Disaster/Pandemic preparedness

[LMonty911]

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

[indigo girl]

Posted with permission from Effect Measure.

The problem of testing the effectiveness of bird flu vaccines

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

problem:

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,

experts admit.

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.

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.

[indigo girl]

Dr. Osterholm At The Vancouver Conference

http://afludiary.blogspot.com/2008/06/dr-osterholm-at-vancouver-conference.html

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.

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

million people.

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.

[indigo girl]

Pandemic Drill In Laurel, Maryland

A very interesting pandemic drill with some very innovative

ideas from the community of Laurel, Maryland.

http://afludiary.blogspot.com/2008/06/pandemic-drill-in-laurel-maryland.html

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.

[indigo girl]

When It Comes to Preparedness, the Ball Is in Our Court

Excellent analysis from Avian Flu Diary. There is so much worth

reading in this one piece.

I pulled out only the one section on the suggestion that families

should stockpile their own Tamiflu.

http://afludiary.blogspot.com/2008/06/ball-is-in-our-court.html

...the working group has determined that the number of courses of

antivirals the United States needs on hand for a pandemic would be

at least 195 million.

Roughly 2.4 times more than the government intends to purchase.

They urge that the private sector, mostly businesses - but `families and

individuals as appropriate' - stockpile the rest.

This would provide:

6M doses for deployment overseas to try to stop an outbreak

79M treatment courses for the infected here in the United States

103M courses to provide prophylaxis for healthcare and emergency

service workers

5M courses for outbreak control in Nursing homes, prisons, and other

closed settings

2M courses for people who are severely immuno-compromised

With an anticipated Federal and State Stockpile (currently lagging behind

the goal) of 81 million courses, this means that the private sector would

have to make up the 114 million course shortfall.

[Ayrman]

The ball is indeed, as they say, in our court. My wife suffers from an innumo-compromised condition that has the past few months caused her health problems. Looking ahead to what may lay in the future we've begun to stockpile her medications in earnest, including Tamiflu. An interruption in the supply system would open the door for opportunistic infection, and we have already seen what that means in her case.

No thank you, I will not sit idly by and wait for the lines to form and prices to react to increased demand along with shortages caused as much by the inability to move the supplies to the areas of highest demand as any actual production shortfalls.

Ayrman

[Laidback Al]

indigo girl posted the following link to a home care toolkit from cidrap in january of this year.

important information from cidrap:

promising practices for pandemic planning

toolkit provides guidance on home care for the sick

http://www.cidrap.umn.edu//cidrap/content/influenza/panflu/news/jan0208homecarepp.html

this portal, promising practices-pandemic preparedness tools, has been updated since then and there are a variety of links and sources relevant to health care workers.

http://www.pandemicpractices.org/practices/article.do?page=home

welcome

this project aims to enhance public health preparedness for an influenza pandemic and conserve resources by sharing promising practices.

cidrap and the pew center on the states (pcs) launched this initiative to collect and peer-review practices that can be adapted or adopted by public health stakeholders. the project was conceived and funded by the pew charitable trusts.

this collection of more than 150 practices represents a yearlong effort. our advisory committee, composed of state and local public health experts in pandemic influenza preparedness nationwide, selected the categories and topics at left.

pandemic planners and others submitted materials, chiefly via surveys. the practices in this project come from 25 us states and 37 counties & cities. if your agency isn't included (click on the map to check) you can still submit practices.

[indigo girl]

A Quick Response to a Flu Pandemic

http://online.wsj.com/article/SB121496565961221997.html?mod=googlenews_wsj

Why not make it easier for Americans to get Tamiflu for their families,

this Professor of Pharmacy Administration asks? It sure isn't easy now.

Why not simply have the Food and Drug Administration waive the

requirement of a physician's prescription for the drug? That way every

American can make his or her own decision about purchasing a

medication that could save their lives and those of their families in the

event of a true public health emergency.

A new behind-the-counter (BTC) class of drugs available through

pharmacies that is currently being considered by the FDA would seem

to be a viable mechanism for optimizing consumer access while ensuring

an appropriate degree of distributive control...

[indigo girl]

HHS Webcast Next Week - home healthcare delivery during a pandemic

http://afludiary.blogspot.com/2008/07/hhs-webcast-next-week.html

This is scheduled for after the long weekend. The national pandemic

plan calls for most people to be treated at home, not in the hospital

perhaps making this one of the most essential topics for families.

That this topic would even need to be discussed, points to the concern

about the ability of the healthcare system to cope with large numbers

of flu victims.

If you missed any of these webcasts, they will be archived for later

viewing.

Key topics:

Assumptions that need to be considered when assigning a care-giving

role to home care agencies during a pandemic

Operational, ethical and legal challenges pandemic planners will face

Strategies home health care agencies can employ to overcome these

challenges

[big-chicken]

A MA hospital is sending letters to all employees regarding an emergency preparedness grant that the Hospital recieved from the Dept of Homeland Security. In order to be prepared for an outbreak of contagious disease, they are requiring all emplyees to complete a questionaire. They are required to list the names of all persons living in their house-holds and any persons they have close contact with. In the event that an infectious disease is brought into the hospital, the employees and their families would be required to be screened and placed on antibiotics.

I understand the hospital's need to be prepared for this sort of thing, however I do see some problems that could result from having to provide all this info to the hospital.

Has anyone experienced this?

big-chicken

[indigo girl]

A MA hospital is sending letters to all employees regarding an emergency preparedness grant that the Hospital recieved from the Dept of Homeland Security. In order to be prepared for an outbreak of contagious disease, they are requiring all emplyees to complete a questionaire. They are required to list the names of all persons living in their house-holds and any persons they have close contact with. In the event that an infectious disease is brought into the hospital, the employees and their families would be required to be screened and placed on antibiotics.

I understand the hospital's need to be prepared for this sort of thing, however I do see some problems that could result from having to provide all this info to the hospital.

Has anyone experienced this?

big-chicken

Interesting, but I have heard nothing about this.

[indigo girl]

Fort Detrick unit to track diseases that affect U.S.

http://www.flutrackers.com/forum/showpost.php?p=167350&postcount=1

Bird flu is just one of many possible problems that they are tracking.

Even before yesterday's name change, the center had begun to focus

more broadly on epidemics that could enter the United States,

endangering civilians as well as government personnel, he said.

For several years, it has written "predictive reports" on avian flu, a

strain of influenza spread by birds that has also killed more than

220 people, most of them in Southeast Asia and Indonesia.

[indigo girl]

Pandemic Impact vs Duration

http://afludiary.blogspot.com/2008/07/long-and-short-of-it.html

The choices that CDC, HHS, and other involved govt agencies have made

for the national pandemic plan are based in part on our past history of

what worked and what didn't in 1918. Then as now, there is no vaccine.

We do have Tamiflu, but not nearly enough.

One of the less frequently mentioned aspects of a pandemic is that the

better job we do of lessening it's impact and slowing it down, the longer

a pandemic wave is expected to last.

With insufficient antivirals, and no prospects of a targeted vaccine during

the first pandemic wave, our national strategy is to slow down the virus

through the use of NPI's, or Non-Pharmaceutical Interventions.