Disaster/Pandemic preparedness - page 27
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
Jun 4, '08Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741HHS Seeking Public Comment On Pandemic Guidance Documents
Quote from afludiary.blogspot.com
The HHS has just published 3 interim guidance documents on pandemic influenza and is asking for public comment on them between now and July 3rd, 2008.
SUMMARY: The Department of Health and Human Services (HHS) is seeking public comment on three draft guidances:
Interim Guidance on the Use and Purchase of Facemasks and Respirators by Individuals and Families for Pandemic Influenza Preparedness;
Proposed Guidance on Antiviral Drug Use during an Influenza Pandemic
Proposed Considerations for Antiviral Drug Stockpiling by Employers In Preparation for an Influenza Pandemic.
Jun 5, '08Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741Hawaii to screen international travelers for flu-like illnesses
Quote from www.flutrackers.com
The Hawaii Department of Health announced Wednesday that the state will implement a voluntary checkpoint screening process for international visitors to detect flu-like illness at Honolulu International Airport.
The program will span a one-year period and was made possible through a cooperative agreement between the Hawaii Department of Health and the Centers for Disease Control and Prevention in the amount of $289,000, the department said.
The Department of Health will collaborate with U.S. Customs and Border Protection, CDC, the Hawaii Department of Transportation and Hawaiian Airlines, the health department said.
Jun 9, '08Occupation: visiting nurse Specialty: Too many to list ; From: US ; Joined: Mar '06; Posts: 5,909; Likes: 1,741Prophylactic Antivirals For Health Care Workers
Commentary on two documents released by HHS last week follow.
Can you believe that they are recommending 12 weeks worth of
antivirals for us? Would our employers really do this?
It is the right thing to do, but seriously, there isn't enough Tamiflu
available. Read the link to see where most of the Tamiflu is going to be
Quote from afludiary.blogspot.com
...the most striking change is the recommendation that private sector
employers consider stockpiling prophylactic antiviral medications, particularly
if their employees will be at high risk of exposure.
That means Hospitals, EMS units, Fire Departments, and Law Enforcement
Agencies, among others.
Outbreak prophylaxis of front-line healthcare and emergency services
workers (fire, law enforcement, and emergency medical services [EMS])
is recommended because of their important role in providing critical
healthcare services, preserving health and safety in communities, the lack of
surge capacity in these sectors and the importance of reducing absenteeism
when demands for services are likely to be increased.
A strong recommendation that hospitals and emergency services provide
12 weeks of prophylactic antivirals to all employees who will have
direct exposure to infected patients.
Jun 10, '08PROPHYLACTIC USE OF TAMIFLU BAD IDEA, LEADING VIROLOGIST SAYS
Forget the prophylactic Tamiflu seems to be the message from this article
in Homeland Security Today. It's better to take Tamiflu 6 hours or
so after symptom onset, and hope it works.
Quote from hstoday.us/content/view/3741/150/(hat tip croftsblog)
The US government's new proposal to use drugs like Tamiflu and Relenza as
a prophylaxis to prevent infection by a pandemic strain of influenza is
wrongheaded, says Dr. Graeme Laver, a former professor of biochemistry
and molecular biology at the John Curtin School of Medical Research at the
Australian National University in Canberra.
Laver, who played a key role in the development of both drugs, has been
studying influenza viruses for nearly 40 years. He and Dr. Robert Webster
(another world-renowned virologist at St. Jude Children's Research Hospital)
are credited with having first found the link between human flu and bird flu.
... it is "much better to use Tamiflu only for early treatment. If people
with flu symptoms take Tamiflu immediately, say within six or so hours after
symptom onset, the infection should be rapidly terminated, the person
should recover, and then, and this is important, should then be immune to
reinfection for the rest of the pandemic. Much better than any vaccine.
This has been called 'Aborted-infection Immunization,' and to use Tamiflu in
this way would allow many health care workers and so on to go about their
business without fear of reinfection."Last edit by indigo girl on Jun 11, '08
Jun 11, '08http://afludiary.blogspot.com/2008/0...-proposed.html
Insightful commentary, as always from Avian Flu Diary on prophylactic use
of Tamiflu. He is right, of course about very few early recoveries. Most
of those that have survived infection with H5N1 were in the hospital for quite
some time. They were the lucky ones. Do you feel lucky? I don't...
I don't feel very trusting either when it comes to believing that the govt
can get that antiviral into our hands within 6 to 8 hours of symptom
Quote from afludiary.blogspot.com
...we haven't seen very many `quick recoveries' thus far.
One could argue that up until now most bird flu patients haven't received
the drug early enough - and that might well be true - but we don't have a
lot of evidence that Tamiflu administered early will be a panacea for
Health Care workers, particularly those with families, are going to have a
difficult choice deciding whether to work during a pandemic.
Jun 12, '08Baxter's Cell Cultured Vaccine
It appears that the future of vaccine technology is in using cell based
cultured vaccines rather than egg based. I am glad for the research
but feel uncomfortable with the use of monkey cells for this vaccine.
Let's hope that we do not need these vaccines soon because we
are not going to have them quickly, and there still will not be enough
for the global population.
Commentary from Avian Flu Diary on the two New England Journal of
Medicine articles on Baxter International's cell-cultured vaccine:
Quote from afludiary.blogspot.com
...a targeted vaccine cannot be produced until a pandemic strain is
identified, and using our current egg-based technology, it can take
another 20-28 weeks to produce the first batches of vaccine.
Second, our global capacity for creating vaccines using this egg-based
technology is limited. No one knows exactly how much we could produce
in a year, but estimates are that only enough vaccine could be produced
to inoculate 10%-15% of the world's population.
Jun 17, '08Public Health Planners Continue to See Problems With Fed Pandemic Plans
Flutrackers.com has posted this original article from Homeland Security
Today. In the event that the original article at HST is no longer available,
the information will be preserved at flutrackers.
There are tremendous problems addressed here. I can not imagine how
they can plan for all of these but I am thankful that they are acknowledging
that these critical issues must be tackled.
Quote from hstoday.us
Public health planners who work on seeing the big picture of preparedness
for a catastrophic event like a global pandemic say the government still
hasn’t gotten a handle on things like coping with continuity and security for
multiple critical resources supply chains and quarantine issues.
One seasoned public health planner said, “I think the reasoning may be
flawed in certain areas, particularly the lack of attention to critical
infrastructure, and lack of notation that poor/ethnic minorities may need
particular support from law enforcement, as their communities may be
most vulnerable to social disorder."
This authority also believes, as do others HSToday.us has heard from, that
the matter of quarantining hasn’t been adequately debated.
But “the largest issue,” the veteran planner said, “is we have yet to describe
the common operating picture we need during a global catastrophic event.
Death and illness will not themselves describe the impact. [We haven’t
adequately addressed] the ability to keep oil flowing from the North Slope [to]
ensure the west coast has gas, potassium from Guam ensures we have
fertilizers, commercial flights from Asia ensure there are critical parts for
Internet servers.The complexity of supply chains is far beyond the
imagination of the public health planners, we almost need a futures market
for information.”Last edit by indigo girl on Jun 18, '08
Jun 21, '08Occupation: Registered Respiratory Therapist!!! Specialty: 8 year(s) of experience in ER, ICU, ; From: US ; Joined: Jun '08; Posts: 101; Likes: 77New here but thought i would put my 2 cents in. I am not only in hurricane ally i was in katrina's path. I worked during katrina. I was not worried about my family. (they evacuted up north) I was not worried about my safety.
I spoke with my husband that morning. My house was flooded. Once the stoem hit, power went out, (generators died on day 2), WE had 7 vented adults, and 7 vented nicu pts. and 7 RTs on duty!!! The windows started to blow. pts were stranded in their rooms. the pressure from wind blew doors shut. we couldnt open them. it was awful! Then when the winds slowed, the locals started walking in. barefooted, naked. They were swept out of their houses and clothes. covered in mud and debri. Each person had a story. A sad, scarey story. It was one of the most horrible things I have ever been through. The whole time knowing my own house was destroyed.
things I wish could have happened:::
*hosp keeping us informed
*hosp not being full of pts
*evacuate pts from rooms with windows before storm starts.
*large O2 cylinders being placed on each floor before elevators stop working!! 5 stories of stairs!!!!!!
*Our dept head finding us a place to shower before storm
As far as being prepared. My suggestion is what ever you get ready put it in the top of the closet!! In a water proof container!! And, just incase your house gets washed away...write your name and address on container!! LOL! I always thought I was prepared. boy was I wrong!
Water, baby wipes, hand sanitizer, bleach,extra clothes, shoes (not crocs)zip loc bags, dog food,
the list is so long. I dont think you can ever be prepared enough.
Jun 22, '08AMA Now Supports Personal Rx Stockpiling For Disasters
Quote from www.ama-assn.org
Personal medication supply in times of disaster: Earthquakes, hurricanes
and floods have headlined recent news reports. This new policy supports
allowing all patients with chronic medical conditions to maintain an
emergency reserve of prescription medications. It also encourages patients
to carry a list of current medications and the prescribing physician's contact
information with them to ensure continuity of care in the event of a disaster
or other emergency.
"There are more than 125 million Americans living with chronic illnesses who
rely on medication," said AMA Board Member Steven Stack, MD. "Disasters
can happen at any time, and ensuring that patients with chronic conditions
have access to needed medications may help minimize the uncertainty,
confusion and health risks following a disaster."
Jun 24, '08Example of Citizen Education for Disaster/Pandemic Preparation
Nez Perce County in Idaho has developed the type of program that is
urgently needed across the country. Using citizen volunteers from the
community to check on neighbors and offer education and assistance in
advance of any disaster makes sense. Everyone gets educated as to
what the risks are and how to minimize them with regards to a pandemic
situation as well. This is an excellent all hazards approach that any
community could use with success.
Quote from afludiary.blogspot.com
Produced by the Lewiston - Nez Perce County Office of Emergency
Management, and the Idaho North Central District Health Department -
this 34 page PDF file provides an excellent template for any community to
begin creating their own neighborhood disaster response.
NET, or Neighborhood Emergency Teams, are designed for an `all threats'
response. Prime among those, however, is the threat of a pandemic or
other communicable disease.
The ability of every community to mount a daily, door-to-door check of its
citizens during a prolonged disaster such as a pandemic will be paramount
if the maximum number of lives are to be saved. For most communities,
volunteers will be needed.
Jun 24, '08Posted with permission from Effect Measure.
The problem of testing the effectiveness of bird flu vaccines
Quote from scienceblogs.comThe Editors of Effect Measure are senior public health scientists and
There is a great deal of activity on the bird flu vaccine front. Several
different new techniques to make vaccines are being tested and so are
additives to vaccines, called adjuvants, that boost the ability of the
preparation to induce the body to make sufficient antibodies to protect
us against infection. The smaller the dose needed for protection, the more
people can be vaccinated for a given amount of production. Since we are
talking about enough productive capacity to vaccinate a significant proportion
of the world's population in the event of a catastrophic pandemic, this is
obviously a critical issue. When it comes to bird flu, the subtype of
influenza A in birds designated H5N1, there is a special problem in
determining whether the vaccine is effective or not and at what dose.
Since a pandemic strain of H5N1, one that transmits easily from person
to person, has yet to develop we can't test to see if the vaccines really
protect against infection in people. It is clearly unethical to infect people
experimentally with existing strains. Current case fatality ratios are over
60%. So how do we know if the vaccines now being developed and tested
will work or not?
If "work" means, protect against infection in a pandemic, we don't. The
best we can do is guess, based on the biology. Vaccines are designed to
raise antibodies against the invading virus. There are different kinds of
antibodies but the ones we are most interested in are the ones that
neutralize the ability of the virus to infect human cells. They are called,
naturally enough, neutralizing antibodies. We test for them in cell culture
systems, seeing whether antibodies produced in healthy test subjects are
sufficient to prevent infection in animal cells. Doing this requires a protocol
and measurement procedure.
It turns out there is no standardized way of doing this. That means that
comparing the effectiveness of the different vaccines depends on two
uncertainties. One is the overall problem of the relationship between a
measurement of neutralizing antibodies in a cell culture system and the
desired ability of that level of antibody to protect against infection in
human beings during a pandemic. This isn't a pure guess. We have some
information about this from seasonal influenza. The other is how the
measurement of antibodies is made. There are different ways to make
the measurement and often slight variations in the test procedure will
produce very different answers.
Canadian Press's Helen Branswell has an interesting piece on this
A study comparing the tests being used by vaccine manufacturers to
gauge the effectiveness of their H5N1 avian flu vaccines shows there
is a lot of variation in the sensitivity of the tests, the British scientist
leading the effort says. Differences in the sensitivity of the tests mean
companies could be underestimating or overestimating the power of their
vaccines as they try to work out what is the smallest protective dose,
As things stand now, there is no way to usefully compare the results of
one company's clinical trials for their vaccine with a competitor's findings.
"If Company A's assay (test) happens to be 10 times more sensitive than
Company B's, Company A and Company B could be evaluating the exact
same thing but reach different answers about whether they worked or
not," says Dr. John Treanor, a vaccine expert who knows of the study but
is not involved in the work. (Helen Branswell, Canadian Press)
Branswell was reporting on a study in progress by Dr. John Wood at the
UK National Institute for Biological Standards and Control that is
attempting to establish an international standard. Variation aside,
effectiveness is measured in terms of the antibodies it produces in trial
subjects, not a demonstrated ability to prevent infection during a
pandemic. That's the best we can do at the moment and probably it is
good enough. We hope.
Meanwhile work on producing an effective vaccine or vaccines moves
forward. The intensity of the work by many companies suggests that
while the threat of bird flu has moved off the front pages of our
newspapers, it is still considered a likely threat by commercial interests
in the pharmaceutical industry.
Make of that what you wish. To me and most flu experts, it seems a
pretty worthwhile wager.
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.
Jun 26, '08Dr. Osterholm At The Vancouver Conference
Dr. Osterholm looks at the bigger picture. We are dependent upon
trade, but our supply lines are fragile. They are likely to fail given
a severe global pandemic. That is the bottom line that few are
willing to acknowledge.
Quote from www.canada.com
North American pandemic planning hasn't factored in its dependency on
Asian markets, Osterholm told attendees to the "Are You Ready for
a Pandemic?" conference.
The impending pandemic will most likely originate in Asia, the
"roulette table" for serious H5N1 flu virus genetic mutations that cause
pandemics, warned Osterholm. If that happens, trade supply lines
will die along with the influenza's victims, he added.
But international influenza researchers predict the next pandemic will
be similar to the 1918-19 Spanish Flu, which killed more than 40
The next pandemic will be global in just weeks and will last 12 to 18
months, Osterholm said, although noting that the economic effects
will be instantaneous.
The problem is that pandemic planning in North America has been
based on all other factors such as trade and electricity being normal,
but that won't be the case, said Osterholm.
Jun 27, '08Pandemic Drill In Laurel, Maryland
A very interesting pandemic drill with some very innovative
ideas from the community of Laurel, Maryland.
Quote from www.gazette.net
Instead of knocking on every door, or relying on telecommunications
that might be down, officials distributed hundreds of placards to
households to display on their front door or window.
Residents could display the number of ill in a household, along with the
total number of inhabitants.
Monitoring crews, equipped with wireless PDA's and binoculars, drove the
neighborhoods and entered in the information which was used to print
Rx labels for needed medications.