Disaster/Pandemic preparedness

Laidback Al · Mar 17, 2008

At the moment these deaths do not appear to be related to an influenza virus, but deaths of medical personnel are always of concern.

Strange Disease Kills 2 Doctors in Ebonyi [Nigeria]
From Christopher Isiguzo in Abakaliki, 03.16.2008
At least two medical doctors have been confirmed dead at Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki, following an unidentified ailment, while a third, is reportedly in critical condition. The first victim, Dr Njoku, Senior Registrar, was said to have died December last year, barely a month after his wedding, while the second victim, Dr Ama, a junior resident doctor who took care of Njoku when he was sick, died last week, after a protracted ailment suspected to be related.
Both victims worked at the Surgery Department where it was suspected they might have been infected in the course of series of surgical operations they performed. Management have closed the surgery department till further notice, in liaison with the state government, while some patients in the place have been moved out, apparently to avoid contacting the disease. Already, THISDAY checks showed that the Federal Ministry of Health has dispatched a team of crack medical experts to the hospital, following a distress signal received from Ebonyi State government and management of the hospital.
The team is expected to carry out detailed investigation of the strange killer disease. THISDAY gathered that a similar outbreak claimed the lives of four nurses in the same hospital in 2005, before it was halted by a team from the Federal Ministry of Health. When THISDAY visited the hospital, a group of doctors from the Federal Ministry of Health, were seen meeting with officials of the hospital.
Leader of the visiting medical team, Dr Mike Ochoga, who refused to give details of their findings, simply said the team was in the process of finding the cause of death of the victims and possibly proffer solution.

http://www.thisdayonline.com/nview.php?id=106097

credits to Shiloh

indigo girl · Mar 18, 2008

With permission from the folks at 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.

Pandemic flu and the best laid plans

Last week The US Department of Health and Human Services (HHS) released a comprehensive pandemic flu guidance document for states, accompanying it with a web presentation, the first of three. I haven't seen the Web Seminar and only quickly perused the document, so I am commenting on the basis of a description in CIDRAP News, a reliable source. You can find the Web presentation and document at pandemicflu.gov. It is always best to see the original, so this is my take from a second hand source. Even so, I don't think our take is likely to be wildly off kilter (assuming you don't think we are always off kilter on this subject; if you do, you'll probably think so again).
The federal government role is to tell the states that they are on their own -- sort of. It is clear the federal government can't be the cavalry riding to the rescue when everywhere needs rescuing at once, including the federal government whose employees will be as affected as anyone. So their role reduces to helping the state and local public health systems. Realistic and fine as far as it goes. Where it heads, though, is problematic:
Christa-Marie Singleton, MD, MPH, associate director for science in the division of state and local readiness at the US Centers for Disease Control and Prevention (CDC), said states, territories, and the District of Columbia are required to submit their pandemic plans to HHS so that the agency can establish a baseline for each state's pandemic preparedness and help each identify gaps in planning. The guidance walks states through each issue to consider and includes details on how to format and submit their plans to the HHS.
Singleton said the federal government might withhold some 2009 funding for states that don't submit their pandemic plans. The guidance document says the plans are due on Jun 16.
Webinar participants said federal officials would be available to help states prepare their pandemic plan submissions. (Lisa Schnirring, CIDRAP News)
Ouch! We're from the Federal Government and we're here to help you. Start by filing paperwork and we'll tell you exactly what the paper work has to have in it. Or we don't feed you.
There is something unredeemingly controlling about this that is discouraging and counterproductive. It might work for some things, but not for this. Localities differ and will solve their problems in specific, perhaps idiosyncratic ways. We need to get them resources, mainly money in the form of Block Grants, and let them use it to make their public health and social service systems fit for duty, functioning properly and working effectively at the community level. Few if any places in the US meet this basic requirement now. The goal is not to fulfill some pre-envisioned planning sequence but to make the community sufficiently robust to function during a pandemic.
One of the overarching goals is to assure the continued functioning of critical infrastructure. Unfortunately much of that infrastructure is outside public control, in the hands of private companies (many water companies, almost all utilities) and there is no guidance as to who will do what and for what reason. There is now widespread recognition of the many problems a serious pandemic would bring. That's a step forward. But unless those problems have solutions, it's not where we need to be. At the same time there is considerable lack of clarity about roles the Federal government might decide to play if it felt it necessary "to protect Americans." We've seen a lot of what this administration would like to do to protect us and many of us feel we want to be protected from our own government instead. The coercive role the Feds might play in all this is a blank page that needs to be filled in with limits and boundaries. Somehow many of us suspect that the federal government is more likely to try to enforce a quarantine order than to take over a utility. It's all about choices.
Some of this is good and goes in the right direction. Planning, in itself, is a big step forward. But the plan on paper will go out the window in the first week (the old military saying applies: no battle plan survives the first engagement with the enemy), even while the planning is valuable by envisioning what is ahead, meeting your counterparts in other agencies, thinking it through, all tremendously valuable. States and localities need to be strongly and forcefully encouraged to do this. But most states and communities are also fully engaged in the desperate business of trying to keep people alive day to day and until they can get out from the falling debris of a system disintegrating about their ears. In those circumstances, pandemic planning is a luxury, even harmful to the extent it pulls people away from other urgent business.
Isolating pandemic planning from the overall health of the system isn't going to work, no matter how detailed the plan.

indigo girl · Mar 19, 2008

US State Pandemic Plans

http://tinyurl.com/33kony

They do not all agree, but here are the plans for each state. Some of them are

much more detailed than others. When you read them, and wonder exactly how

they will do some of what they are saying, you might get the feeling that for some

it was just an exercise on paper that the feds forced on them since there is always

the threat of federal funds being withheld. The devil is in the details. Our role as

nurses and HCW is in those details somewhere. We are commodities.

indigo girl · Mar 19, 2008

HHS includes online services in pandemic communication drill

http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/mar1908exercise.html

Blogging has become an acceptable way to reach the public with important

information as this report from CIDRAP indicates with bloggers as well as

well known news sources participating in this HHS pandemic drill on March 17th.

(hat tip Avian Flu Diary)
The US Department of Health and Human Services (HHS) recently held a tabletop exercise to assess how it could best work with the news media--including blogs and other online-only information sources--to get status updates and vital health information to the American people during an influenza pandemic.
The session was held on Mar 17 at HHS headquarters in Washington, DC. Representatives from online avian-flu information services such as Avian Flu Diary, FluTrackers, FluWiki, WebMD, and CIDRAP News participated in the exercise along with those from several national media organizations, including ABC News, National Public Radio, and Reuters.
The exercise was the second time HHS has reached out to blogs. In May 2007, the department featured posts from bloggers such as Michael Coston of Avian Flu Diary and Greg Dworkin, MD, of FluWiki in a 5-week pandemic preparedness blog series.

Avian Flu Diary on the HHS Pandemic Exercise:

http://afludiary.blogspot.com/2008/03/hhs-pandemic-exercise.html

During this day-long `tabletop' exercise, representatives from the HHS, CDC, Homeland Security, State Department, State and local Health Departments, Print and broadcast journalism, and yes . . . three representatives of flu forums and flu blogs, plus representatives from CIDRAP and WebMd . . . worked through a 12 week pandemic scenario.

indigo girl · Mar 20, 2008

From US Department of Health and Human Services, Secretary Mike Leavitt's Blog,

comes his commentary on the Pandemic Exercise of 17 March with members of

govt, journalists and flu bloggers that was held in Washington, D.C.

It's not only the media that reads the flu blogs, however, the govt does too.

Count on it.

Pandemic Exercise with Bloggers

http://secretarysblog.hhs.gov/my_weblog/2008/03/pandemic-exerci.html

(hat tip Avian Flu Diary)

indigo girl · Mar 20, 2008

Why you should care about Indonesia

http://blogs.computerworld.com/why_you_should_care_about_indonesia

(hat tip Avian Flu Diary)

sharona97, BSN, RN · Mar 21, 2008

So true, protecting ourselves from the government, and the ideology of having a separate task force clearly for pandemic planning interfering with the current healthcare.

Great post.

indigo girl · Mar 28, 2008

There are very few pharmaceutical choices available for countries preparing

for the next pandemic especially if the virus being fought is the dreaded H5N1

bird flu. Here are two links discussing the urgent need to come up with solutions.

Immune-boosting Adjuvant Patch

http://crofsblogs.typepad.com/h5n1/2008/03/branswell-on-im.html

Makers of a patch that ramps up the immune system's response to influenza vaccine reported impressive results Thursday, showing that a vaccine against H5N1 avian flu given with the patch raised what are thought to be protective levels of antibodies with a single dose.
The preliminary finding raises hopes a one-dose vaccine-patch regimen might be a possibility in a flu pandemic, eliminating the need to bring every person to be immunized in for a booster dose several weeks after the first or priming dose was given...

Bali Conference: The Need For New Antivirals

http://afludiary.blogspot.com/2008/03/bali-conference-need-for-new-antivirals.html

"We have learnt some bird flu patients in Hong Kong and Vietnam have shown resistance to old medicines"...
Many countries are currently using Osetamivir, locally known as Tamiflu, to treat patients diagnosed with bird flu.
Tamiflu must be given to bird flu patients early as it reacts with the virus while it is still in the patient's blood. Once the virus enters the patient's lungs, the tablet is not much use, Amin said.

indigo girl · Mar 30, 2008

NIOSH Accepting Comments Until June 1 on Health Workers' PPE Plan

http://www.ohsonline.com/articles/60287/

(hat tip fluwiki/kobie)

June 1 is the new deadline for stakeholders to comment on NIOSH's Personal Protective Equipment for Healthcare Workers Action Plan, a 66-page document intended to help guide the effort to get the nation's 14 million health care workers ready for an influenza pandemic.
The SARS episode in 2003 had already demonstrated the importance of protecting health care workers during mass disease outbreaks, and this was part of the reason for the IOM panel's three overall recommendations: 1) understand influenza transmission, 2) commit to workers' safety and appropriate use of PPE, and 3) innovate and strengthen PPE design, testing, and certification.

indigo girl · Mar 31, 2008

Volunteers Will Be Needed

http://afludiary.blogspot.com/2008/03/hhs-blog-redux.html

I would be the first to say that not everyone should work in nursing

during a pandemic. If you have kids, or sick family members, or you

are pregnant, please stay home. You also may be more at risk if under age

40 because this is the age group of most of the victims of bird flu.

That said, there will be an urgent need for volunteers not just in

health care, but for doing the essential things that keep communities

functioning. Our nation has been through some difficult times before,

when volunteers and the collective will of the people has gotten us through

as noted in the following terrific essay from Fla Medic. His blog is read by

CDC, HHS and, and probably many other govt agencies as well as private

citizens. Right, it's a blog, and the govt takes it seriously enough to read it,

and invited him to Washington to participate in a pandemic flu exercise as

as part of the recent HHS interactive blog with Secretary Leavitt. Imagine that.

No, not everyone will volunteer to work during a pandemic. I understand that. Not everyone is suited for it. There are personal risks involved. It takes a special type of person, often one without family responsibilities, to undertake this sort of assignment in a crisis. But there are more of them out there than you know. You just have to ask them to come forth.
Officials are often loath to ask for help from the public. They see it as an admission of failure on their part. But the real failure would be in not asking, when the need is this obvious. They can't handle a pandemic alone. They know it. We know it.

indigo girl · Apr 3, 2008

Pregnant women would have special needs in flu pandemic

http://tinyurl.com/26fj5g

Recognizing this group's vulnerability, the U.S. Centers for Disease Control is gathering experts with backgrounds varying from drug metabolism in pregnancy to baby delivery to come up with special pandemic guidelines for pregnant women.
In the 1918 Spanish Flu pandemic, one study reported on 1,350 pregnant women who became infected; 27 per cent died from the flu. In the milder Asian Flu pandemic in 1957, half the women of reproductive age who died from flu in Minnesota were pregnant.
"From the limited information that we have from previous pandemics, it looks like pregnant women are expected to be a vulnerable population for future pandemics," says Dr. Sonja Rasmussen of the CDC's National Center on Birth Defects and Developmental Disabilities..."

indigo girl · Apr 4, 2008

More on the concerns that pregnancy presents during a flu pandemic as reported in

the Helen Branswell article, and the state of our healthcare system with permission from Effect Measure:

Flu preparedness and pregnancy
One of the least talked about problems in pandemic preparedness planning is that even if there is flu all around us and the health care system is struggling (and almost certainly failing) to handle the resulting demand of patients, people will still be getting sick from the usual things (heart attacks, strokes, etc.), having accidents, and yes, getting pregnant.
There is pretty good reason to think that getting the flu when pregnant is even worse than getting the flu otherwise. A pregnant woman's immune system reacts differently because of the special circumstance of accommodating the foreign antigens represented by the fetus. Evidence from past pandemics suggests that the risk is not only higher but very high for pregnant women during a pandemic. And this has CDC worried. Helen Branswell of Canadian Press sets it all out in a characteristically informative and well-informed piece:
Women who are pregnant when the next flu pandemic strikes will find themselves with special needs, concerns and risks -- and very little science to help decide things like whether it's safe to take flu drugs or necessary to wear medical masks in public.
Recognizing this group's vulnerability, the U.S. Centers for Disease Control is gathering experts with backgrounds varying from drug metabolism in pregnancy to baby delivery to come up with special pandemic guidelines for pregnant women.
The nearly 70 experts convene in Atlanta on Thursday and Friday to go over what little data exists. In the process, they will try to figure out what to recommend on issues such as antiviral drug use in pregnant woman and how to try to ensure continuity of obstetrical care for mothers-to-be during what is expected to be a medical emergency.
An expert from the University of British Columbia who will be attending the meeting acknowledges at least some of the recommendations will not be typical evidence-based guidance, but rather advice "couched in the language of ignorance."(Helen Branswell, Canadian Press)
I want to pause for a minute and stand back and admire this reporting. The pull quote is the first 175 words of a 798 word article. Consider how much we learn in that short space. The craftsmanship here is really stunning, the more so because we are usually unaware of it.
But back to the subject. The rest of Branswell's piece supplies details about some of the topics of concern: the effects of fever on pregnancy outcome, the unknown adverse effects of prophylactic antivirals and vaccines with novel adjuvants, the extent of increased risk and how to advise and handle pregnant women during a pandemic. The problem of pregnant women is a special concern for most people because if we weren't wired to worry about the next generation we probably wouldn't have survived as a species. But in a medical, rather than an evolutionary sense, it is part of a much bigger problem: what about all the non-flu related medical problems during a pandemic . . . heart attacks and strokes, acute appendicitis, kidney stones, auto accidents, etc. It's not just a triage question for flu patients (which flu patients will be treated first, who will get respirators, etc.) but a triage question for all urgent medical cases, many of which will not be flu, even in a pandemic. We can cancel elective medical procedures but the emergency room is full of non-elective medical demands.
The fact that the medical care system is already broken should be alarming, but apparently we have gotten used to it, sort of like having a stone in our shoe. We keep limping along, ignoring the nagging pain. But if we have a pandemic we will be asked to run for our lives, not just from flu but from all the other routine things, too. Flu prepping won't protect us from those. Only an adequate health care system can do that.
By all means let's each of us do what we can individually to be ready for a pandemic. But to be really ready we are going to have to get together and invest in a public health and social service system. I don't see a lot of evidence we are doing that. At all.

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.