Disaster/Pandemic preparedness

Nurses COVID

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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 for weeks after the storm.

That concerns me. I wonder in case of disasters like hurricanes, earthquakes and pandemics if the nurses who work in the area have problems like that. I'd be worried about leaving my family if there was no heat or electric. After loosing electric in the ice storms in the Carolinas a few years back, my husband bought us a generator. I try to keep enough gas stored so that I could run that and maybe have an extra tank of gas for getting back and forth to work, if things were shut down. I never want to wait in the cold on those gas lines again; or have to risk driving around to find necessities!

What disasters have you been through? What lessons did you learn about what things would make life easier if it happens again to you? What can we learn from your experience, and how can we prepare for so we dont have to go through th esame problems you did?

Where there any sepcial tricks or issues that came up that helped you at work? Any special problems that nurses in disasters face?

I have a confession- my home first aid kit is pretty anemic right now :) DH burned his hand prety badly at work last week. I hadnt checked my kit in awhile, and was shocked to see how low I was on some stuff. I only had one roll banfage and had to make a run to WallyWorld the next day! If the stores were shut or the roads iced in or otherwise impassible that would have been an issue. Maybe not life threatening- but its a small example of how not being well prepared can be a problem.

I'd have been so embarrased to admit to hubby I couldnt take care of it, or come thru when he needed me to.

What do you do to prepare? I'm going to restock my kit, and get some more OTC stuff to keep on hand too. What else should I be thinking about?

Laura

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The Myth of "Just in Time" (JIT) Prepping

http://afludiary.blogspot.com/2008/04/myth-of-jit-prepping.html

This essay is on home prepping supplies, but consider also that

healthcare facilities will face the same problem of running out of essential

supplies like O2. My facility plans on being supplied by barges on the river.

How realistic is this scenario? Where will the supplies come from when every

other hospital, and nursing home will be asking for the same limited resources?

Over the past few weeks a relatively small handful of individuals and restaurant owners have stockpiled extra rice as a hedge against its rapidly escalating prices, and that has caused some large retail outlets to run short. Buyers at Sam's and Costco, two major bulk distributors, have found either empty rice shelves or rationing at many locations.

Imagine what it would have been like if, instead of a few hundred people stocking up, it had been millions of families all racing to the store to buy a 90-day supply of food?

The days of stores having a `stock room' filled with pallets of food waiting to be put out on the floor are gone. Stores use JIT stocking, and many get replenished every day of the week.

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National Discussion Needed on Antiviral Drug Distribution During a Flu Pandemic

http://www.flutrackers.com/forum/showpost.php?p=151839&postcount=1

There is not enough antiviral for the entire population, therefore they have to

decide who gets it. Another consideration to think about is this. At what

point do people who are lucky enough to receive Tamiflu begin to take it?

If waves of infection hit your city for over 4 weeks, surely you are not going

to be taking the drug for that long even should you happen to have that much

Tamiflu available at the currently recommended dosage. Do you only take it

if you know you are exposed? How will you know that? Do you only take it

if you think that you are getting sick? HCW could be exposed for weeks not

that it is likely that all of them would be given prophylaxis. Just wondering

because if many are sick, there is likely to be a lot of exposure and not all of

it will not be obvious.

Uncertainties about the availability and effectiveness of antiviral drugs during a

flu pandemic require federal and state officials to begin a national discussion

about the difficult choices they may be forced to make about the drugs'

distribution, says a new report from the Institute of Medicine.

"We need to engage the public in a discussion about the use and distribution of

antiviral drugs in advance of a pandemic when there will be limited time for

deliberations because large numbers of people will be getting sick," said

committee chair June Osborn, president emerita, Josiah Macy Foundation, Falls

Church, Va.

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IOM Report Questions Size and Intent Of US Tamiflu Stockpile

http://afludiary.blogspot.com/2008/04/iom-report-questions-size-and-intent-of.html

Interesting commentary on that IOM Report on the Tamiflu Stockpile.

CIDRAP is calling the current planning documents "fuzzy." Lots of unanswered

questions come to mind for many of us that are concerned about getting

the country ready.

An IOM committee of experts asserts that the government needs to clarify its goals concerning antiviral use in a pandemic, because current planning documents are fuzzy on prophylactic use of the drugs.

The nation currently has about 71 million treatment courses of antivirals in federal and state stockpiles, with a goal of 81 million courses, the report says. But in a pandemic, it might take more than twice that amount to treat sick patients and offer preventive doses to people at risk for exposure on the job, it asserts.

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US Orders More Pre-Pandemic Vaccine

http://afludiary.blogspot.com/2008/04/us-orders-more-pre-pandemic-vaccine.html

Just as the viruses causing seasonal influenza change every year requiring

the vaccines to change, bird flu changes. Here we see that the US has

ordered another version of prepandemic vaccine. I remember reading

that the committee that makes these decisions did not have a lot of confidence

in their prior purchase but felt it was better to have some vaccine on hand

rather than none at all.

Disagreements with Indonesia where the case fatality ratio is about 80%,

means we can not use samples of their latest version of the virus for a

vaccine unless they agree, and they don't without major compensations.

It would appear that the current order is based on a 2005 strain of

Clade 2.2.

This antigen will be based on Clade 2.2 (A/Barheaded goose/Qinghai Lake/01/2005)of the H5N1 virus, seen in migrating birds.

In 2007 the United States purchased 126 million dollars worth of prepandemic vaccine based on Clade 2.0 of the virus. Smaller amounts of a clade 1 vaccine were produced prior to 2007.

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HHS Webcast On Wednesday April 30th - Closure of Schools During a Pandemic

You have questions? Hopefully they have answers. School closure

is a majorly important mitigation strategy to slow the spread of virus

and help kids, families, and communities be safer.

http://afludiary.blogspot.com/2008/04/hhs-webcast-on-wednesday-april-30th.html

Email your questions for the webcast panelists during the program to [email protected].

Please include your first name, state and town.

This webcast will cover the impact of implementing the community

mitigation intervention of dismissal of students/school closures. It will

provide the opportunity for a live question-and-answer session with these

Federal specialists:

Francisco Averhoff, MD, MPH, Centers for Disease Control and Prevention

Camille Welborn, U.S. Department of Education

Barbara Bingham, U.S. Department of Labor

Brenda Lisi, U.S. Department of Agriculture

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Florida's agriculture commissioner's panflu planning guide

http://tinyurl.com/6p4pc8

Scott McPherson's blog is always a great read. This particular piece

is wonderful. The emphasis in this plan is on taking care of family first,

a concept that many nurses in the poll here at allnurses would relate to.

https://allnurses.com/forums/f8/will-you-work-during-pandemic-258506-21.html

Scott is the CIO for the Florida House of Representatives.

Placing families first, ahead of business concerns, is key to successful management of a pandemic. I cannot tell you how many panflu plans I have seen (or COOP/DR plans, regardless of event) that fail because they fail to take reality into account. That reality is that people's concern moves away from the business or corporation or government, and moves correctly into concern for family and the safety of the family. Once the family is secure and safe, then the consciousness moves back to the workplace.

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Toronto

Though cash-strapped, Toronto is going to purchase $1.5-million worth of

Tamiflu to treat up to 13,000 municipal employees in the event of pandemic

outbreak. Funny that the word HCW is not mentioned among the recipients.

They remember SARS just not who took care of the sick, and got infected

as a result?

http://www.flutrackers.com/forum/showpost.php?p=152521&postcount

=1

Toronto is the only major Canadian city stockpiling its own supply of influenza-

fighting drugs for its employees after learning from the SARS epidemic.

The decision follows the recommendation of Toronto's medical officer of health,

who said Toronto must act now given the long lag time involved in acquiring

Tamiflu, which is not a vaccine but one of the key drugs expected to be crucial

in the event of an outbreak.

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Another Possibility for Those Who Will Have No Access to Vaccines or Antivirals

http://www.thelancet.com/journals/laninf/article/PIIS1473309908700707/abstract?iseop=true

In countries where prepandemic vaccines are being ordered there will never be

enough for everyone, and we do not know how effective they will be. It is hoped

that they will give enough protection to prevent death, but it may be not enough to

prevent illness. Still being sick is better than being dead, imo. The unfortunate

truth is that there will be no vaccine or antivirals for most of the world's

population in the event of a severe pandemic. That tragic reality was the

impetus for this study. This abstract is suggesting a possible fix to what might

otherwise be a hopeless situation for many.

Statins, fibrates, and chloroquine are produced as generic medications in developing countries. They are inexpensive, could be stockpiled, and would be available on the first pandemic day. With a lack of realistic alternatives for confronting the next pandemic, research is urgently needed to determine whether these and other generic agents could mitigate the effects of what might otherwise become an unprecedented global public-health crisis.

Australia Gives Preliminary Thumbs Up On Two Vaccines

http://afludiary.blogspot.com/2008/05/australia-gives-preliminary-thumbs-up.html

The vaccines, called Pandemrix and Panvex, have become the first to reach the final step towards registration in Australia, the pharmaceutical bulletin Pharma in Focus says.

The Australian Drug Evaluation Committee has recommended the formulas, which both protect against the H5N1 strain of bird flu responsible for outbreaks of avian flu in Asia, the Middle East, Europe and Africa.

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Children, avian influenza H5N1 and preparing for the next pandemic

http://adc.bmj.com/cgi/content/abstract/93/5/433

Children will be affected at least as much as adults and may play an important role in amplifying transmission. Pharmacological and public health interventions focused on children will save lives through suggested community measures such as pre-emptive closures of schools, and need to be considered carefully, balancing benefits against negative consequences. Child health services will be hugely stressed by any pandemic but also have the potential to save many lives. The challenge will be to deliver core services in the face of major staff illnesses...

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An H5N1 Virus Neutralization Strategy

http://www.pnas.org/cgi/content/abstract/0801367105v1

The first confirmed human cases in Turkey occurred in early January 2006,

and gave Europe a wake up call. This abstract looks at using antibodies

from the survivors.

...we report the generation of combinatorial antibody libraries from the bone marrow of five survivors of the recent H5N1 avian influenza outbreak in Turkey.

The large number of antibodies obtained from these survivors provide a detailed immunochemical analysis of individual human solutions to virus neutralization in the setting of an actual virulent influenza outbreak. Remarkably, three of these antibodies neutralized both H1 and H5 subtype influenza viruses.

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Rationing Care during a Pandemic

http://www.flutrackers.com/forum/showpost.php?p=153921&postcount=1

Doctors know some patients needing lifesaving care won't get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.

Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

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Pandemic triage recommendations overdue, necessary, welcomed

http://tinyurl.com/4zr9pt

Wow! This is quite the thought provoking essay by Scott McPherson, CIO

of the Florida House of Representatives. Who gets treated in a category

5 pandemic, and who does not? When there isn't enough, who gets the Tamiflu?

Who gets that ventilator?

Sadly, I would have to agree with Scott on this one, but it would be a very, very

difficult choice. You and I are not going to be the ones who will decide this.

How would you choose? Look at the most at risk group. Read the essay.

Back in late 2006, HHS floated a trial balloon: Let the governors of the states

decide how best to distribute vaccine and antivirals during a flu pandemic, once

the first responders were taken care of. I sent my friend, then-governor Jeb Bush,

an email that included the balloon from HHS. I concluded in the missive,

"Jeb, Who do you vaccinate in a pandemic? Your future or your past?" I also told

Jeb that, blessedly, he would not have to make that decision -- but his successor

very well might.

The answer to my rhetorical question is very, very clear to me: It is whoever

is at highest risk. If it's 1918 all over again, I would not hesitate to treat and vaccinate the most vulnerable first, based on mortality: Young adults 18 to 40...

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