Disaster/Pandemic preparedness - page 18

I was looking the the other Disaster/Pandemic thread that Florida1 started. She mentioned that after the hurricanes, that they had problems getting basic supplies and food stores were often closed... Read More

  1. by   indigo girl
    San Francisco Archdiocese Pandemic Preparedness Plan

    The good news is that they recognize that there is a threat. The bad news
    is this plan is not realistic, and in actuality this plan will place many more
    kids and their families at risk. I hope that parents will pull their kids out
    of the schools at the first sign of a pandemic, and NOT let someone else
    make the decision of whether or not it is safe for their child to go to school.
    Having parents be proactive about this is critically important.


    Quote from http://www.catholic.org/diocese/diocese_story.php?id=26073

    At all levels of infection, infected children and staff are to stay home. If the level of infection rises above 30 percent of a school's population, the plan calls on principals to close the school and cancel all non-academic events.

    Part of the plan includes a series of letters to be distributed to parents at various stages of a hypothetical pandemic. These letters are meant to calm fears and give instructions as the outbreak runs its course.
  2. by   indigo girl
    Flu Pandemic Would Cost Hospitals Billions

    This essay is deeply disturbing. I hope that those who read it will understand
    exactly what is at risk, and why 1918 as bad as it was, may not be as bad as
    it could get. People really need to understand this because the cavalry is not
    coming to the rescue this time. We have to depend upon ourselves. This does
    not mean giving up because the task is too daunting. It means facing the
    reality of a worse case scenario so that we can plan for it individually and as
    a community. We are, in fact, a community, and as such we are powerful.


    Quote from birdflujourney.typepad.com/a_journey_through_the_wor/2007/12/pandemic-accoun.html

    Planning assumptions for a severe pandemic rarely account for anything worse than 1918. In fact, today is day two of a web dialogue on the US vaccine prioritization preliminary guidance, and the "PanFlu aware" who are participating are continually running up against the facilitators inability (or refusal) to step outside of the possibility that the next PanFlu could be worse, or even significantly worse, than the 1918 pandemic.

    This steadfastness is in the face of WHO findings, multiple scientific papers, notable experts, and just plain common sense given available facts.

    A human adapted H5N1 avian influenza is a "different beast" than the 1918 pandemic strain, which, via genetic reconstruction, was determined to have been wholly avian on a genetic level as well. We don't understand why H5N1 has such a frightful mortality rate, but just because we don't understand it doesn't make it not so.
  3. by   indigo girl
    Pandemic Crisis Simulation in Chicago

    If it is H5N1 that we are dealing with, it will be a crisis unless it loses
    some of its virulence.

    Trust for America's Health has been working with many organizations
    and meeting with stakeholders around the country to increase
    awareness and help train leaders.

    I wish that they would help train nurses as leaders also as we
    will be intimately involved should this come to pass.


    Quote from Chicago Tribune

    The effects of the computer-simulated flu pandemic kept getting worse and worse: highways and airports shut down, hospitals filled to capacity, pharmacies running out of medicine.

    As the consequences of the virtual disease became direr, public and private officials taking part in an emergency-response drill Thursday got a taste of the high-pressure decisions they would have to make should such a disaster happen in Chicago.

    About 100 employees of various city agencies and private businesses watched on projection screens as the officials decided how to respond to power outages, staffing shortages at police and fire departments and a lack of basic supplies at supermarkets.
  4. by   indigo girl
    Extrapolating the Unknown from What We Do Know

    Sophia Zoe does not call her essay by this title, but I think that it somewhat
    describes what she is trying to do. Do not read this if you do not want to
    think too deeply. She is discussing the possibility of a pandemic outbreak
    of H5N1, and whether the planning is realistic given what we know about
    pandemics and the H5N1 virus Case Fatality Rate (CFR).


    Quote from birdflujourney.typepad.com/a_journey_through_the_wor/2007/12/informed-seats.html

    In order to qualify as a Viral Tsunami, by my definition, an influenza pandemic would have to have a high Clinical Attack Rate (CAR) and a high Case Fatality Ratio (CFR), as well as encompass a single wave of illness. There is strong belief that the CAR will be between 30-35% of the population and CFR will be no worse than ~2.5%. Because there is strong belief in this scenario as the upper limit of potentials, those figures represent the worst case scenario in so many plans. In addition, I must say, there are many plans that use numbers lower than these as their "upper limits".

    CAR, a major component, utilizes a number known as R0, the basic reproduction number. From Wikipedia:

    In epidemiology, the basic reproduction number of an infection is the mean number of secondary cases a typical single infected case will cause in a population with no immunity to the disease in the absence of interventions to control the infection. It is often denoted R0. This metric is useful because it helps determine whether or not an infectious disease will spread through a population.

    If an infectious disease has an R0 of less than 1.0 it will burn itself out, if greater than 1 it will continue to spread if not mitigated. The UK PanFlu Framework assumes an R0 than they believe will range from somewhere between 1.4 and 2.2. It is useful to understand that at 2.0 cases will double every one or two days, at 4.0 they would quadruple, etc, on up the scale.

    The assumptions of 1.4 - 2.2 R0 are frightful enough, to say nothing of difficult to address. The same assumptions assume community mitigation measures will have a significant effect on the CAR and R0, a very reasonable assumption. Modeling suggests the dramatic difference between a local outbreak with and without mitigation:

    A lot rides on our plans, the actions we prepare ourselves to take, the plans our leaders civic and governmental leaders will institute on our behalf.

    What if planning assumptions are wrong?
  5. by   indigo girl
    From the Medical Journal of Australia

    A food “lifeboat”: food and nutrition considerations in the event of a pandemic or other catastrophe


    Quote from http://www.mja.com.au/public/issues/187_11_031207/hau10357_fm.html#intro

    Large catastrophes have caused the collapse of empires and civilisations.
    Science and knowledge may help prevent some catastrophes, but urbanisation and narrowly concentrated food supplies, climate change and terrorism contribute to considerable risk. Viruses responsible for severe acute respiratory syndrome (SARS) and avian influenza A (H5N1) or “bird flu” are among the most immediately identifiable risks. The World Health Organization has stated that the risk scenario associated with an outbreak of pandemic H5N1 influenza should be considered more serious than was previously assumed.

    Early self-isolation and social distancing measures are known to be highly effective. In the event of a lethal pandemic, emergency measures such as closing schools, staying home with family and friends, and avoiding contact with other people (until all have been immunised) will be instrumental in avoiding infection. People employed in essential services or occupations may be required to reside at their workplace for the whole period of the crisis. To achieve this type of isolation, sufficient food of adequate quality and quantity must be available.

    The Australian Government and the Australian Food and Grocery Council (AFGC) have been planning for such a scenario for several years and have advanced plans in place (Russell Neal, AFGC, Canberra, ACT, personal communication). Nonetheless, the logistics and practicalities of household food stockpiling should be given greater media coverage...
    Last edit by indigo girl on Dec 12, '07
  6. by   indigo girl
    Non-Pharmaceutical Interventions for Use During a Human Influenza Pandemic

    U.S. Department of Health and Human Services,
    Centers for Disease Control and Prevention
    U.S. Agency for International Development
    December 2007

    I am providing this link to Flutrackers because this govt document keeps
    disappearing for some reason. Sometimes it is there, and sometimes it
    isn't. Clearly, it used to be there!

    This is valuable information, and needs to be archived, and thankfully
    Flutrackers has done this.


    Quote from http://www.pandemicflu.gov/nonpharminterv.html

    Response to a human influenza pandemic should include a wide spectrum of medical and non-medical interventions at local, national, and international levels to reduce morbidity and mortality and to mitigate the socio-economic consequences. However, there is uncertainty about the potential effectiveness of pre-pandemic vaccines against the future specific influenza strain causing the pandemic. There is also concern about the amount of time that will be needed to develop, manufacture, and distribute a vaccine that would be specific to the pandemic strain.

    To help prepare the nations of the world for a possible global influenza pandemic, the U.S. Government is promoting the consideration of non-pharmaceutical interventions for use during an influenza pandemic, both domestically and internationally. We offer this condensed and adapted version of our national “community-mitigation guidance” – developed by the U.S. Centers for Disease Control and Prevention (CDC) within the U.S. Department of Health and Human Services (HHS),1 in accordance with recommendations of the Secretariat of the World Health Organization (WHO)2 – which provides information on key non-drug, non-vaccination measures that can mitigate the effects of disease during an influenza pandemic. We believe the core principles of community mitigation highlighted in this document are adaptable for use outside the United States – particularly in developing countries, which could suffer significant morbidity and mortality in the case of a human influenza pandemic. In addition, this document intends to articulate the principles in language the WHO can use to guide national and local governments as they create their own community-mitigation policies for a human influenza pandemic.
  7. by   indigo girl

    Quote from http://tinyurl.com/preview.php?num=2nzbym

    The World Health Organization warned Monday that countries should be on alert for bird flu because it is again on the move, with Pakistan reporting new infections and Myanmar logging its first human case.

    "The key to the public health response is surveillance," said Peter Cordingley, spokesman for the WHO Western Pacific region in Manila. "If we do actually get to the cases with antivirals early on, the health outcome is a lot better."

    The H5N1 virus often flares during the winter months. In some countries, like Indonesia, poultry outbreaks and human cases are reported year round, but many countries experience a flurry of activity when temperatures drop.

    "It starts to pop at this time of the year, not just in this region where it's endemic, but it starts to appear in the West," Cordingley said. "Between now and April is a very dangerous time of the year."
  8. by   indigo girl
    With permission from Effect Measure:

    WHO's pep talk and fighting bird flu
    Category: Bird flu * Birds * China * Pandemic preparedness * Public health preparedness * WHO
    Posted on: December 17, 2007 7:14 AM, by revere

    Quote from Revere

    With everyone on tenterhooks over the confusing outbreak of human
    bird flu cases in Pakistan and the first reported case in Burma (aka
    Myanmar), WHO is taking the opportunity to give its member nations
    a pep talk about swift reporting. Since there is evidence the reporting
    might not have been so terribly swift in that case, one must assume
    they consider this a "teachable moment" rather than an exemplar

    The World Health Organisation (WHO) on Sunday praised Asian countries
    for swiftly reporting the latest bird flu cases after Pakistan and Myanmar
    were hit by a resurgence of the disease. Asia-Pacific spokesman
    Peter Cordingley said prompt notification was helping keep the virus in
    check after Pakistan announced its first human death and Myanmar
    revealed its first human case.

    "People have learned that hiding cases just makes things worse,"
    Cordingley told AFP [Agence France Presse].

    This month China, which has previously been accused of withholding
    information, reported its 27th bird flu death and Indonesia, the worst
    hit country, reached 93.

    Outbreaks have also been reported among poultry in Germany and
    Russia as bird flu, which has killed more than 200 people worldwide
    since late 2003, re-emerges. (Agency France Presse)

    Getting countries to report promptly will remain a struggle. There are
    lots of reasons for delay, many of them specific to particular geographic
    regions, political realities and functioning infrastructure.
    In the Pakistan
    and Myanmar cases things could have been much worse but they could also
    have been better. Maybe it wouldn't have made a difference but the principle
    is clear and WHO is trying to punch it home. WHO has had its own
    credibility problems, of course. Maybe this is a good time to give them a pep
    talk, too
    . More transparency, please.

    But there is a curious coda to the WHO news story (a story WHO
    clearly wanted told, so we assume they also want this part told, too
    Cordingly observes that flu season was upon us, that birds got the flu,
    too, even before humans, and because of wild bird migration and human
    caused poultry movement (legal and illegal) bird flu will continue to
    spread unless ... unless what?

    "This virus will continue. We cannot fight it on a public health front, it
    depends on how farmyards and chickens are raised and that is a long-term
    fight," he said.

    What's the take home lesson here? What does it mean to say we
    "cannot fight it on the public health front"? Vaccines for humans and poultry
    are surely weapons on the public health front. More importantly, however,
    public health and social service systems are the public health front.
    I would think an essential message here would be that along with trying
    to stop a pandemic emerging from the current panzootic of avian
    influenza, an effort that is likely to fall short, we should be preparing
    for the consequences of a pandemic.

    That means turning our attention to the global, national and local public
    health front. Or am I missing something?
    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.
  9. by   indigo girl
    Failure to Participate Will Have Consequences


    Seven states have failed to purchase any of the federally subsidized
    antivirals, that are a hugh part of the nation's pandemic preparedness plan.

    The seven states that have declined to purchase tamiflu are: Colorado,
    Connecticut, Florida, Massachusetts, Mississippi, North Dakota and
    Rhode Island. On a personal note, I am working in Ct, living in RI, and I am
    moving to Florida. Am I surprised? No, but I can see that it is time for some
    phone calls to the press, and for holding govt and health departments
    accountable earlier rather than later.

    How does your state measure up to protecting its citizens?

    Quote from afludiary.blogspot.com/2007/12/what-we-have-here-is-failure-to.html

    The Trust For America's Health has issued it's fifth annual "Ready or Not? Protecting the Public's Health from Disease, Disasters, and Bioterrorism" report, and its findings are not encouraging.

    Among the key findings:

    Thirteen states do not have adequate plans to distribute emergency vaccines, antidotes, and medical supplies from the Strategic National Stockpile.

    Twenty-one states do not have statutes that allow for adequate liability protection for healthcare volunteers during emergencies.

    Twelve states do not have a disease surveillance system compatible with the Centers for Disease Control and Prevention's (CDC) National Electronic Disease Surveillance System.

    Seven states have not purchased any portion of their federally-subsidized or unsubsidized antivirals to use during a pandemic flu.

    Seven states and D.C. lack sufficient capabilities to test for biological threats.

  10. by   indigo girl
    From a newspaper in Georgia, some good advice, not enough advice maybe,
    but it's a start:


    Quote from www.macon.com/197/story/223637.html

    Authorities at the Division of Public Health and the North Central Health District of Georgia know all too well the danger of a widespread influenza pandemic and encourage all 13 counties in the district to be prepared for that possibility.

    Their mission is to work with local agencies, businesses, schools and churches to have a coordinated community plan in place to avoid the overwhelming effects such as those experienced in this country during the 1918 Spanish Flu Pandemic.

    Historically, pandemics - defined as epidemics over a widespread geographic area - have caught the world by surprise, giving communities little time to prepare for the abrupt increases in illness and even death that characterize these events and make them so disruptive.

    Currently the spread of the H5N1 avian influenza virus - often referred to as bird flu - is enhancing the worldwide warning. Circumstances have been unfolding in areas of Asia over the past year that make conditions favorable for another pandemic.

    Every household should have a disaster kit. Consider gathering the following items that would help in caring for someone with the flu: thermometer, disposable gloves, acetaminophen, ibuprofen, bleach, soap, tissues, paper towels, hand sanitizer, surgical masks for each member of the household, sugar, baking soda, salt and salt substitute.

    The final four items on the list are used to treat dehydration for someone over the age of 12. Combine 1 quart of water, teaspoon of baking soda, teaspoon of table salt, 3 to 4 tablespoons of sugar and teaspoon of salt substitute.

    Mix well and flavor with lemon juice or sugar-free Kool-Aid. The electrolytes in the solution will help reduce dehydration.
  11. by   indigo girl
    I should have posted this on New Year's Eve when it was written, but I was too
    worn out from lack of sleep. Hopefully, I will not be working nights much longer.

    Gratefully posted with the permission of the editors of Effect Measure.
    This is an excellent and thoughtful commentary given from
    experienced public health docs.

    The reformat was done to help simplify understanding:

    Pandemic influenza subtypes: end of the year musings
    Category: Bird flu * Birds * Epidemiology * Infectious disease * Pandemic preparedness * Public health preparedness * Surveillance * biology

    Quote from Revere

    Everyone seems to have an opinion about whether bird flu will be the next terrible global pandemic. In current parlance "bird flu" means human infection with the highly pathogenic avian influenza/A subtype H5N1. There is no doubt that this is the 800 pound gorilla in the global health room at the moment, but not because it is more likely to become a pandemic (NB: pandemic by definition is a globally dispersed sudden increase in infection among humans; the same situation for animals is called a panzootic, and it is plausible to say we have an H5N1 panzootic for birds now). On the basis of biology humans are potentially susceptible to influenza viruses, although only the H1, H2 and H3 subtypes circulate or have circulated in human populations. But a handful of human infections have also been reported from H5, H7, H9 and H10 subtypes, although except for H5 the infections have been relatively mild. Out of 103 cases of the non-H5 subtypes there has been only one fatality (H7N7, one fatality with 88 non-fatal cases), whereas the current official tally for H5N1 gives 213 deaths in 346 cases (61%). Which is why the H5N1 gorilla weighs 800 pounds. This influenza/A variant is a remarkably virulent virus. Is it the most likely virus to cause the next influenza pandemic?

    Recall the terminology here, as it makes distinctions that are important. A virus is pathogenic for a host if it is capable of infecting the host cell and cause disease in the host. So there are two criteria for pathogenicity: it can infect the cell; and the host organism gets a disease. This last criterion is vague. The "disease" state might range from very mild or hardly noticeable to fatal. The underlying idea is that the infection was in some sense parasitic, i.e., the virus reproduced itself with the host cell machinery at the expense of the host. That cost might be tiny or catastrophically large, but it wasn't neutral or beneficial (symbiotic). The degree to which the cost of the typical infection is on the serious side is the virulence of the virus. Virulent viruses are by definition pathogenic, but in addition they cause serious disease. By this terminology the H7, H9 and H10 are human pathogenic viruses that aren't very virulent (the most frequent disease symptom was conjunctivitis, "pink eye," in the Netherlands H7N7 outbreak of 89 cases).

    There is a bit of special usage in the flu world here, which we should also clear up.

    The avian version of H5N1 exists in two main forms that differ in virulence, called confusingly low pathogenic and high pathogenic.

    To be consistent with the terminology used in the rest of infectious disease epidemiology they are both pathogenic viruses, one of low virulence, the other of high virulence. The standard test for high path was to see if it killed chicks. These days it is more common to look at a genetic feature, the presence of extra basic amino acids at the cleavage site of the hemagglutinin protein.

    What bearing do these distinctions have on which of those influenza subtype is likely to become the next pandemic strain? None, really. They are all subtypes to which humans have had little prior exposure so there is no pre-existing immunity to the main antigen (the one designated "H"). It could also be a subtype not listed as having caused human infections, like an H6 or an H13. The thing that will decide whether a new subtype becomes pandemic, in addition, is whether it is easily passed from person to person, as is "ordinary" seasonal influenza (currently certain H2 H1 and H3 subtypes). This is still given by yet another term, transmissibility. On that list of non-H1 to H3 subtypes pathogenic for humans the most transmissible was H7N7, so on those grounds one might expect this to be the next pandemic. Why aren't we more worried about it? Because a pandemic of "pink eye" is not the same thing as a pandemic that has a 60%+ case fatality ratio (CFR), the way H5N1 does. For comparison, the horrendous 1918 flu had an estimated CFR of under 3%.

    All of these influenza subtypes mutate with ease. Most mutations are bad for the virus (in the sense that the mutated virus replicates less well than the unmutated version). So ease of mutation isn't going to tell us which is the next pandemic subtype. We also don't know the features that make an influenza virus easily transmissible. There are likely multiple combinations of features that can do this (i.e., many roads to the same end), but we don't know what they are. We don't know how these subtypes interact when they circulate simultaneously. For example, if another N1 is circulating, does this make it less likely a second N1 virus coupled with a different H will also gain a foothold? How likely are they to infect a host simultaneously? As if these questions weren't themselves of key importance, we also don't know the relationship between transmissibility and virulence. They are logically and biologically independent in general, but changes that affect transmissibility might also affect virulence. Because we don't know any of these things (and lots more besides), it is not possible at the moment to quantify the probability of one or another (or any) subtype to "go pandemic." Experts can make judgments ("subjective probability") based on evidence, but at the moment the evidence isn't strong enough to narrow the huge range of plausible judgments. The best we can do is make some assumptions, for planning purposes. Those assumptions are the source of most of the contentious arguments over the adequacy or lack thereof about pandemic preparedness.

    Because perseveration is a characteristic and privilege of the aged, we will repeat again in this last bird flu post of 2007 what we have been saying here since late 2004. The best way to prepare for an influenza pandemic is to do those things which make for a robust community, especially building and strengthening the public health and social service infrastructure. This is like repairing the roof on your dwelling. It will help protect against heat, cold, rain, sleet or snow. It won't keep you safe from an asteroid or a nuclear attack. A strong public health system also won't protect you from a pandemic with a 30% attack rate and 60% CFR. But it will help with a hell of a lot of other things, including many of the most plausible candidate influenza pandemic viruses.
    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.
  12. by   indigo girl

    CIDRAP on the US vaccine-allocation "draft guidance"

    How vulnerable are we when it comes to the supply chain?

    When it comes to medical supplies, we are in serious trouble:


    Quote from crofsblogs.typepad.com/h5n1/2008/01/cidrap-on-the-u.html

    The Centers for Infectious Disease Research and Policy at the University of Minnesota has been a vocal and aggressive advocate for pandemic preparation. On December 31 CIDRAP released its Comments on the Draft Guidance on Allocating and Targeting Pandemic Influenza Vaccine. Dr. Michael Osterholm is the lead author...
    Quote from http://www.cidrap.umn.edu/cidrap/files/13/hhsvaccpriority.pdf

    ...we believe that HHS and DHS must determine a priority list of critical products and services that, should they be unavailable during a pandemic due to disruptions in international trade and travel, will result in significant morbidity and mortality.

    For example, in the health care delivery system during the next pandemic, regardless of where routine and influenza-related patient care takes place or how many health care providers actually come to work, we will need even more drugs such as antibiotics; medical devices and other products such as needles, syringes, IV bags, gloves, and masks; and routine laboratory and diagnostic tests.

    Yet today most of these products have supply chains and production locations outside of the United States.
  13. by   indigo girl
    Important information from CIDRAP:


    Toolkit provides guidance on home care for the sick


    Quote from www.cidrap.umn.edu//cidrap/content/influenza/panflu/news/jan0208homecarepp.html

    As healthcare facilities become overwhelmed during pandemic influenza, many of the sick may have to receive care elsewhere, including at home. The "Stay at Home Toolkit for Influenza," developed by health officials in Maryland's Montgomery County, offers the public practical guidelines on how to nurse ill household members.

    The simple guide, from the Montgomery County Department of Health and Human Services Public Health Services, highlights prevention and caregiving with outlines on what people should or should not do when assisting those sick with the flu.

    Rachel Abbey and Betsy Burroughs of the county's Advanced Practice Center (APC) for Public Health Emergency Preparedness and Response compiled the toolkit and said the idea developed following suggestions from other public health officials about the necessity for home care guidelines.

    "During a pandemic, in order to deal with surge, we would need residents to take care of sick people," said Abbey, a program specialist at the APC.