girl · Apr 18, 2007

The Council on Foreign Relations held a live webcast last week on pandemic influenza.

The video made from that webcast is available now and is well worth your time:

Is the Bird Flu Threat Still Real, and Are We Prepared?

http://afludiary.blogspot.com/2007/04/video-are-we-prepared-for-bird-flu.html

indigo girl · Apr 19, 2007

Scottsdale, Az is one community involved in pandemic planning. Here is a link to an article addressing many of their concerns, and not all have been resolved. Virtually all communities will be dealing with the same issues:

http://www.linksforsolutions.org/digests/FluPrimer.pdf

Here is a video about their emergency pandemic preparedness system. I found the comments about the the Canadian HCW, and how many of them left healthcare in the aftermath of SARS to be very disturbing. What could have made a difference for them, and should we not be thinking about this before something happens?:

http://www.firstresponderproducts.com/homeland_security_news_media.php?articleid=26

indigo girl · Apr 19, 2007

Non-pharmaceutical Interventions (NPI)

http://afludiary.blogspot.com/2007/04/npi-long-and-short-of-it.html

The choice, it seems, is between a short pandemic wave, where we see a lot of infections (and deaths) over a relatively short time span, or a longer wave, with fewer weekly infections.
The total number of infections, and deaths, may not differ much in the end. But the impact on society, and the demands on services would be lower with a longer, less steep infection curve.

indigo girl · Apr 19, 2007

Director of Dept of Health in Hawaii is personally prepared.

http://www.curevents.com/vb/showpost.php?p=715269&postcount=57

Preparing now will help soften the blow, the experts say. And that doesn't just mean state agencies and businesses - that means you because the system may be too swamped to respond when you call 911 or need to get into the emergency room.
"In America we believe the healthcare system is accountable for every life and death," Fukino says. "In a pandemic, all dibs are off. The rules change.
"We need to be able to care for ourselves for a long enough period of time so we can muster our forces, otherwise we are in deep kimchee. We are sitting in the middle of the ocean; there is no cavalry coming in from the neighboring states."

No cavalry coming in for anybody anywhere.

indigo girl · Apr 21, 2007

WHO: Avian Flu Treatment Protocols

To have the most up to date information on what works, and what does not, physicians who have dealt with H5N1 are sharing data. Hopefully, we will all benefit from their collective experience:

http://afludiary.blogspot.com/2007/04/who-avian-flu-treatment-protocols.html

Since the last meeting in Hanoi, May 2005, eight new countries have reported human infections with avian influenza A(H5N1) viruses. Clinicians, epidemiologists, virologists and public health specialists from the countries with human cases, and experts in pulmonary medicine, critical care, and influenza attended the meeting to share their experiences.

Doubling the Tamiflu stockpile is being considered in the UK:

http://afludiary.blogspot.com/2007/04/uk-ministers-want-to-double-flu-drug.html

In terms of their Tamiflu Stockpile, the UK is far ahead of most countries, including the United States. They already have 15 million 10-pill courses, for a population of 60 million. That's enough, at the standard course, to treat 25% of their people.
The United States currently has enough to dispense to somewhat less than 10% of their citizens, and of course, many nations have very little at all. Complicating matters, there is doubt that a 10-pill course will prove adequate for treating the H5N1 virus.

indigo girl · Apr 21, 2007

The Numbers Game

Different communities are using wildly divergent numbers in their pandemic planning. On the positive side, at least they HAVE a plan. But, is there some reason why they can not consider that the actual death rate in Indonesia is over 70%, and that their planning should reflect this?

I will never be able to understand this disconnected thinking. If you are going to plan, get it right. Think about the characteristics of the current contenders, and always plan for it to be worse than you could imagine. Try to give us a safety net if you can, and plan for more. Emergency planning is never a waste of time, but they need to consider that it really could be worse than in 1918.

One other thing, can you imagine yourself helping to triage hugh numbers of frightened flu patients in these auditoriums? Picture yourself in an N95 mask in goggles surrounded by a sea of people ill with a disease that will kill some of them, accompanied by their family members who may be distraught with worry. It is hard to think of this, isn't it? But, that is exactly what these types of exercises are planning for in different communities around the world.

http://afludiary.blogspot.com/2007/04/numbers-game.html

indigo girl · Apr 21, 2007

Taking care of the dead is another necessary aspect of pandemic planning.

No one wants to face this, but we have to.

http://afludiary.blogspot.com/2007/04/new-zealand-operation-cruickshank.html

New Zealand

...Some bodies would not be able to be buried where families requested. Instead, they would have to go into a Government arranged plot. People who wished to be cremated may have to be buried, due to an expected shortage of medical professionals - two of whom are required to carry out a cremation.
Manning said there was no chance authorities would have to resort to mass graves.
Mitchell said legislative changes last year had enabled agencies "to streamline the process" of body disposal in a declared pandemic.

indigo girl · Apr 22, 2007

Pandemic Planning and the Blood Supply

http://www.aabb.org/documents/Programs_and_Services/Disaster_Response/fluplanning.pdf

(hat tip PFIF/nightowl)

PANDEMIC INFLUENZA PLANNING
Efforts to Ensure a Safe, Available Blood Supply

The blood community, under the auspices of AABB, has established the AABB
Interorganizational Task Force on Pandemic Influenza and the Blood Supply ... to help identify the issues raised by, and planning options available to respond to, the threat of pandemic influenza... The third section provides a
summary of recent communications between the task force and the federal government regarding the critical role blood may play in a pandemic and warranted government actions.
The task of preparing for an event as severe as the 1918 pandemic appears overwhelming, but the benefits will be manifold...
Blood Supply: The most useful framework for planning would seem to be a pandemic approaching the magnitude of the 1918 pandemic with clinical attack rates in the 25% to 35% range during the initial wave and high mortality. An additional 10% loss of both donors and staff can be anticipated due to the need to care for ill family and children in the event of school closures, or fear of workplaces and public venues. Current estimates for the first pandemic wave range from 8 to 17 weeks, and center on 12 weeks; the duration of waves could be shorter in individual communities. It is anticipated that there will be up to three waves, each separated by 12 weeks or more.

indigo girl · Apr 22, 2007

We all depend on our utility companies to provide 24/7 service. Here is a conference that some will be attending designed to educate those companies regarding the ability to function during a pandemic emergency. This is serious and necessary planning that we will all benefit from should the need arise.

https://www.euci.com/conferences/0507-pandemic-flu/index.php

https://www.euci.com/conferences/0507-pandemic-flu/agenda.php

(hat tip flutrackers/laidback al)

indigo girl · Apr 22, 2007

Medical care will be different during a pandemic. It may be hard to wrap your mind around, but you need to realize that our current standards of care will no longer be met. Here is some commentary and an article from Washington state regarding some of what you can expect to occur.

http://afludiary.blogspot.com/2007/04/washington-state-flu-would-overwhelm.html

The public should be prepared to care for many of the sick at home, he said, with only the sickest of the sick, such as those who need mechanical ventilators to help them breathe, being treated at hospitals.
"Everyone else, if we believe they could manage, we're going to try to keep them at home," he said.
This warning is just one of the steps that health officials, both here and throughout the Puget Sound region, are taking to try to prepare the public for a global flu epidemic.
These worldwide flu outbreaks have occurred periodically over the last 100 years, including the Spanish flu of 1918 and the Hong Kong flu of 1968-69.
This week, health officials will meet with newspaper, radio and television journalists in Seattle to discuss how a major flu pandemic could be detected and how health care workers and law enforcement agencies would react.
"Pandemics do happen," said Li-Vollmer, communication specialist for Public Health Seattle & King County.
Although the public may have become a little jaded about reports of health threats, "it's a very realistic possibility that it will happen in the near future, although we can't predict exactly when," she said.
Public services could be reduced or disrupted. "So people need to be prepared to stay at home for at least a week," she said.

They do expect of course, that waves of infection of approximately 12 weeks duration will most likely occur at 2 to 3 times in a year. If you are able to, you should take this into account in your planning. Having only one week's worth of supplies means that you will have to go out into the community to try to restock. There is no guarantee that stores will have what you need or that they will be open. There are also personal safety issues to consider. If you have children or pets, think of what you will need to put by for them, and aim for 3 months worth of goods if you can. You do not want to be out fighting with other desperate people for food or water in a flu infected community to keep your family fed. You might also consider buying masks and gloves.

indigo girl · Apr 23, 2007

ANA 2007 Quadrennial Policy Conference

Nursing Care in Life, Death, and Disasters

Functioning under a different and lesser standard of care is something that few of us have ever had to do. The ANA will face this timely issue in its conference addressing the different types of major disaster/emergencies that our nation may experience in the future.

Atlanta, Georgia

June 20 thru 22 2007

http://nursingworld.org/meetings/2007/quadpolicy/overview.htm

The American Nurses Association is hosting its inaugural quadrennial policy conference, Nursing Care in Life, Death and Disaster, on June 20-22, 2007, at the Hyatt Regency Atlanta, in Atlanta , Georgia . This conference 1) is dedicated to considering the significant health and disaster preparedness policy questions related to an altered standard of care that can result from a major natural or manmade disaster, 2) will inform nurses, policy makers, government and other disaster planners and responders regarding reconciliation of the professional, legal and regulatory conflicts of a diminished standard of care and 3) will promote better decision-making, all to improve possible patient outcomes and the quality of care provided during a major disaster.

(hat tip flutrackers/snowy owl)

indigo girl · Apr 25, 2007

This is really quite a fascinating study on the communities that successfully were able to decrease the numbers of people infected with influenza in 1918. It is amazing that they were actually as effective as they were.

It is an unfortunate fact that should our population become exposed again to a virulent novel virus as it was in 1918, we will have to resort to exactly the same type of measures to decrease infections and fatalities. Without an effective and targeted vaccine, and with scarce amounts of antivirals, there are simply no other options.

Notice the govt agency that commissioned this study. To view the story of each community, click on each place in the upper right hand corner.

http://www.med.umich.edu/medschool/chm/influenza/index.htm

The Center for the History of Medicine
The 1918-1920 Influenza Pandemic
Escape Community Digital Document Archive
In the summer of 2005, the Center for the History of Medicine at the University of Michigan Medical School was contacted by the Defense Threat Reduction Agency (DTRA) and asked to conduct research into and write a report on American communities that had experienced extremely low rates of influenza during the infamous 1918-1920 influenza pandemic [download a copy of the report]. A team of historians from the Center for the History of Medicine visited these communities to locate, assess, and collect available primary source material from libraries, archives, and other private and public holdings. We then undertook a historical evaluation of the non-pharmaceutical interventions (NPI) as employed by successful communities during the second wave (September-December 1918) of the pandemic.