Disaster/Pandemic preparedness - page 25
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
-
May 5, '08Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741Lloyd's of London weighs in on pandemic issues
Another great essay from Scott McPherson:
http://tinyurl.com/69dfzj
Quote from www.scottmcpherson.netThe last of Lloyd's Top Ten things to remember in a pandemic:
...CFO Sink required all her senior staff to listen as I gave my then-new "First pandemic of the information age" presentation, giving new meaning to the axiom "Death by Powerpoint." Her senior managers and policy experts came to terms with the sheer volume of human suffering and the resultant stress that a sudden spike in death claims would have upon the life insurance industry, not to mention a downturn in tax receipts. The actuarials in the audience quickly performed their unique calculus and their faces went pale with concern about the solvency of some life insurance companies who would hypothetically be paying death claims on young lives whose premiums had not been given time to prosper within the Law of Large Numbers that is the industry's hallmark.
...for some, confirmation only comes whan a prestiege firm such as Lloyd's comes out and says, "Do this."
For those people, consider yourself warned. Lloyd's is taking the approach that a pandemic is an event with a very close beginning date.
Quote from http://tinyurl.com/4fqmev
* Expect a more fluid job market as employees react to how they were treated by employers during the pandemic. -
May 6, '08Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741Better anti-viral drugs urged by 70 scientists at pandemic conference
http://tinyurl.com/3qrxdb
(hat tip PFI/helblindi)
Quote from http://tinyurl.com/3qrxdbDid he really say almost 1/4 of Canadians are showing resistance to Tamiflu?
A chief concern... is the growing human resistance to Tamiflu, the anti-viral stockpiled by the government to combat a possible avian influenza pandemic.
About 24 per cent of Canadians show resistance to Tamiflu, Carver said, and that number is a huge surprise.
"We're still searching for answers as to how this happened," Carver said.
...the growing resistance to the anti-viral doesn't mean that it's useless.
What it means, he said, is that a combination of drugs will be needed to combat an avian flu pandemic.
I am in shock, and you should be too! This is a startling percentage. Actually,
what this should be saying is that the virus that 1/4 of these people were
infected with, was resistant to the antiviral.
A combination of antiviral drugs? What effective drugs are left, and they don't
even know why this is so?
I am going to bet that this did not occur from treating patients in Canada with Tamiflu.
http://tinyurl.com/6x8zrl
H1N1 is one of our common seasonal flu strains. H5N1 is bird flu.
Quote from tinyurl.com/6x
Participating in the symposium was Dr. Albert Osterhaus, the virologist who discovered the human virus strain H5N1. “The issue we are raising, if it is possible for H1N1 to spontaneously become resistant to Tamiflu, that resistance could emerge in other virsues,” he explained. “We will need stockpiles, but more work needs to be done around combination therapies. It is important to focus on rapid vaccine development.”Last edit by indigo girl on May 7, '08 -
May 9, '08Occupation: IM/Critical Care/Cardiology Specialty: compassion ; Joined: Sep '03; Posts: 1,555; Likes: 656Quote from indigo girlHuge eye opener, again.Better anti-viral drugs urged by 70 scientists at pandemic conference
http://tinyurl.com/3qrxdb
(hat tip PFI/helblindi)
Did he really say almost 1/4 of Canadians are showing resistance to Tamiflu?
I am in shock, and you should be too! This is a startling percentage. Actually,
what this should be saying is that the virus that 1/4 of these people were
infected with, was resistant to the antiviral.
A combination of antiviral drugs? What effective drugs are left, and they don't
even know why this is so?
I am going to bet that this did not occur from treating patients in Canada with Tamiflu.
http://tinyurl.com/6x8zrl
H1N1 is one of our common seasonal flu strains. H5N1 is bird flu. -
May 9, '08Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741Thanks, Sharona. Here is why I think that the Tamiflu resistance in Canada is
not linked with widespread treatment of Canadian patients with Tamiflu.
The viral genetic marker, H274Y is associated with Tamiflu resistance. The link
below explains that it has appeared in many different locations where Tamiflu
is not widely used, hence the surprise.
The Tamiflu blanket is a term that means that a group of people in some cases,
a whole village has been given prophylactic Tamiflu because there is so much
virus in their environment, and probably that human cases have occurred or
are at risk of occurring. In this case, the virus of concern is bird flu, H5N1,
but the resistance to the antiviral is now showing up in cases of our common
seasonal flu.
How does this happen? Viruses have to "learn" from each other. They pick up
these pieces of genetic material by co-infection. In other words, the person
or bird has to have more than one type of flu at the same time. Make sense?
Recombination is a still controversial theory that explains how viruses pass
information to each other. The evidence is mounting that this is how these
changes actually do occur. They are probably not random mutations, but
rather a form of viral evolution.
This evolutionary change is going to be a problem because Tamiflu is the
drug being stockpiled by many countries interested in pandemic influenza
preparation. It is the only antiviral being stored. Basically, there is no
backup.
http://www.recombinomics.com/News/01...274Y_H5N1.html
Quote from www.recombinomics.com
In the United States the change was in the Solomon Islands variant, which links back to Asia, where the identical change has been seen in H5N1 from patients treated with Tamiflu, as well as birds, including wild birds in Astrakhan in 2005.[/B]
Like the wild birds, most of the recent human isolates are from hosts that have not been treated with oseltamivir.
These polymorphism are appended via recombination, and the widespread use of a Tamiflu blanket provides a selective environment for the acquisition of H274Y in human H1N1 co-infected with H5N1 patients.
Evidence is accumulating for mild human cases of mild H5N1, which are largely going undetected.
The sudden appearance of H274Y in seasonal H1N1 after Tamiflu blankets had been applied extensively in recent preceding years is not a coincidence. -
May 10, '08Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741Japan to Conduct Clinical Trial of Prepandemic Vaccine and Begin Using It
http://search.japantimes.co.jp/cgi-b...0080511a1.html
This is a very significant decision, and merits some attention. It is the
kind of plan that might cause you to ask, why are they feeling the
need to do this now?
Instead of stockpiling all of its prepandemic vaccine on the shelf, Japan
has decided to stockpile it in some of the people," whose work is related to
maintaining basic functions of society." Actually, this is not a bad idea.
Worthy of note is that Japan is planning on vaccinating some youngsters
under age 20. Hmm...Certainly, a significant amount of kids have been
infected with bird flu, however, the greatest mortality rates from H5N1
infection have been in those aged 20 to 40. I am also questioning whether
it is smart to include kids in a clinical trial like this?
Quote from search.japantimes.co.jp(hat tip carol @sc)
The government has also decided to conduct a clinical test this fiscal year
in which some 6,000 doctors, quarantine inspectors, other medical and
health professionals and immigration and customs officials will be inoculated
with stockpiled "pre-pandemic" vaccine based on the H5N1 virus strain. It
also will inoculate 120 children at least 6 months old and younger than 20 with
the same vaccine. If the vaccination proves safe and effective, it plans to
vaccinate 10 million people whose work is related to maintaining basic functions
of society.
The use of the pre-pandemic vaccine before an outbreak of a new flu type is the
first in the world.Last edit by indigo girl on May 10, '08 -
May 11, '08Occupation: Nurse Educator, psych forensic hosp Specialty: 45 year(s) of experience in pure and simple psych ; Joined: Mar '05; Posts: 804; Likes: 120Once again, indigo girl, you present the most amazing information. How nice of Japan to become the clinical trial for the world. I just hope that the next administration is a bit more focused on this.Last edit by sanctuary on May 11, '08 : Reason: goofed -
May 13, '08Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741Taking Responsibility for Yourself and Your Family
http://afludiary.blogspot.com/2008/0...-have-cpo.html
We can blame our jobs, and the govt for not preparing us, but ultimately,
we have to look in the mirror. Only you are responsible for you, and yours.
http://afludiary.blogspot.com/2008/0...-have-cpo.html
Quote from afludiary.blogspot.com
Nothing is likely to happen until someone takes the responsibility to make it happen. A pandemic plan doesn't just come of the rack like a cheap suit, it has to be tailored to fit each organization, and that includes all the way down to the family level.
You don't have to be an expert in pandemics, or pandemic planning to get started. There are plenty of resources available on the Internet. Just Google Business Continuity Pandemic, and you'll have a month's worth of reading at your fingertip.
But to get started, go to www.pandemicflu.gov, and visit the Individual planning page for preparing your family, and the Workplace planning page for businesses. -
May 14, '08Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741Critical care panel tackles disaster preparation, surge capacity, rationing
http://www.cidrap.umn.edu/cidrap/con...1308chest.html
(hat tip Avian Flu Diary)
Quote from www.cidrap.umn.edu
The series, from the Critical Care Collaborative Initiative's January 2007 Mass Critical Care Summit, appeared recently in a May supplement issue of the journal Chest. The five articles...on current capabilities, a framework to optimize surge capacity, medical resource guidance, and recommendations for allocating scarce critical care resources in a mass critical care setting.
...all predictions are that the need for ventilators in a major pandemic will far exceed the supply. The US national stockpile has about 4,600 ventilators, the report says.
One consumable medical item that may run short in a disaster is oxygen, the report says. The number of oxygen suppliers and the number of tanker trucks for shipping oxygen are limited.
Concerning personnel, the report says staff shortages have not typically been a problem in past disasters, but absenteeism has been high in some crises that were prolonged or affected employees personally.
The task force said most of the Department of Homeland Security's disaster scenarios represent a double-edged sword. Events, such as a terrorist attack or influenza pandemic, have the potential not only to raise the demand for critical care medical supplies, they also can also sever supply lines.
Hospitals typically rely on "just-in-time" inventories to reduce supply, equipment, and storage costs, they note.
The task force suggested several strategies that healthcare groups could use to augment critical care staffing:
Physicians willing to serve in intensivist roles could be encouraged to join critical care teams.
Critical care nurses could help mentor noncritical care caregivers.
Noncritical care nurses and pharmacists could become responsible for medication delivery to all of the critical care patients.
Paramedics could help maintain airways of critical care patients.
Respiratory therapists who specialize in critical care could oversee groups of their noncritical care colleagues who could quickly ramp up their skills with just-in-time training materials.
Pharmacists from regional health systems could help redistribute scarce pharmaceutical resources.
...previous antiviral rationing guidance in the event of an influenza pandemic has generally placed healthcare providers in top-priority tiers, the task force does not recommend that health workers--or any other population group--receive preferred status. -
May 14, '08Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741OSHA's Proposed Guidance On Respirators And Facemasks
http://afludiary.blogspot.com/2008/0...spirators.html
Quote from afludiary.blogspot.com
OSHA, the Occupational Safety & Health Administration, released their proposed guidance for Workplace Stockpiling of Respirators and Facemask for Pandemic Influenza yesterday. OSHA is looking for public comment on these proposed guidelines, and will accept written submissions until July 8th, 2008.
As stipulated in yesterday's release, these guidelines are not yet adopted.
This proposed guidance reflects the current thinking on the stockpiling of respirators and facemasks for the purpose of pandemic influenza preparedness. The information contained in this document is distributed solely for the purpose of pre-dissemination public comment. It has not been formally disseminated by DOL. It does not represent and should not be construed to represent any agency determination or policy.
Although I've run the numbers in a back-of-an- envelope calculation before, showing that our national stockpile of PPE's would be quickly exhausted in a pandemic, OSHA has put together some more detailed numbers.
...we may see multiple waves, and our ability to resupply in between waves may be severely limited. -
May 15, '08Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741London Regional Resilience Flu Pandemic Response Plan updated
http://www.londonprepared.gov.uk/dow...se_plan_v3.pdf
Wow, this is a very, very sobering document...
I have pulled out a few paragraphs but you should read the full document
for yourself. They are telling pulling no punches. This planning reflects
the seriousness of the threat.
Quote from www.londonprepared.gov.uk(hat tip pfi/pixie)
A growing reservoir of infection in birds, combined with transmission to more people over
time, increases the opportunities for the A/H5N1 virus either to adapt to give it greater
affinity to humans or to exchange genes with a human influenza virus to produce a
completely novel virus capable of spreading easily between people and causing a
pandemic. However, the likelihood of, and time span required for such mutations are not
possible to predict.
2.12 Experts agree that A/H5N1 is not necessarily the most likely virus to develop pandemic
potential. However, due to the potential severity of a pandemic originating from an H5N1
virus, this possibility cannot be discounted.
Key points - Health impacts of an influenza pandemic in the UK
All age groups are likely to be affected, but children and otherwise fit adults could be at
relatively greater risk.
Clinical attack rate may be of the order of 25% to 35%, but up to 50% is possible.
The projected scale of excess deaths during a pandemic particularly at the upper end of
the planning assumptions is likely to present many challenges for local services. Planning
in both the local health community and Local Authorities will need to recognise the
requirement for sensitive and sympathetic management of potentially large numbers of
deaths, including faith considerations.
3.14 All ages are likely to be affected but children and otherwise fit adults could be at relatively
greater risk as older people may have some residual immunity from possible previous
exposure to a similar virus earlier in their lifetime.
3.15 Although the potential for age-specific differences in the clinical attack rate should be
noted, they are impossible to predict, and a uniform attack rate across all age groups is
assumed for planning purposes. More severe illness than usual seasonal influenza is
likely in all population groups – rather than predominantly in high risk groups as with
seasonal influenza – with a higher number of people than usual developing severe
prostration and rapidly fatal overwhelming viraemia, viral pneumonia or secondary
complications. It is not possible to predict numbers in advance.
Pre-pandemic wave immunisation with an influenza virus related but not specific to the
pandemic strain might offer some limited protection. Currently, there are very limited
stocks of an A/H5N1 vaccine purchased specifically for the protection of healthcare
workers. Pre-pandemic vaccination of those most likely to spread the disease or suffer
complications could also help reduce hospitalisations and deaths in vulnerable groups.
Decisions on use would be decided following assessments undertaken at the time of the
pandemic, however, response plans should consider arrangements for limited pre-
pandemic vaccination of targeted groups.
3.19 The use of antiviral medicines or other definitive pharmaceutical interventions are an
important countermeasure, although they may be in limited supply. The UK has
established national stockpiles of oseltamivir (Tamiflu) that allow for the treatment of all
symptomatic patients at clinical rates of up to 25% and arrangements to make it rapidly
available are a critical part of the health response. This will be particularly important
before a specific pandemic vaccine is widely available. Higher clinical attack rates would
require prioritisation of use, but operational plans should initially aim to make antiviral
medicines available to all patients who have been symptomatic for less than 48 hours
from reporting symptoms indicative of influenza.
It is highly probable that the pandemic will consist of one or more waves and once
established its speed of spread will leave little time for contingency planning or
preparations.
4.3 Once efficient person-to-person transmission is established, preventing an influenza
pandemic is unlikely to be possible, as most people are likely to be exposed to the virus at
some stage during their normal activities. Those with influenza like symptoms should
minimise contact with others by remaining at home until the symptoms have resolved.
Those who are not symptomatic should continue normal activities for as long as possible.
By avoiding unnecessary close contact with others and routinely adopting high standards
of personal and respiratory hygiene, the likelihood of catching or spreading influenza will
be reduced.
4.4 The overall aim during a pandemic will be to encourage those who are well to carry on
with their daily lives normally for as long as that is possible, within the constraints imposed
by the pandemic. Although existing business continuity plans for other disruptive
challenges provide a good starting point for planning for an influenza pandemic, it must
be recognised that pandemic influenza presents a unique scenario in terms of prolonged
pressures through a reduced workforce and potentially increased workload. Organisations
are, therefore, expected to develop specific business continuity and contingency plans to
ensure that critical services and outputs continue to be delivered throughout an influenza
pandemic. -
May 16, '08Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741Infectious diseases expert warns of chaos during pandemic flu
http://afludiary.blogspot.com/2008/0...demic-flu.html
Quote from www.postbulletin.com
Power company workers, coal miners and others on the front lines handing basic services will be the most essential laborers during an outbreak, Osterholm said. Yet there's no plan to safeguard them.
A pandemic will be like a Hurricane Katrina happening all at once worldwide, with six- to eight-week waves of illness. Food, water, power, cellular and Internet service will be interrupted because stores, hospitals and even power companies use "just-in-time" supplies. Most medicines, for example, come from overseas.
"The current national disaster response system will collapse...," Osterholm said. -
May 16, '08Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741With permission from Effect Measure:
Bad Behavior in the World of Flu Science
This change is long, long overdue. The public sleeps unaware that
that data that they have paid for is being privately hoarded. Why
is this important? Because for the first time in history, we are able
to look at what could be the possible beginnings of a world wide
catastrophe, and prepare for it before it occurs. This is so important
that normal rules for considering research data as proprietary should
not apply. This information belongs to us.
Dr. Henry Niman of Recombinomics has been like a lone voice in the
desert calling out for the need for the release of viral flu sequences
particularly regarding the bird flu virus, H5N1. It's nice to know that
the Reveres agree with him.
Quote from scienceblogs.comThe 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.
Last week WHO's flu maven, Keiji Fukuda, said what we and others have been saying for a long time. Flu scientists need to change their research ethics. The world of flu virology has developed a mandarinate that is impeding progress for its own benefit. And their bad behavior is enabled and imitated by some public health agencies, like CDC. Researchers and CDC are sitting on H5N1 genetic and other flu sequences of public health importance. They treat their data as proprietary, to be used for their own benefit in scientific publications.
This isn't unusual. It is the normal way of doing academic science. But when it comes to research on one of the major global public health problems this is no longer acceptable. And WHO is saying so, gently but clearly:
Current international research is highly competitive and the results of studies are often held back pending publication, which could delay their usefulness in a public health emergency, WHO officials said.
Keiji Fukuda, coordinator of WHO's global influenza programme, said that more sharing of research was required, as happened informally between experts during the deadly SARS epidemic in 2003 which spread from southern China to Canada.
"In developing a WHO public health research agenda (on influenza) we are trying to push for a paradigm change," Fukuda told the final session of a four-day WHO meeting on bird flu.
"What we hope to improve is the kind of sharing and flow of information and take it to another level," he said. (Reuters)
I'm an epidemiologist and the data I collect is obtained through hard work and a lot of money and a lot of time. Once I have collected it there is a tendency to think it's "mine" by virtue of the sweat equity I've put into it. I understand the thinking and am more than normally sympathetic to it. Why should others be able to scarf up the benefits of my hard work? But I've come around to the idea the data aren't mine -- it is paid for by taxpayers -- and it should be accessible to other scientists. Yes, I'd like a first crack at it, but I'll have it before anyone else and will know it best so I automatically have an advantage. If I'm not quick enough in using it, then others get a chance.
But I'm not a flu scientist, so my data is not usually that urgent. Research on pandemic influenza is a matter of urgency and timeliness and there aren't nearly enough hands working on it. If the sequences are made available then many more scientists can be mining the data, not just the ones connected to the big labs.
The paradigm shift required is one of ethics, not science. Fukuda suggests that one way to force this more ethical behavior is for research support to be tied to a requirement for disclosure. That's a good idea. But there are other ways, too. We have previously suggested that no manuscript on pandemic influenza should be accepted for publication unless the genetic information it references is already in a publicly accessible data base, like GenBank, at the time of submission. If it isn't, then the manuscript will no longer be considered further for publication.
Some of the biggest names in the world of flu science have been warning us of the extraordinary threat we could face. What they say makes a great deal of sense to many of us. But if the threat is extraordinary then the reaction to it should be, too. Instead flu scientists still operate under the old rules. Not good enough. Speaking as a public health scientist myself, I consider it also unprofessional and unethical. CDC and all you flu scientists: release all your sequences now.
It's time for New Rules.Last edit by indigo girl on May 24, '08 -
May 17, '08Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741Research in Vietnam on Antibodies Countering H5N1
http://english.vietnamnet.vn/tech/2008/05/783461/
This sounds promising except for this rather startling detail:
Quote from english.vietnamnet.vn(hat tip fluwiki)
The Vaccine and Biotechnology Company 1 is one of three agencies that is researching and developing H5N1 vaccine in Vietnam. The company uses cells from monkey kidneys in research, which makes it different from the two others.
According to US experts, the World Health Organisation (WHO) worries about the safety of vaccines that are produced from living cells such as the cells of monkey or dog kidneys because these living cells may contain viruses that man doesn't know about yet and germs that can infect humans. To be sure that living cells are suitable for producing vaccines, they must be tested very carefully, which can make vaccine costs very high. They have urged Vietnam to be careful in the current period of testing on humans.
