Disturbing Statistic..

http://news.yahoo.com/s/ap/20090725/ap_on_he_me/us_med_swine_flu

This is what stood out for me from your link, DeepFriedRN:

"Hopefully, mitigation efforts will have a big impact on future cases," he said. Besides pushing flu shots, health officials might urge measures such as avoiding crowded places, handwashing, cough covering and timely use of medicines like Tamiflu.

When I think of mitigation strategies, I think of school closure first and foremost, and then prohibiting mass gatherings such temporary closures of movie theatres, sports events, dining in restraurants. Mexico, and to an extent Argentina have used this strategy in limited measures to slow down the viral spread of cases. You notice, that Skinner of CDC is not advocating this in his description of mitigation strategies. He relies soley on the future vaccine, and on Tamiflu though he knows full well that its days are numbered. The first few cases of Tamiflu resistance are already occurring. There will be more.

Some schools will close, at least temporarily as we have seen if only because some parents won't take chances once they hear of cases in their kids' schools. We have seen school districts restrict info to parents about what specific schools were having cases. Censoring this type of information creates mistrust, and rightfully so.

http://news.yahoo.com/s/ap/20090725/ap_on_he_me/us_med_swine_flu

This is what stood out for me from your link, DeepFriedRN:

When I think of mitigation strategies, I think of school closure first and foremost, and then prohibiting mass gatherings such temporary closures of movie theatres, sports events, dining in restraurants. Mexico, and to an extent Argentina have used this strategy in limited measures to slow down the viral spread of cases. You notice, that Skinner of CDC is not advocating this in his description of mitigation strategies. He relies soley on the future vaccine, and on Tamiflu though he knows full well that its days are numbered. The first few cases of Tamiflu resistance are already occurring. There will be more.

Some schools will close, at least temporarily as we have seen if only because some parents won't take chances once they hear of cases in their kids' schools. We have seen school districts restrict info to parents about what specific schools were having cases. Censoring this type of information creates mistrust, and rightfully so.

Agree totally. And I think we can safely assume that mass vaccinations will almost certainly not occur before flu season in the northern hemisphere is in full swing--perhaps not even before next year sometime. And there is also the problem of availability of the vaccine itself. Despite our country's contracts to purchase, how likely are the producing companies to send their product out of their own country if the virus gets more deadly/med resistant? That could be a big problem.

The exclusion of the measures you mention is definitely concerning, and it's my opinion that they are using the economy and the "inciting panic" excuses to avoid including mention of them in these releases. I don't feel like it's the best strategy though, because in general, the average citizen fails to take into consideration the havoc that could be created by mass amounts of the population all being sick at the same time. They mostly worry about whether or not the virus is deadly. Average Joe figures, "hey, TPTB say this isn't going to kill me, if I get sick I'll just go to the hospital, get some Tamiflu, etc."

There needs to be more education as to potential consequences of pandemic flu, and the social and communtiy implications of mass illness. The possibility of temporary closures of schools, social events, theaters, etc needs to be included in discussions of mitigation. At this point, I really believe officials need to step up and start laying this info on people. There will always be those that will not prepare, and those that will panic. But there are also a heck of a lot of people who would probably get prepared, and react rationally and do what was necessary, if they just had all the information. Considering the projections being given at this point as to the scope of the situation to come, it seems as though the sooner they start doing this, the better.

The single biggest problem will be the overwhelmed medical system. Three months ago steps could have been taken but it is to late now. The poor direct care nurses and doctors are going to be the ones in the line of fire when the public starts to realize they are not going to get treated.

Something that bothers me about the vaccination thing is this...In cases where such is limited for some reason, the focus is on getting it to the elderly, the ill, etc. But this flu strain seems to be more of a problem for the younger, the healthier. (Just like the 1918 strain)

Will vaccination efforts waste precious time if this proves to be true? Will we expend our efforts on the wrong groups while the virus spreads among the ones who aren't being given priority?

Something that bothers me about the vaccination thing is this...In cases where such is limited for some reason, the focus is on getting it to the elderly, the ill, etc. But this flu strain seems to be more of a problem for the younger, the healthier. (Just like the 1918 strain)

Will vaccination efforts waste precious time if this proves to be true? Will we expend our efforts on the wrong groups while the virus spreads among the ones who aren't being given priority?

Good point, however it is well known by now that the elderly are at the least risk. This is a pandemic virus. These viruses are skewed towards the young. The first to be vaccinated will likely be the HCW because we have to take care of everyone else.

Pregnant women are probably going to be vaccinated in the first groups. Also folks with health issues such as reactive airway disease, and the immuno-compromised would be amongst the first groups.

The elderly are likely to be last which is totally different from with seasonal flu because we are in a situation that is totally different from seasonal flu, despite what some are saying. This is very different.

The CDC is meeting today, July 29 on this very issue. There is likely going to be some press coming out on this shortly, and I wil post it as it becomes available. My friend, FlaMedic at Avian Flu Diary has been listening to the meetings that have been going on since 8 am. His email says that some are voicing concerns about releasing these vaccines without as much testing as there would normally be...

Anyway, soon we will be know what they decide.

I am reading that this vax will have thimerosol which may be problematic for some, and no adjuvants at this time which means two shots will be needed.

I don't believe the emergency departments will be able to handle the upcoming crisis. As a whole the ER has become the "primary medical provider" and "at your convienence clinic" for the nation. We are already at surge capacity. During the last wave of influenza, the system was so inundated with people it was a crisis in and of itself. Folks were coming in for the slightest symptoms (along w/ the 5 family members) along with the regular toe pains and pain med seekers. Many were sent in by their PMDs!!!! Lord knows how many people were exposed to these sick people.

People (patients and family) would not follow isolation protocols. It was a waste of material and manpower!

Management thinks that just because the problem is addressed on paper, everything is "good to go", when in actuality, it was just short of chaos.

A radical approach (and it would never fly) would be to treat it as a HAZMAT situation-i.e. lock the doors and screen folks before getting in to the ER. Send people away with mild/moderate symptoms- w/ FLupacks (tylenol/motrin/cough syrup). Also we need to clamp down on the visitors. Perhaps only parents w/ children stay w/ patients, NO ON ELSE!

Sounds Draconian but I really think this is what needs to be done. Let folks in w/ other ailments. Set up a seperate area for those w/ symptoms that need further treatment. The main idea would be to keep the ERs operating as they normally would. Divert flulike symptoms patients elsewhere (home or a section of the hospital isolated away from others).

A media blitz needs to be done to educate folks not to come to the ER for simple symptoms. Also all ERs should be on the same page and provide the same treatment (the above mentioned scenerio, also make it known that Influenza swabs will not be done- many patients came in just to see if they had H1N1. If all ERs refuse to do it (except maybe on admitted patients only) then this would eliminate many of the visits. I know here in NJ people were driving from ER to ER to see which one would do influenza swabs on all patients!

-Also reinforce to PMDs not to send people to the ER. Do a little education over the phone! We've also become the "redheaded step child" for PMDs.

Not to sound like an alarmist, but something needs to be done, the present systems set up will not work!!!!!!!!!

I don't believe the emergency departments will be able to handle the upcoming crisis. As a whole the ER has become the "primary medical provider" and "at your convienence clinic" for the nation. We are already at surge capacity. During the last wave of influenza, the system was so inundated with people it was a crisis in and of itself. Folks were coming in for the slightest symptoms (along w/ the 5 family members) along with the regular toe pains and pain med seekers. Many were sent in by their PMDs!!!! Lord knows how many people were exposed to these sick people.

People (patients and family) would not follow isolation protocols. It was a waste of material and manpower!

Management thinks that just because the problem is addressed on paper, everything is "good to go", when in actuality, it was just short of chaos.

A radical approach (and it would never fly) would be to treat it as a HAZMAT situation-i.e. lock the doors and screen folks before getting in to the ER. Send people away with mild/moderate symptoms- w/ FLupacks (tylenol/motrin/cough syrup). Also we need to clamp down on the visitors. Perhaps only parents w/ children stay w/ patients, NO ON ELSE!

Sounds Draconian but I really think this is what needs to be done. Let folks in w/ other ailments. Set up a seperate area for those w/ symptoms that need further treatment. The main idea would be to keep the ERs operating as they normally would. Divert flulike symptoms patients elsewhere (home or a section of the hospital isolated away from others).

A media blitz needs to be done to educate folks not to come to the ER for simple symptoms. Also all ERs should be on the same page and provide the same treatment (the above mentioned scenerio, also make it known that Influenza swabs will not be done- many patients came in just to see if they had H1N1. If all ERs refuse to do it (except maybe on admitted patients only) then this would eliminate many of the visits. I know here in NJ people were driving from ER to ER to see which one would do influenza swabs on all patients!

-Also reinforce to PMDs not to send people to the ER. Do a little education over the phone! We've also become the "redheaded step child" for PMDs.

Not to sound like an alarmist, but something needs to be done, the present systems set up will not work!!!!!!!!!

I have been saying same thing for 2 or 3 months. I am so glad I am retired, a disaster is in the making here. WE MAY be able to get through this without a shut down of essencial services like gas, electric and food and water. However, you probably will go to places like Fast Food Joints and find them close 'cause they run on kid power and there will be times they have no staff. However, there is NO CHANCE of us getting though without the medical establishment going into complete meltdown. My sympathy to the bedside workers that will take the brunt of the public's unhappiness when they figure out they are not going to get medicine, they are not going to see a doctor.

I don't believe the emergency departments will be able to handle the upcoming crisis.

Not to sound like an alarmist, but something needs to be done, the present systems set up will not work!!!!!!!!!

You are not an alarmist. You are a realist. You get it. Now, what can we do to make this better?

Here is what they are doing in one place:

http://www.thecourier.co.uk/output/2009/07/29/newsstory13528460t0.asp

Other hospitals have tried triaging in the parking lot with tents. Could your facility do this? Having people outside of the ER in fresh air is better than having them inside passing virus to everyone else. Some places in NYC used tents last spring.

Phone hot lines help, as do PSA'S telling people what to come to the ER for, and what not to come for. Even mailings in some communities.

Somebody has to be figuring this out before the fall. We can not let everyone come to the ER therefore, we have to target the people that will do this with information before it happens. This is do-able, but we need to be making some noise about this issue like yesterday already.

Something that bothers me about the vaccination thing is this...In cases where such is limited for some reason, the focus is on getting it to the elderly, the ill, etc. But this flu strain seems to be more of a problem for the younger, the healthier. (Just like the 1918 strain)

Will vaccination efforts waste precious time if this proves to be true? Will we expend our efforts on the wrong groups while the virus spreads among the ones who aren't being given priority?

The CDC is recommending that pregnant women have the 2 vaccinations first, due to the tragic circumstances resulting when they become ill with H1N1, and then those with preexisting conditions, and after them, the HCWs and those between 6 and 64 years of age........ Clinics in supermarkets, "big box" stores, and pharmacies make vaccinations widely available. Since this vaccine isn't made in eggs, production is much faster, and those allergic to eggs can have it.

H1N1 is far from the one in the circumstances found with the 1918 epidemic, as there weren't antibiotics or antivirals, such as Tamiflu back then! The vaccine, and the above meds make this round entirely different, as there will still be some who don't want it, for various unlikely reasons, or just because they hate getting "shots". Using EMLA patches (by prescription) an hour before the injection, on the site most likely to be used (upper, distal arm) will help, with those people and children. It won't be entirely without mortality, as there will still be those in denial about their or their children's s/s.

There was no vaccine production in 1918 against their bug, and it remains to be seen, if mutations occur, how fast a vaccine can be prepared against it. That's what good reporting due to good documentation of the rate of illness is for........

So those of you nurses here (RNs and LPNs can give the shots in locations without pharmacists giving them, others can assist with crowd control, registration, etc.), if you want work, call some of the HH agencies involved. Maxim was doing it for years.......

I wonder, if the virus blows up big in the fall (it might not), if this could turn into the next public outrage like we saw after Hurricane Katrina.

Here's what I'm getting at: In a severe pandemic, we wouldn't have enough ventilators for the patients who need to be on vents. People would die. The public would be outraged that we knew a pandemic flu was coming, and there was little public health preparation for having enough ventilators and that the US government relied upon private hospitals to have enough ventilators on hand in the event of a pandemic flu. I know I'm lining up quite a few "ifs" here, but I could certainly see public outrage that would go on for years related to not having enough ventilators and relying on private hospitals to manage public health crises.

I wonder, if the virus blows up big in the fall (it might not), if this could turn into the next public outrage like we saw after Hurricane Katrina.

Here's what I'm getting at: In a severe pandemic, we wouldn't have enough ventilators for the patients who need to be on vents. People would die. The public would be outraged that we knew a pandemic flu was coming, and there was little public health preparation for having enough ventilators and that the US government relied upon private hospitals to have enough ventilators on hand in the event of a pandemic flu. I know I'm lining up quite a few "ifs" here, but I could certainly see public outrage that would go on for years related to not having enough ventilators and relying on private hospitals to manage public health crises.

You are reading my mind. No matter how mild the virus is the sheer number of cases will test the medical system. We have no NH like the UK to make centralized decisions. We are relying on a very decentralized system to do the right things. Some of them are so focused on their falling revenues that they have done nothing to get ready, they are laying off staff not hiring, they certainly are not buying equipment. Others have done a better job of preparing and are taking steps. It is very hit and miss. I think there could be a post Katrina like public back lash, very high probability of a lot of anger. In a normal flu season you would divert vents to the young from the old. It won't be that way. You will be asking, should the 6 year old get the vent, should the 10 year old or should the 12 year old. Which child will live, which child will die? What about these pregnant women, which one should get the vent? I am glad I am not the one to be making those decisions. People are going to be mad as hell and looking for someone to blame. After raking the bedside HCW over the coals their next target will be politicians and CEOs. The melt down is so close, possibly weeks, 2 months at most.