WHO raises swine flu pandemic alert to phase 5

gardenia1 · Apr 30, 2009

Here's a link to a memo CBS has: http://www.cbsnews.com/blogs/2009/04/28/politics/politicalhotsheet/entry4975598.shtml#addcomm As of now, quarantines can be enforced by $25,000 fine or 1 yr prison term. "A Defense Department planning document summarizing the military's contingency plan says the Pentagon is prepared to assist in "quarantining groups of people in order to minimize the spread of disease during an influenza pandemic" and aiding in "efforts to restore and maintain order." I don't want to be the nurse taking care of people being involuntarily quarantined by the Pentagon.

I work for a home health care agency, and so far they don't seem to be concerned about the flu. When I mention it, I get that glazed-over look from others. I thought one of our roles is to educate our patients and the public, not to mention being pro-active. There doesn't seem to be any sense of urgency regarding moving fast on this if it hits here, so I'm getting material gathered up on my own ahead of time so we will have it if we need it, even if nobody else seems to see the need to be prepared. Are you guys having that reaction too?

RedWeasel, RN · Apr 30, 2009

I have a coworker who is going to Mexico on Thursday....I just couldn't do it. I half hope the shut the border so she can't go. I worry about her! We heard on our floor tonight that there were 3 cases in my state that hadn't had any confirmed yet and a few others near us. I feel it would be smart to make all staff wear masks all the time--to prevent getting and spreading it before symptoms appear. It just makes sense. Plus why wait till it is widespread to shut down travel to other countries and borders. Isn't the idea prevention, not playing catch up? It is weird at the CDC they break down the numbers of confirmed per state. The largest numbers are Texas, NY and CA---all 'border' states to me in relation to the USA. It is only a matter of days for those numbers to climb as the influx rises in the states towards the center of the USA (if that makes sense-its late sorry).

libnat · Apr 30, 2009

Stopping travel for something like this now is rather pointless.

Even if it had been detected earlier you wouldn't contain it's spread forever and with an incubation period who knows who has it. Good hygiene and a vaccine seems the most sensible approach to infectious disease.

Valerie Salva, BSN, RN · Apr 30, 2009

I give up. Who?

:lol_hitti

Absolutely13 · Apr 30, 2009

Stopping travel for something like this now is rather pointless.
Even if it had been detected earlier you wouldn't contain it's spread forever and with an incubation period who knows who has it. Good hygiene and a vaccine seems the most sensible approach to infectious disease.

No vaccine has been developed yet and it appears to have spread to new locations by travel. Mutated strains are a big concern too.

indigo girl · Apr 30, 2009

I have a coworker who is going to Mexico on Thursday....I just couldn't do it. I half hope the shut the border so she can't go. I worry about her! We heard on our floor tonight that there were 3 cases in my state that hadn't had any confirmed yet and a few others near us. I feel it would be smart to make all staff wear masks all the time--to prevent getting and spreading it before symptoms appear. It just makes sense. Plus why wait till it is widespread to shut down travel to other countries and borders. Isn't the idea prevention, not playing catch up? It is weird at the CDC they break down the numbers of confirmed per state. The largest numbers are Texas, NY and CA---all 'border' states to me in relation to the USA. It is only a matter of days for those numbers to climb as the influx rises in the states towards the center of the USA (if that makes sense-its late sorry).

Here is the WHO briefing on the decision to go to Phase 5. They will never shut the borders or restrict the travel of people or goods.

It is too late for prevention. Expect Phase 6 within 2 weeks, imo. They said we are close to it.

http://www.who.int/mediacentre/multimedia/swineflupressbriefings/en/index.html

libnat · Apr 30, 2009

they don't have the power to shut boarders even if they wanted to. sovereign nations and all that. besides it would kill the world economy.

Chewie_123 · Apr 30, 2009

http://www.who.int/csr/disease/avian_influenza/phase/en/index.html

Doesn't have a whole lot of info, but does go over the levels.

indigo girl · May 2, 2009

H1N1 Influenza 2009

http://flutracker.rhizalabs.com/

For an interactive map, please click on the map or go to this snapshot within Rhiza Insight, where you'll be able to access the raw data and make your own version of the map. Please excuse any performance issues, because of the popularity of this topic, our servers are getting hit quite a bit.

This map is a work in progress. I could not get it to work, but will try again later. Frankly, I do not think that they will be able to keep up with all the suspect cases, only confirmed which will be much less. Effect Measure does a better job of explaining about suspect and confirmed cases than I am able to do as they are public health officers.

http://scienceblogs.com/effectmeasure/2009/05/swine_flu_case_definitions_and.php

indigo girl · May 2, 2009

Exponential Growth: Swine Flu Probe Slowed by Backlog in Mexican Sample Testing

http://www.bloomberg.com/apps/news?pid=20601087&sid=aCq75QoLBuDo&refer=home

Swine flu samples caught in a laboratory backlog in Mexico are slowing the probe into the severity of the virus that’s sweeping across the world, experts including the World Health Organization’s Francesco Checchi say.
Mexico, the first country known to be hit by the new H1N1 flu strain that has reached 11 nations, has about 35,000 samples waiting to be analyzed, said Dick Thompson, a spokesman at the World Health Organization. Those samples, which experts say hold the key to understanding the virus, are held in a guarded laboratory surrounded by walls, gates and guards, that’s less than 4 miles from downtown Mexico City.
“While we know of a given number of confirmed swine flu deaths, we do not know by any means the actual number of swine influenza cases that have occurred in Mexico,” Checchi, a WHO epidemiologist, said in an April 28 e-mail. “It is extremely difficult to assess just how lethal the virus is in Mexico.”
The Canadian government said April 29 that it will test 200 patient samples to help get Mexico through the logjam. Canada has also given Mexico genetic analysis equipment that can pinpoint H1N1 in patients within a matter of hours, said Miguel Angel Lezana, director of the National Center of Epidemiologic Control in Mexico City. Scientists are working night and day on the effort, he said April 28 in an interview.
As testing ramps up, the number of people confirmed with swine flu is likely to jump into the thousands in the coming days to weeks, said Gustavo Reyes, laboratory chief at Mexico’s National Institute of Respiratory Diseases’ Center for the Investigation of Infectious Diseases in Mexico City. About 90 percent of suspected cases of swine flu, which now number about 2,500, will soon be confirmed, he said.
“Overall we had an almost exponential growth compared with two weeks ago,” he said in an interview yesterday.
Many cases may never be diagnosed, Reyes said. The new virus has a tendency to disappear from sputum five to seven days after infection, and people who arrive at the hospital later than that often can’t be sampled, he said.
General hospitals that treat Mexico’s poor routinely give antivirals to those with influenza symptoms and send them on their way without taking samples, Reyes said.
“It’s probable that we’ve been missing some cases,” he said. “The mild cases surely have been confused with a minor respiratory deficiency caused by other viruses.”
Mexico has just three laboratories with the level 3 biosafety rating required to do the precise testing to confirm swine flu, said Reyes, whose lab is one of them. Becton Dickinson and Co., the Franklin Lakes, New Jersey-based maker of medical devices, will donate equipment worth about $500,000 that will enable him to diagnose cases in hours, rather than the five or six days it took to send samples to the CDC for confirmation.
The Pan American Health Organization, a Washington-based division of the WHO, has an office of about 30 people in Mexico City and has sent at least 12 more scientists to Mexico to help trace and understand the virus, said Daniel Epstein, a spokesman.
CDC has lent five scientists to PAHO for the effort, said David Daigle, a spokesman for the Atlanta-based CDC.
Careful studies are needed to confirm which cases are caused by the H1N1 A strain, commonly known as swine flu, and which are linked to other viruses. Most of Mexico’s patients have been diagnosed only with rapid tests that can determine whether a patient has some form of flu, Lezana said.
On April 28, about 60 ambulances began fanning out in search of swine-flu infected people. Doctors and emergency medical technicians are giving antiviral medications, Roche Holding AG’s Tamiflu and GlaxoSmithKline Plc’s Relenza, to those who appear sick, and sending the worried well on their way.

indigo girl · May 2, 2009

CDC Guidelines on Pregnancy and Pandemic Flu

http://afludiary.blogspot.com/2009/05/cdc-guidelines-on-pregnancy-and.html

The CDC has spoken, and this is what they have to say about pregnant HCW. Healthcare facilites should take notice, and I am wondering if they will just say that PPE is adequate protection for everyone. If the CDC has written this guidance, they must not be certain that it is enough. I find these guidelines to be serious cause for concern.

http://www.cdc.gov/h1n1flu/guidance/pregnant-hcw-educators.htm

Health care workers treating patients with suspected or known illness easily transmitted by contact, droplet, or airborne transmission (e.g. influenza viruses) should do a risk assessment to determine the type of transmission-based precautions needed. Contact, droplet, or airborne precautions may be indicated (OSHA_pandemic_health.pdf, pages 16-17).
Pregnant women who will likely be in direct contact with patients with confirmed, probable, or suspected influenza A (H1N1) (e.g., a nurse, physician, or respiratory therapist caring for hospitalized patients), should consider reassignment to lower-risk activities, such as telephone triage.
If reassignment is not possible, pregnant women should avoid participating in procedures that may generate increased small-particle aerosols of respiratory secretions in patients with known or suspected influenza, including the following procedures:
* Endotracheal intubation
* Aerosolized or nebulized medication administration
* Diagnostic sputum induction
* Bronchoscopy
* Airway suctioning
* Positive pressure ventilation via face mask (e.g., BiPAP and CPAP)
* High-frequency oscillatory ventilation

indigo girl · May 2, 2009

Swine flu: the overreaction overreaction

http://scienceblogs.com/effectmeasure/2009/05/swine_flu_the_overreaction_ove.php#more

Laurie Garrett of the Council on Foreign Relations and a well-known authority on emerging infectious diseases was on PBS's Newshour last night and she made a very important but little appreciated point. Mexico has made a major national sacrifice for global public health by shutting down its country and interrupting transmission of disease. The cost to Mexico has already been enormous it will continue to pay in other ways.
There is some evidence from 1918 that cities that acted immediately to interrupt transmission by reducing opportunities for contact ("social distancing") did better than those that didn't. We would of course expect this on common sense grounds as well. That's what Mexico has done -- and I echo Laurie Garrett's point, they have done so at great cost to everyone's benefit. That is what is behind CDC's recommendations that a school be closed as soon as a case is confirmed. There is a cost to that, too.
The irony is that the overreaction backlash will be more severe the more successful the public health measures are. If, for example, the virus peters out this spring because transmission was interrupted long enough for environmental conditions (whatever they are) to tip the balance against viral spread, CDC and local health officials will be accused of over reacting.
If this virus does wane with the summer months (something we expect to happen), it's current mildness and its disappearance may lead citizens and decision makers back into the kind of reckless disregard of public health facts that has produced our current weak and brittle health infrastructure. But flu season will come again next fall, and it would be no scientific surprise if this strain is part of flu's repertoire. Most of the world would still be unprotected unless we spend the interim preparing for the possibility it will reappear in a more serious clinical form (flu viruses are notorious for that kind of change). When I say prepare, I am not just talking about a vaccine, although that will be an important, but difficult

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.