Disaster/Pandemic preparedness

Ayrman · Aug 17, 2007

It seems that the best we can do for now is prepare to protect ourselves. The logistics of vaccine production - assuming as noted above that the eggheads can come up with a workable formula in time - already make receipt of said vaccine a very iffy proposition before the virus itself strikes any of us. Granted we as healthcare workers here in the US would be farther up the line for vaccination than a village resident in far off Nepal owing to time and distance logistics if nothing else, but there is nothing to indicate that even frontline providers here have reason to expect vaccination (again assuming a workable formula is available) anytime before or even during the next flu season, or even the next one after, say 2008.

My hospital here has recently acquired an infectious disease specialist (doc), our first ever. A huge step in the right direction, recruiting him. But I have seen literally nothing done to prepare as far as planning or physical stocking of supplies, etc. There is no plan, and I'm not sure the pandemic committee - which my manager put me in for over 2 months ago - has ever met.

Personally I am taking my own steps to prepare for the possibility that I will have to care for family/friends outside the hospital. I recently "raided" a medical warehouse and came away with cases of isolation gowns, nitrile gloves, decent masks (0.1 micron filtration, not simple TB masks), Dispatch spray, disposable thermometers and more. I honestly have more for home use than my floor - 35 beds including 2 reverse isolation rooms - ever has stocked, and sometimes even has available from Supply.

Ayrman

indigo girl · Aug 21, 2007

Australia Testing New `Super' Adjuvant

http://afludiary.blogspot.com/2007/08/australia-testing-new-super-adjuvant.html

A standard formulated H5N1 vaccine, one without an adjuvant, requires a distressingly high amount of antigen to convey a decent level of protection to the recipient.
In some cases, it has required 12 times as much antigen for an H5N1 vaccine as is needed for a seasonal flu shot.
... their long-term side effects are largely unknown. There are some who fear that their widespread use could result in many cases of autoimmune diseases, like lupus, down the road.
... no serious side effects have been attributed to these adjuvants, although the incidence of `minor' side effects appears to be higher with the adjuvant.
It's a gamble, obviously, and a heck of a field experiment to give an experimental adjuvant enhanced vaccine to tens of millions of people during a pandemic.

Leader of the research team Director of Diabetes and Endocrinology Professor Nikolai Petrovsky says the sugar-based adjuvant is safe.
"Our data already shows our adjuvant enhances the immune response against the common flu virus and we expect it to work equally well for an avian (bird) flu vaccine," he said.
Head of Microbiology and Infectious Diseases Professor David Gordon said the addition of an adjuvant is critical for providing protection and conserving vaccine supplies in the event of a pandemic.

indigo girl · Aug 21, 2007

Thoughtful commentary from a new emergency preparedness blog on why we don't prepare for emergencies even though we know we should...

http://crisisready.blogspot.com/2007/08/two-cans-of-tomato-paste-and-some.html

The reality of the world we live in is the simple fact that disastrous events are increasing in frequency and severity. Most of us live in areas with known and significant hazards. The ethic of individual preparedness needs something new, perhaps the able hand of a truly world-class marketing firm. It needs to get modern, it needs multiple channels, it needs to stop sounding like something our Mom told us to do when we were kids and more like something everybody’s doing, it needs to get sticky, it needs to be more approachable, and it needs to appeal to various audiences. And somehow we have to take the fear out of it –because I suspect underneath all that denial is a measure of fear, a “weirdness factor”, that is grounded in the thought that if you think too much about emergency preparedness then you have to think about some pretty unpleasant stuff.

Don't think, just do. Go shopping. It's good for you.

indigo girl · Aug 23, 2007

Ontario

Ontario Hospitals to Stockpile N95 Masks

http://www.cbc.ca/canada/toronto/story/2007/08/23/nurses-safety.html

(hat tip pixie/PFI)

In a bid to protect Ontario's nurses from potentially life-threatening diseases like SARS and avian flu, the province will spend up to $55 million to stockpile N95 respirators, the Health Ministry announced Thursday.
The government will also make the use of safer needles mandatory in all hospitals starting Sept. 1, 2008.
The respirators — moulded masks frequently used in industrial workplaces — are designed to provide a higher level of respiratory protection for the wearer compared to looser-fitting, thinner surgical masks.
Nurses said wider use of the N95, which can be fitted to an individual's face, could have prevented their colleagues from getting sick when they became the front-line workers during the Toronto-area SARS outbreak in 2003.

Of course, had those nurses even realized that they might have been exposed, then they might have taken more precautions in the first place. I think part of the problem was that they did not even know that patients with SARS were on their units until it was too late.

More about SARS in case you have not read this:

https://allnurses.com/forums/2172920-post27.html

indigo girl · Aug 24, 2007

Effect of School Closures

New abstract discusses how much would closing schools reduce transmission during an influenza pandemic?

http://www.flutrackers.com/forum/showthread.php?t=33624

Abstract:
BACKGROUND: When deciding whether to close schools during an influenza pandemic, authorities must weigh the likely benefits against the expected social disruption.

indigo girl · Sep 3, 2007

Just wanted to mention a book by two Canadian physicians, who experienced

the SARS outbreak:

The Flu Pandemic and You: A Canadian Guide (Paperback)

by Vincent Lam (Author), Colin Dr Lee (Author), Margaret Atwood (Foreword)

I was reminded of this book because I noticed that Dr. Lam has just authored another book, a fictional work that I am not going to mention because you can easily look it up.

About The Flu Pandemic and You, from an editorial description:

An essential survival guide - both to pandemic influenza, and to the hype surrounding it.

Written by an emergency physician and a public health physician, The Flu Pandemic and You is a frank and clear book about how to prepare for the next influenza pandemic, and how to understand the broader context in which the threat exists.

With cool heads and great professional expertise, the authors describe the history of influenza pandemics, the scientific reasons for the current health concern, the effects a pandemic would have, and the steps governments are likely to take when, not if, it hits. Drs. Lam and Lee carefully explain how readers can assess their level of risk, and set out practical advice on how an individual can prepare for a pandemic and maximize their chances of living through it. They draw on the latest evidence and their experience of the SARS outbreak of 2003. The Flu Pandemic and You develops a lucid framework to help people respond to the latest news stories about avian flu, and understand the current media anxiety about influenza in the context of the risks we all face in our daily lives.

indigo girl · Sep 9, 2007

Prioritization Strategies for Pandemic Influenza Vaccine

http://www.flutrackers.com/forum/showpost.php?p=99678&postcount=1

... it is expected that pandemic influenza vaccine production can only start once the pandemic virus has been recognized. Therefore, pandemic vaccine capacity will be limited at least during the first phase of an influenza pandemic, requiring vaccine prioritization strategies. WHO recommends developing preliminary priorities for pandemic vaccine use. The goal of this review is to provide a thorough overview of pandemic vaccine prioritization concepts in the 27 European Union (EU) member states and the four non-EU countries of the Global Health Security Action Group.
Most common reported vaccine priority groups were health care workers (HCW) (100%), essential service providers (ESP) (92%) and high risk individuals (HRI) (92%). Ranking of at least one vaccine priority group was done by 17 (65%) of 26 countries. Fifteen (88%) of these 17 countries including a ranking strategy, decided that HCW with close contact to influenza patients should be vaccinated first; in most countries followed and/or ranked equally by ESP and subsequently HRI.
... In most public plans the criteria by which prioritized groups are identified are not easily recognizable. Clarity however, may be necessary to assure public acceptability of the prioritization.

woody62, RN · Sep 9, 2007

Personally I am taking my own steps to prepare for the possibility that I will have to care for family/friends outside the hospital. I recently "raided" a medical warehouse and came away with cases of isolation gowns, nitrile gloves, decent masks (0.1 micron filtration, not simple TB masks), Dispatch spray, disposable thermometers and more. I honestly have more for home use than my floor - 35 beds including 2 reverse isolation rooms - ever has stocked, and sometimes even has available from Supply.

Ayrman

While I understand what you have done, wouldn't the owner of that medical warehouse consider what you did as theft of his supplies?

indigo girl · Sep 9, 2007

The Rehydration Solution

http://afludiary.blogspot.com/2007/09/rehydration-solution.html

Dehydration, and severe diarrheal disease, particularly among children in the third world, is a massive killer. Recognizing this threat, more than 25 years ago the WHO (World Health Organization) came up with what is now called ORS, or an Oral Rehydration Solution.
In a Flu Pandemic, the need for ORS will be great throughout the world. In western societies, where modern medical care is common, IV's are generally used instead of ORS. There are economic and psychological reasons for this, although many doctors argue that ORS would be just as effective for the majority of patients.
Dehydration, from a prolonged bout of flu; with it's fever, vomiting, and diarrhea, can easily kill patients that might have otherwise survived the virus. As IV's may well be in short supply, or simply unavailable during a pandemic, the use of ORS may well be the most beneficial treatment that most patients can receive. Certainly, with home care being the most likely venue for most patients, ORS will play a large role in the treatment of pandemic flu.

indigo girl · Sep 9, 2007

Personally I am taking my own steps to prepare for the possibility that I will have to care for family/friends outside the hospital. I recently "raided" a medical warehouse and came away with cases of isolation gowns, nitrile gloves, decent masks (0.1 micron filtration, not simple TB masks), Dispatch spray, disposable thermometers and more. I honestly have more for home use than my floor - 35 beds including 2 reverse isolation rooms - ever has stocked, and sometimes even has available from Supply.
Ayrman
While I understand what you have done, wouldn't the owner of that medical warehouse consider what you did as theft of his supplies?

woody,

I happen to know that this poster makes frequent buying trips where supplies are available. Please do not assume that anything was obtained illegally. I feel very uncomfortable that anyone on any thread, but especially this one, would be accused of any wrongdoing. Thank you for understanding.

Ayrman · Sep 9, 2007

"Raided" is wry term in this case. I make buying trips to this place. Some items I sell, others I stock away for my own use. I have a relationship established with them going back 10+ years so they are willing to sell to me in less than case lots.

Ayrman

indigo girl · Sep 11, 2007

GAO Report to Congressional Requesters

http://afludiary.blogspot.com/2007/09/flaw-in-ointment.html

I almost did not bother to look at this federal document. Thankfully,

Fla Medic has done an excellent job of distilling the information, and

that inspired me to brave yet another govt document. I was glad that

I did. Probably everyone should have a look for themselves because

what is in that document most likely will have an impact on your wellbeing.

I have looked at many of the state pandemic flu plans, for myself. I have

to agree that many of those plans are very nebulous. You are left guessing

as to how they will implement some of what is down on paper. They are

surprisingly short on the details. There was so much left unsaid, that I was,

indeed left with the feeling that they were just doing what the

feds said that they had to do, that they would be waiting for someone up the

chain of command to tell them how to do it...

Where does that leave us?

The variance between state plans, with some states planning for a repeat of the mild 1957 pandemic, while others are gearing up to face a 1918 style disaster, shows how little leadership there's been on the Federal level. At a minimum, you'd think the states would all be planning for the same level of disaster.
Many of these plans have sizable gaps in them, where they state that authorities should plan to deal with various crises, yet fail to indicate how they should do so.

A prime example of `and then a miracle happens', is the admission that hospitals will be quickly overrun, and that ad hoc flu facilities must be established in schools or civic centers. Exactly who will man these facilities, and where they will get their medical supplies, is generally left unsaid.

Here is the document:

http://www.gao.gov/new.items/d07781.pdf