Pandemic News/Awareness.

indigo girl · Feb 2, 2007

Hello, indigo girl,
(I'm sure you remember our private conversation about this topic a few weeks back;) )
I thank you for your time and effort presenting the facts to us here at allnurses.com.
You touched on one plan of action regarding the public and their jobs. One thing that will have to be in place is job security. As we all know, to stay in house for "12 weeks" will seriously jepordize any job for any one person. Each and every employer will have to have a plan of action in place that offers job security. (yes, I realize this might be a moot point should all out pandemic hit and over 70,000,000 million succumb).....
Again, thank you for the links and a HUGE thank you for your explanations and the ability to break down this information for us.

Siri, of course I have not forgotten our conversation which as you have pointed out, was private and not part of a panflu thread. You are very welcome to the information. I will try to make it more accessible for everyone, but I truly do need feedback. If your eyes are glazing over, let me know.

You are on target, of course, about the issue of job security. Dept of Labor is addressing this. One of the reporters asked specifically about employers continuing to pay their employees if they had to stay home. He also asked about the government giving unemployment insurance. None of these questions were answered very well. But, the conversation is just beginning. The Harvard Study that was done addressing these questions indicated that most people can not afford not to work. It's a dilemna. Every business will have to have a plan. Another issue, even people who work for mortgage companies have mortgages to pay also. Perhaps they will consider a temporary freeze for everyone.

It's unfortunate for all of us that we will have to deal with this in our lifetime, but it's the reality. We are on precious, borrowed time, and we must get ready. Perhaps it will only be a low category of pandemic if we get very, very lucky.

indigo girl · Feb 2, 2007

.
A recent article I ran across stated that some studies on the 1918 flu pandemic indicate that one possible reason it was so deadly and targeted so many healthy individuals was that something about it triggered an over-reaction in the immune system. This in turn caused a person's body to fight itself to death, after the actual infectious organism had been subdued. If there is any truth to this, it's a frightening thought. Have you heard any of this?

The cytokine storm is what this complication is called. This is what is happening with H5N1 victims right now. They die of multi-organ failure. I am going to post a link that describes a drug trial that had the unintentional effect of putting the volunteers into cytokine storm. Some of the explanation is complicated.

I am going to highlight the pertinent parts so that you can see what happened to them, and won't have to read the more difficult parts unless you choose to.

The reason why the victims of avian flu are generally young people under age 40, is because they have stronger immune systems that will react as described below.

The median age of victims in 1918 was age 27, and this is about the same now with

H5N1.

I would also like to point out that I think at least one of the pediatric cases in Alabama had these symptoms. I don't know this for sure, but from sources that have read what the family is saying, the symptoms were very close to this. That is why I keep asking about pediatric flu cases in ICU. Additionally, I just found out that there were 9 kids in ICU from influenza in Alabama. Reuters just corrected the information from 9 that died to 9 cases. The first pediatric case became ill just after Thanksgiving. She was ventilated, and eventually put on ECMO. She is still ventilated and getting dialysis.http://today.reuters.com/news/articl...2_healthNews-7

http://scienceblogs.com/effectmeasure/2006/10/a_cautionary_tale_about_cytoki.php

In the spring of this year the drug was tested on humans. Six subjects received doses of the drug lower than given the animals because this was a safety trial. This is what happened:
Around 60 to 90 minutes after the men received their injections, their bodies were flooded by a surge of inflammatory chemicals called cytokines, which combat severe infections like those seen in patients with blood poisoning. The cytokines caused severe inflammation.
1 hour - simultaneously, the six men begin suffering excruciating headaches, shivering, back pain, gut pain, diarrhoea, swelling and nausea
4 hrs - all have fevers, are flushed, their blood pressure drops dangerously low and their hearts start to race. Blood tests show their lymphocytes and monocytes are fast vanishing.
5 hrs - one patient begins fighting for his breath. All suffer lung pain. They are all given steroids and other medications to ease inflammation.
12 hrs - the patient fighting for his breath is so bad that he has to be taken into intensive care and put on a ventilator to keep him alive.
Suntharalingam [physician supervising the trial] decides to take all the volunteers into intensive care as a precaution.
24 hrs - two people are on ventilators, and the four others need support with breathing.
48 hrs - the four least affected men start to recover, but all six begin to suffer multi-organ failure, and have to be attached to kidney machines, one of them for a fortnight.
Thereafter, the men began to recover and their lymphocyte and monocyte counts began to creep up again. (New Scientist)

Laidback Al · Feb 2, 2007

.... What does all of this mean to you? Why should the rest of us be concerned?
Please, give us something to go on other than mounds of indigestible data.

I am not indigo girl and I am not a nurse. But I’ll attempt to answer the question.

You need to be concerned because a pandemic is inevitable, it may be tomorrow, it may be next year, or it may be decades from now. There is no way to know. But it will come and it will be devastating.

Because of the recent research on the 1918 pandemic, we know that the 1918 pandemic was a result of an avian influenza virus that apparently made the jump directly to humans. Right now, today, the mostly likely candidate virus for a worldwide pandemic is H5N1. It is an avian influenza virus and has already killed more than 160 individuals in more than 10 countries around the world. Most of those deaths were probably caused by a cytokine storm as described in the above posts. More importantly, however, is the CFR or Case Fatality Rate of the H5N1 infections, that is the percent of people who die after contracting the virus.

As of today, based on WHO data, the CFR is 60%. That means that 6 out of every 10 people that contract H5N1 are dying. Will this number go down once a pandemic starts? Will fewer people who contract the virus die once it starts to spread rapidly? Who knows, there are arguments both ways. But one should always be prepared for the worst.

Those of you who are nurses know better than I do how often people can contract influenza through their family members, friends, neighbors, and random contacts. Think of the sickness and colds going around in your family and friends and ask yourself "how would I react if 6 out of each of these 10 sick individuals I know died?"

To cope in a pandemic you need to anticipate the event and understand the consequences. First, you need to determine how you will respond as an individual. Now is the time to examine what your own goals and motives might be once a pandemic starts. You need to ascertain what you will do to protect yourself and your loved ones. Then, given your chosen profession as a nurse, you will need to decide how you will apply your training and experience in the event of a pandemic. Nurses have skills, knowledge, and abilities that are not available in the general population. Those skills will be important during a pandemic and even more important after a pandemic.

You don’t need to make a decision today about your position on Avian Influenza. But best management practices dictate that you urge your clinics, hospitals, and other health care facilities to stock up on PPE. Expend the extra dollars now, while there are still supplies to be obtained. PPE will make a difference to HCWs once a pandemic starts. Increasing stockpiles of PPE may over-extend budgets today, but those extra PPE will be necessary when a pandemic strikes. Maybe not tomorrow, maybe not next year, but sometime, sometime in the future, they will be necessary to protect you and the lives of your coworkers once a pandemic starts.

cactus wren · Feb 2, 2007

Why should nurses and all HCW be concerned about Panflu ?

60% of those people whi have contracted it have died despite recieving ICU care.

We have nowhere near enough ICU beds or even MS beds to deal with what would be needed in an outbreak. IMO,within 2 weeks of an outbreak hospitals will be providing care at a 1918 level. That means holding someone`s hand as they die, wiping a fevered brow, cleaning up code browns, etc. There will be no IVs, no meds, no nothing which we expect as a HCW in 2007.

Another point, in 1918 the fataality rate in young,healthy pregnant women approached 100%.

Are YOU going to work with no PPEs,no meds, no supplies, and every day face the risk of acquiring this ,or worse taking it home to your loved ones? I`m not.

indigo girl · Feb 2, 2007

Why should nurses and all HCW be concerned about Panflu ?
60% of those people whi have contracted it have died despite recieving ICU care.
We have nowhere near enough ICU beds or even MS beds to deal with what would be needed in an outbreak. IMO,within 2 weeks of an outbreak hospitals will be providing care at a 1918 level. That means holding someone`s hand as they die, wiping a fevered brow, cleaning up code browns, etc. There will be no IVs, no meds, no nothing which we expect as a HCW in 2007.
Another point, in 1918 the fataality rate in young,healthy pregnant women approached 100%.
Are YOU going to work with no PPEs,no meds, no supplies, and every day face the risk of acquiring this ,or worse taking it home to your loved ones? I`m not.

Out of supplies? Good point if no one has thought to stockpile. I know the PPE's will be gone. I wonder if anyone has thought about adequate laundry supplies, and how they will get non-nursing support staff to come to work.

Someone has to provide food, housekeeping etc. to healthcare facilities.

A 12 week first wave of infection will seem like an eternity. How will we be able to do this?

indigo girl · Feb 2, 2007

Truthfully, I go back and forth about what I would do. I want to help, but I know that many places where I work, the PPE is inadequate. I don't think that I should sacrifice myself. Once the PPE is gone, I will probably be gone also. I think most nurses will agree with that.

The issue of mothers with kids, personally, I think you should stay home with your kids. Pregnant women, absolutely should not work, because they are at the highest risk.

Do you know that the public is assuming that we will volunteer to work?

I read this over and over again. It is a prevalent belief everywhere. Does it never occur to them that we might not? All the panflu plans that health departments are making, assume that we will be working. Has any government or private agency ever thought to ask the nurses directly what we will do? All this planning is taking place for healthcare, but we seem to have no place in decision making. Why is that?

Don't any of you want to have a say about this? You will be doing the work, and incurring the risk. You should be part of decision making.

oramar · Feb 2, 2007

They mentioned on news that there is a new scale out sort of like the way they rank hurricaines and earthquakes. This will rank severity of flu outbreaks. I hope to see a link here soon.

gr8greens · Feb 2, 2007

I've been reading these Pandemic flu threads for a while........Indigogirl has done an excellent job of posting relevant links. Some of the best info on the flu....avian and/or pandemic.....can be found on other forums for one's own education........I mean some really good stuff. Try PFI.com, Fultrackers.com. The one called Fluwiki is tough to navigate for me, but great info is there.

As hospital nurses, this thread should be relevant to us. Trying to get the proper PPE's to the floor for your occasional TB pt can be a hassle. Imagine needing multiples! I've approached our ID docs about a flu pandemic....and was told that it's only a matter of time. As for avian flu pandemic....he didn't say anything definate....but shook his head as if saying, "who knows"? Personally, that's some pretty eye-opening stuff. :scrying:

indigo girl · Feb 2, 2007

Which countries are researching possible vaccines and/or treatments? How close have they come to developing either? Will this prove to be like the current flu vaccines which morph every year into a new form that requires subsequent vaccination?

Here is an example of what is going on regarding vaccines for H5N1, lots of secrecy, lots of money to be made:

http://www.abc.net.au/am/content/2007/s1838108.htm

Sadly, it's all about money, again. China has a vaccine, and there was a closed door meeting just a few days ago with the WHO, supposedly about that vaccine, and other developments, one presumes. We hear about various Asian countries working on vaccines, but no one knows if they are effective or not. At least one of the big European companies is working on it. The Swiss, supposedly have ordered enough for all of their citizens, but it is a small, wealthy country. I think Sanofi-Pasteur is the manufacturer.

Just like seasonal flu, H5N1 is mutating, and forming several clades, and sub-clades. Experts are saying that you will need two jabs for maximum protection since this is a novel virus that none of us have any immunity to. There is no guarantee that you will not get the flu, but it hopefully will prevent mortality. I noticed that the CDC did not mention this yesterday in their conference.

For most of us, it will be at least six months into a pandemic before we will see a vaccine.

I think I posted a link in the last thread about a company in Alabama that is

developing an IV form of antiviral. That is the only new development in antivirals. Tamiflu, Relenza, amantadine, that's about it for tx options.

We don't even know if H5N1 is the virus that WILL become pandemic. We only know that we are overdue for a pandemic, and that they happen every 30 to 40 years. It's looking like a serious contender though, and keeps spreading despite the best efforts of modern countries like Korea and Japan. Forget stopping it in densely populated poor countries like Indonesia, and Nigeria. Nigeria is a really big concern. It is a matter of grave concern if it can not be slowed down or stopped there. We are just trying to buy time with the culling of poultry and other infected animals. The more time we have, the more we can prepare our people, our businesses, and the economy to survive this if it is turns out to be a category 5 event. The fear is that H5N1 with its devasting case fatality rate, will be a category 5 event. That is why we become more vigilant when we see instances of cases where human to human transmission have occurred. This may have happened in Nigeria, but it is not confirmed, just suspicious because of the dates.

Then we had this announcement:

http://public.cq.com/docs/hs/hsnews110-000002442447.html

The federal government has declared a potential pandemic emergency, prompting liability protection for avian influenza vaccine manufacturers.
The declaration says there is “credible risk that the spread of avian influenza viruses and resulting disease could in the future constitute a public health emergency.”
The notice is expected to help persuade manufacturers of pandemic vaccines and countermeasures to contract with the government, without fear of liability if their drugs are misused or have unknown effects.
“The big news is that you now have a very strong pronouncement by [the Department of Health and Human Services] that the threat of the avian flu pandemic is significant,” said John Clerici, a biodefense consultant.

cactus wren · Feb 2, 2007

Nigeria is now testing 11 more people for HN51. They report that these folks have had contact with those ones that died. Scary !

Have any of you thought about where that IV bag you just hung was made? Probably not here in the USA. And, when our Just in Time economy breaks down?

Not only do hospitals have no room to stock stuff for a 3 month "wave", there isn`t a 3 month supply to be had.

CDC is downplaying the use of N95 masks to the general public because there is already a shortage. With only a couple of plants making them already producing at full capacity, none to spare.

I have talked to some nurses that are buying their own personel stock of them.

indigo girl · Feb 2, 2007

Nigeria is now testing 11 more people for HN51. They report that these folks have had contact with those ones that died. Scary !
Have any of you thought about where that IV bag you just hung was made? Probably not here in the USA. And, when our Just in Time economy breaks down?
Not only do hospitals have no room to stock stuff for a 3 month "wave", there isn`t a 3 month supply to be had.
CDC is downplaying the use of N95 masks to the general public because there is already a shortage. With only a couple of plants making them already producing at full capacity, none to spare.
I have talked to some nurses that are buying their own personel stock of them.

I noticed in that audiocast from CDC yesterday that when a reporter asked about how people should prepare, that masks really were downplayed. Yet, they said that they expected most people to be treated at home unless they were really sick. How do they expect family members to protect themselves without something as basic as a mask? I am sure that there are not enough to go around, however, should the general public get serious about prepping and try to purchase enmasse.

gr8greens · Feb 2, 2007

Nigeria is now testing 11 more people for HN51. They report that these folks have had contact with those ones that died. Scary !
Have any of you thought about where that IV bag you just hung was made? Probably not here in the USA. And, when our Just in Time economy breaks down?
Not only do hospitals have no room to stock stuff for a 3 month "wave", there isn`t a 3 month supply to be had.
CDC is downplaying the use of N95 masks to the general public because there is already a shortage. With only a couple of plants making them already producing at full capacity, none to spare.
I have talked to some nurses that are buying their own personel stock of them.

PPE's are a BIG component of whether or not a majority of HCW will stay on the job. I like to believe most will stay on the job until those masks, gloves and gowns are gone. Then, personally, I'll take my chances on losing that job and go home to care for my family.

On another note.....how many negative pressure rooms are available? In my 225 bed facility, we only have 20. How many vents does any facility have at any given time? We have approx. 30.....but not everyone is qualified to care for vented pts.

For those of us that are curious about how prepared our facilities are, we should ask the nurse/ MD in charge of infection control. The answers may scare you.