Disaster/Pandemic preparedness

indigo girl · Jun 4, 2007

What do you tell your school board when it asks about avian flu readiness?

http://www.newfluwiki2.com/upload/Avian%20School%20Prep.pdf

(hat tip fluwiki/DemfromCT)

Connie Harden, J.D., is a principal and legal consultant in the San Francisco office of Mercer Human Resource Consulting, Inc. She has 25 years of experience as an employee benefits attorney and consultant, working to help ensure her clients' compliance with federal and state rules applicable in the design and operation of their employee benefit plans.

The purpose of this material is not to frighten; rather it is to promote thoughtful action. Preparation need not be expensive; leadership and information are the primary ingredients of success. Simple measures such as educating staff and parent groups, cooperating with public health authorities, and purchasing inexpensive supplies can have a significant impact.

Scientists agree that we cannot know when the next pandemic will strike, but they are sure that one will occur at some time. Furthermore, given the spread of the H5N1 virus to date, as well as its pathogenicity and virulence in birds, we may be closer to a pandemic than at any time in several decades.
Scientists have described H5N1 as the most highly pathogenic virus they have ever encountered.
Health care systems would be severely affected by both the illness of their own employees and dramatically increased demand for services. In addition, changes in our public and private health care system over the past 20 years have greatly reduced the surge capacity of hospitals, and we have an inadequate reserve of critically important equipment and facilities such as respirators and intensive care beds. Public health authorities readily acknowledge these issues and expect to use school auditoriums and other such facilities to care for the ill, as occurred during the 1918 pandemic.

I keep hearing that we will be taking care of patients in armories and school auditoriums. That is what the state panflu plans are saying also.

indigo girl · Jun 4, 2007

Hospital Pandemic Influenza Planning Check List:

http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf

(hat tip flutrackers/florida1)

Planning for pandemic influenza is critical for ensuring a sustainable healthcare response. The Centers for Disease Control and Prevention (CDC), with input from other Federal partners, have developed this checklist to help hospitals assess and improve their preparedness for respondingto pandemic influenza. Because of differences among hospitals (e.g., characteristics of the patient population, size of the hospital/community, scope of services), each hospital will need to adapt this checklist to meet its unique needs and circumstances.

This checklist should be used as one of several tools for evaluating current plans or in developing a comprehensive pandemic influenza plan. Additional information can be found at http://www.pandemicflu.gov. An effective plan will incorporate information from state, regional, tribal and local health departments, emergency management agencies/authorities, hospital associations and suppliers of resources. In addition, hospitals should ensure that their pandemic influenza plans comply with applicable state and federal regulations and with standards set by accreditation organizations, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Comprehensive pandemic influenza planning can also help facilities plan for other emergency situations.

Is your hospital doing any of this????

indigo girl · Jun 7, 2007

Recently, the Agency for Healthcare Research and Quality, the R&D arm of HHS, looked at the issue of all hazards and pandemic response in the face of a serious HCW shortage, specifically, not enough respiratory therapists to provide ventilator care in a pandemic. The value of mechanical ventilation in H5N1 illness is being hotly debated presently, but the reality of respiratory illness in bio terrorism and nature is a concern, none the less. AHRQ contracted with a group in Colorado to develop a program for "extenders", to be used in a "readiness" or "just in time" format. The material is very basic. Any feedback is welcome. The report, posted here, does not include the training program, 6 part DVD.

rrteacher :: Project Xtreme

To receive a copy of the Program DVD and a report/guidance document, e-mail;

[email protected]

and request;

AHRQ Publication No. 07-0017

indigo girl · Jun 25, 2007

Pandemic Influenza - A Citizen's Guide

http://afludiary.blogspot.com/2007/06/pandemic-influenza-citizen-guide.html

...a pdf file you can download from the Internet with clear, concise information for everyone on how to prepare for a pandemic. It has been issued under the creative commons distribution license, which means you can freely distribute it (with attribution).
This guide contains a forward by Dr David L. Heymann of the WHO, and contains a good deal of basic flu care information, courtesy of Dr. Grattan Woodson. It runs about 60 pages.

Thanks, FlaMedic because people need this information.

indigo girl · Jun 28, 2007

A discussion on prepping for 2 weeks versus 3 months can be found at this link:

http://www.flutrackers.com/forum/showthread.php?t=27993

Personally, I think that this is a no brainer, but everyone has issues. I just want for my family to have the simple security that having enough food put by can provide.

If there is a natural disaster, or some other catastrophic event, we will not have to

rely on outside assistance.

indigo girl · Jul 3, 2007

FDA approves Roche's low dose Tamiflu for children:

http://www.flutrackers.com/forum/showpost.php?p=89034&postcount=1

The U.S. Food and Drug Administration approved Tamiflu capsules for sale at 30 milligram and 45 mg doses for the treatment and prevention of influenza types A and B in patients one year and older, Roche said.
The shelf life of the capsules is five years, the company said, considerably longer than that of the 24-month shelf life of the standard liquid suspension formulation.
Many countries are stockpiling the anti-viral drug with the hope that it will be able to lessen the effects of an influenza pandemic if and when one strikes.
The 30 mg and 45 mg capsules will be available nationwide and for government stockpiling in time for the 2007-2008 flu season, Roche said.

indigo girl · Jul 6, 2007

Reprinted with permission from the editors of Effect Measure

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.

Alexandria thinks ahead

Category: Bird flu • Pandemic preparedness

Posted on: July 5, 2007 7:56 AM, by revere

There was a story about prepping for a pandemic in the Washington Post a couple of weeks ago I made note of but didn't get to commenting on. Now's my chance.

When Alexandrians opened their June FYI newsletter, out slipped a slick brochure with a photo of a stern-faced crowd staring out from the cover. "Be Ready, Alexandria!" the boldface type warned, "For a Pandemic Flu Outbreak."

[snip]

"We must take this risk very seriously," Mayor William D. Euille said in an interview. "If a pandemic were to occur, we are going to have a lot of people infected. People are going to die. Some people are going to have to be quarantined. Events are going to have to be canceled. Schools are going to have to be closed. It's a serious state of affairs.

"Rather than wait until something happens and be reactive, my position is to be proactive," he said.

So seriously have Euille and city leaders taken the threat of a flu pandemic that they have gathered representatives from government, business, hospitals, churches, nonprofit groups and other organizations for meetings. They have been meeting since November 2005 to figure out how to respond to an outbreak. Eight work groups are considering such matters as how government would continue to function, where emergency health stations could be set up, how to keep the supply of groceries flowing and, most soberly, finding warehouse space for bodies should fatalities overwhelm local mortuaries.

[snip]

The main message to residents is this: If the worst happens, you have to be able to fend for yourself. Wash your hands. Stay home if you have flu symptoms, unless the situation becomes dire. Don't expect grocery stores to have as much food as usual or restaurants to be serving. Have medicines and a supply of water and canned and dry food on hand.

"People are going to need to do some of this themselves," said John Clizbe, emergency planner for the city's Health Department. "There isn't anything that the government or the private sector can do to assure people that everything is going to be like it normally is, because it won't be.

"The important message in that brochure is, people need to start thinking how they are going to be accountable for some of their own health care," he said. "There are things people are going to have to do differently if a pandemic comes." (WaPo)

This is a long article with much I wish to comment on, but let's start with the pull quote, above. First it must be said, planning and thinking ahead is the right thing to do. Taking the risk seriously, even if the risk is small, is also the right thing to do because it is a high consequence event. I don't see anyone in Alexandria panicking or unduly frightened. I see a city government doing what it is supposed to be doing.

I am more hesitant about the projected notion there are only two possibilities: the health care system and government take care of you or you are on your own. There is a lot of room between these two extremes. A third alternative is that we work to take care of each other. A description of the eight working groups the mayor has set up -- groups such as one that looks at government continuity of operations in the face of widespread absenteeism or the one looking at how isolation and quarantine would work, show none explicitly oriented to the organization and efficient use of volunteers, the organization of non-governmental groups or similar techniques to promote community resilience and cohesion. I am sure this is part of the discussion in one or more of the working groups. I'd like to see it as a front and center objective.

Some of the groups are also of dubious value, or worse, for example the isolation and quarantine working group.

Another working group is studying how isolation and quarantines would work. How would a mandatory quarantine work? (It wouldn't, Clizbe said. At least not once the numbers became overwhelming or the deputies guarding the houses got sick.)

So some people get it. The mayor apparently doesn't. The distinction between quarantine and isolation -- quarantine the explicit segregation of people who are well but possibly exposed, isolation the segregation of the sick -- is not just terminology but of practical significance. Quarantine won't work. Isolation will be relatively easy. We are past time when these two terms should be confused.

There is a lot government can do in advance of a pandemic event, even if its active role during a pandemic will be reduced because of general absenteeism. So what Alexandria is doing is good.

But there is room for improvement and clearer thinking. Most importantly, there is a need to get citizens involved. Some of them are no doubt already way ahead of their leaders.

--------------------------------------------------------------------------------------

We have to change the message about it being OK to come to work when we are

sick. It is not OK. This is the article from the Washington Post:

http://www.washingtonpost.com/wp-dyn/content/article/2007/06/13/AR2007061300662.html

One group is studying how to effectively communicate before and during a pandemic. "There is that tone in our culture that encourages people to go to work if they're sick. People have the feeling that they're invaluable or are a martyr," Clizbe said. "One thing we're trying to encourage in our communication is: If you're sick, stay at home." And that goes for businesses and the expectations they communicate to employees as well, he said.

indigo girl · Jul 7, 2007

Influenza Pandemic

Preparation and Response:

A Citizen's Guide

http://www.newfluwiki2.com/upload/Citizen's%20Guide%20-%20Version%201.2.pdf

indigo girl · Jul 9, 2007

From Effect Measure with permission of the editors:

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.

Local pandemic flu hotline: selling a good idea

Category: Bird flu * Pandemic preparedness * Public health preparedness

Posted on: July 9, 2007 7:14 AM, by revere

CIDRAP had an interesting story about some Stanford undergraduates who designed a local pandemic flu hotline staffed by home-based volunteers. The idea emerged from a course in innovation and "entrepreneurship." The course was designed to teach students the rudiments of taking an idea of social utility and getting it implemented and they are fairly common. They give students a perspective on the many steps and obstacles between a good idea and a good product in the real world. But I sometimes wonder if they teach the right things.

First the idea:

The classes aim to teach students methods of innovation and the art of social entrepreneurship and to develop their technical, leadership, team, and presentation skills. The student's professor, William Behrman, elected to work on innovations for a pandemic after consulting with public health experts; the students knew the course's theme when they signed up.

On completing the class, the four students published a report on their work, titled "Social Innovation and Entrepreneurship: Saving Lives in the Next Pandemic." Other groups of students developed plans for two other projects: (1) an Internet site or home page with local, timely pandemic information and (2) a public school curriculum to educate children and parents and develop "community resiliency" by fostering and mobilizing community support networks.

According to the students' report on the pandemic hotline, people calling in would be greeted by an automated message asking for their language preference and the reason for the call. Emergency calls could be routed directly to experts, bypassing the volunteer, who would have general knowledge.

The caller would then be routed to a volunteer for help. The volunteer would use a computer program to obtain local pandemic information on the Internet by typing in the caller's zip code. Callers could obtain information on such topics as hygiene, local school closures, and how to stay healthy during a pandemic. If the volunteer's Internet service went down?a possibility during a pandemic?calls would be routed to other volunteers. (CIDRAP)

Quite nice. If people are staying home, a system like this would , in essence, connect up home bound people with other home bound people who have a resource to help them. It's still just an idea. It needs to be fleshed out and software developed to implement and replicate it in local communities. But it's still a good and promising idea. So what's not to like?

Courses like this most often promote the idea that the best way, or even the only way, to make the fruits of your labors available to society is to commercialize it. Most scientists want to have their research make a difference in the world but they have been convinced by NIH, their professors and their colleagues this means patenting, licensing and selling it. That's "how it works" in the modern world. If you're not willing to get your hands dirty in the business world your idea/discovery/invention will remain an academic curiosity or be picked up by someone else who will profit from it in your place. Apparently this is the idea, here, too:

"We want to have a product with scripts, costs, and details of what technology is needed so an individual organization can set up a hotline within 2 weeks," she said. At this point it is not clear who will own and market the product, Skapinsky said, and that is something the team wants to determine this summer.

"We are hoping someone will take ownership of this after we do all the work," she said.

There are a couple of problems with this. While for many ideas, commercializing is the right strategy, it is not true for all of them, or perhaps not even for most of them. Some ideas are extremely good but not profitable. If it isn't profitable, you won't get someone to produce it. Or if they do, they often require an exclusive license, they then charge too much and the product will fail but it will be out of your control. The scientific world is full of examples of research examples of good work that was patented, licensed and then faded away because the barriers to use by others were too great. Plenty of bioinformatic software falls into that category. On the other hand there are also outstanding examples of ideas that were made available at no cost and are now in common use. The open source statistical package R is a good example. It rivals its competitors in features, flexibility, breadth of application and users.

For many products, and this sounds like one of them, the best way to have them used is to give them away, in this case, in the form of open source software others can use, develop and implement without restriction. If your interest is mainly to make a useful product for society and not to make a lot of money, many times the optimal route is not to commercialize it.

These Stanford students probably most likely just want to do a good thing for the world. They shouldn't believe the only way to do it is to find a company who will sell it. Make it and its source code available on the web. If it's good, it will be used.

indigo girl · Jul 10, 2007

This is the Washington State, Dept of Health's Pandemic Influenza site.

There is some very basic information here.

The video is excellent! It will take 22 minutes of your time, and was produced

in 2005 so the numbers of cases, countries involved and some info will not be

up to date. Nevertheless, this doctor does a great presentation.

http://www.doh.wa.gov/panflu/

indigo girl · Jul 21, 2007

Seriously looking for the ants amongst all those grasshoppers

http://birdflujourney.typepad.com/a_journey_through_the_wor/2007/07/biological-impe.html

Here's why the message can not be heard, and why no matter what information is being given, it will never make any difference to the outcome:

David Pollard's How to Save the World
The Coming Pandemic: What the Experts Say
July 12, 2007
1. Most people cannot be expected to plan ahead or prepare for it: It is not in our nature to plan for eventualities until and unless we are convinced they are virtually certain and imminent. We can send out all the information we want on emergency preparedness and emergency kits. Most people will ignore it until it is too late.
2. Public expectations of what government will do to prevent, mitigate and manage a pandemic are substantial, growing and largely unrealistic. This is another instance of the phenomenon of learned helplessness, and it's exacerbated by governments that are prone to overpromise things to assuage gullible voters. After Katrina, we should know better.

But we still keep on trying...

It's been an interesting journey. Thank you, Sophia Zoe for saying it so well.

Amazingly, intelligence has little to do with doing what is necessary.

indigo girl · Jul 21, 2007

http://afludiary.blogspot.com/2007/07/alabama-pandemic-drill.html

From Avian Flu Diary with permission from the author:

Saturday, July 21, 2007

Alabama Pandemic Drill

http://www.al.com/news/birminghamnews/index.ssf?/base/news/1185007621186400.xml&coll=2

# 998

Pandemic drills are fairly common, and not terribly newsworthy. This small notice in the The Birmingham News today caught my eye for a couple of reasons.

Drill will simulate flu pandemic

Saturday, July 21, 2007

The Alabama Department of Public Health has scheduled an exercise at Garrett Coliseum in Montgomery on Tuesday to simulate an outbreak of pandemic influenza. The one-day drill will simulate a situation in which large numbers of people become ill. Only the sickest patients will be sent to the hospital, and home care will be stressed. An alternative care site also will be set up to care for influenza patients who have no caregivers. Finally, the exercise will demonstrate the distribution of antiviral medications to priority groups.

The Montgomery City-County Emergency Management Agency, Alabama Hospital Association, Alabama Department of Public Safety, local hospitals, American Red Cross, volunteers and health department staff from the Anniston, Mobile, Montgomery and Selma regions are participating.

Readers of this blog are certainly acquainted with the idea that, during a pandemic, most people will never see the inside of a hospital. We have roughly 1 million hospital beds in the United States, 90% of which are occupied at any given time, and a pandemic could simultaneously sicken millions across the nation.

Even if hospitals could maintain their current staffing levels, something highly unlikely during a pandemic, the surge capacity simply isn't there to handle millions of flu cases. We haven't the beds, or the personnel.

At some point, even the sickest of the sick may be turned away from hospitals. Most people will have to ride out the flu at home, cared for by their loved ones or friends.

This hospital crisis will affect those without the flu as well. Anyone who needs hospital care, whether it be for a heart attack, stroke, cancer, or trauma will find that the level and availability of care will be less than during normal times. Elective procedures may be canceled, and lets face it, going to a hospital filled with sick and infectious people might not be the healthiest thing someone could do.

The second thing that caught my eye was the statement that antivirals would be handed out to `priority groups'.

Exactly what that means is unclear. But given the limited amount of antivirals we will have available, it isn't terribly surprising. Whether antivirals are dispensed based on severity of symptoms, or some other criteria, there won't be enough to hand out indiscriminately.

Some surprisingly blunt admissions are creeping into the reportage of late. The sort of things you'd only have read in a blog a year ago.

I wonder if anyone is paying attention?

posted by FLA_MEDIC @ 8

Nope, Fla Medic, for the most part, they are not. Even if they read it,

they will not do anything to help themselves.