Pandemic News/Awareness.

indigo girl · Jan 30, 2007

Commentary on Tamiflu resistance in recent mortalities in Egypt. Viral

sequences obtained prior to starting Tamiflu, indicate very clearly that the

resistance to this antiviral existed in the virus infecting these patients prior

to treatment:

http://www.recombinomics.com/News/01300701/H5N1_N294S_Prior.

html

[quote name=www.recombinomics.com/News/01300701/H5N1_N294S_Prior.html

"]http://www.recombinomics.com/News/01300701/H5N1_N294S_Prior.html]

The detection of N294S in the two pre-treatment samples raises concern on

the distribution of this polymorphism in bird or mammalian reservoirs. Last

season Qinghai H5N1 migrated through Europe, the Middle East, and Africa.

Since N294S was not in prior Qinghai sequences in Egypt, it appears to be a

relatively new acquisition via recombination.

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Nigeria, the difficulty with testing is that sometimes a negative result is not

really negative:

http://www.recombinomics.com/News/01300702/H5N1_Lagos_Equivocal.

html

indigo girl · Jan 30, 2007

Info on CDC Press Briefing, Audio Webcast 1 Feb 2007

http://afludiary.blogspot.com/2007/01/cdc-press-briefing-audio-webcast-feb.html

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This takes a long time to load, but is very detailed and informative about the cases in Indonesia with histories, lab work, x ray results, etc. Don't look if you don't want serious detail about the disease process:

(hat tip PIF/frenchiegirl)

http://www.litbang.depkes.go.id/download/simpnas/makalah%20utama/FluBurungSoeroso.pdf

indigo girl · Jan 31, 2007

Indonesian govt may declare bird flu outbreaks to be a national disaster:

(hat tip flutrackers/niko)

http://www.bloomberg.

com/apps/news?pid=20601203&sid=afb8VWDBzPvs&refer=insurance

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More on that closed door Beijing Conference:

http://afludiary.blogspot.com/2007/01/more-on-beijing-conference.htm

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About Nigeria and those supposedly negative test results, well at least one case

was not really negative after all. It is possible that at least one of the other cases, the girl's mother is also positive. They both died of influenza. Are we to believe that they died of two different types of flu? Not likely... (hat tip flutrackers/dutchy)

http://www.alertnet.org/thenews/newsdesk/L31736640.htm

http://www.recombinomics.com/News/01310701/H5N1_Lagos_Confirmed.html

http://www.flutrackers.com/forum/showpost.php?p=62178&postcount=13

The Nigerian cases may be very important. As more information becomes available, there are more questions that beg to be answered:

http://www.fortwayne.com/mld/newssentinel/news/local/16588779.htm

(hat tip flutrackers/niman)

http://www.fortwayne.com/mld/newssentinel/news/local/16588779.htm]
ABUJA, Nigeria - Health officials reported Nigeria's first cases of bird flu in humans Wednesday, saying one woman had died and a family member had been infected but was responding to treatment.

Look at the dates of infection: Index case dies January 4, daughter of index cases dies January 17, family member responding to tx on January 31.

As Dr. Niman has pointed out at Flutrackers today, this is looking like human to human to human transmission has occurred. No one has confirmed this officially, however.

But, it does look suspicious, and this would be a very serious problem.

indigo girl · Feb 1, 2007

Migrating Tamiflu Resistance in Qinghai H5N1:

http://www.recombinomics.com/News/01310702/H5N1_Tamiflu_Migration.html

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Can't think of a worse possible place for this to happen:

http://afludiary.blogspot.com/2007/01/nigerian-side-step.html

http://afludiary.blogspot.com/2007/01/nigerian-side-step.html
The war against this virus, through happenstance, must be fought, and won or lost in developing countries around the world. Failure to contain the H5N1 virus there will mean it will spread to other nations and increase the risks globally. It may one day achieve the ability to spread H2H (human-to-human), and produce a pandemic. Until that happens, there is still a chance of containment.
Hopefully Nigeria will be a wakeup call; to nations to look more closely at their own risk factors, and to the International community to do more to support their efforts.
The time has come though, to stop looking the other way.

indigo girl · Feb 1, 2007

Another source of information on pandemic influenza is a hugh

site, Fluwiki started by a group of people including the Reveres, senior public health officials posting at Effect Measure, and Dr. Greg Dworkin, pediatric pulmonologist, (DemfromCT). This is a large collaborative effort that includes many other people. Here is the home page link:

http://www.newfluwiki2.com/frontPage.do;jsessionid=C3A1A6AEC13A10157E6195683B4276AF

You are encouraged to explore and learn as much as possible to contribute to your own safety and that of your community.

There are other very good sources of info on pandemic flu. There are links throughout this thread and the prior flu threads leading to these other sites.

rn/writer, RN · Feb 1, 2007

It might be easier to get something out of your posts if you summarized the point of each of the links. Maybe it's just my tired brain, but I don't have the time or the patience to wade through page after page of jargon.

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.

indigo girl · Feb 1, 2007

It might be easier to get something out of your posts if you summarized the point of each of the links. Maybe it's just my tired brain, but I don't have the time or the patience to wade through page after page of jargon.
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.

OK, Miranda,

If I am understanding you correctly, you are asking for each post to contain more basic info, and to make it understandable as to how this will impact nursing.

If that is the correct interpretation of your post, I would respectfully like to suggest that something more than just this is going to be needed, such as a

specialized forum for pandemic flu information with different threads for different flu topics. This is a very complicated subject. Nurses should not have to go to non-nursing forums for this type of information. They should also be able to discuss their concerns and get support, right here at allnurses. Working with only one thread, I have been forced to lump the topics together, and I take responsibility for the difficulty any reader would have making sense of this information in this format. There is no way to organize information in this limited format. I can interpret each piece of information for readers, but would it not be better to educate colleagues to interpret for themselves what the information is saying, rather than anyone having to take my word for it? This is an expanding field of knowledge. Nurses need some basic terminology to understand it, and stay current with what is happening in the world because the situation is changing rapidly.

One thread would be needed for teaching the "jargon" that you will need to know. Some of this information will not be new to you, but other terms might be. This thread would be very basic, and even repetitive because it does take some time to be comfortable with the terminology. There needs to be a place where everyone can go to, such as a dictionary of terms relating to influenza science. I did not "get it" right away, either. It was only thru constant reading, and asking questions at other panflu forums that I began to understand this language. I had have many thoughtful people to assist me in my learning process at those forums, and I continue to learn from them.

Another thread could be for more detailed medical information, and most importantly there needs be a thread for news and analysis. Readers would then have a choice as to how much, or how little information they would want to handle.

There is no better way to get the impact of the threat of a pandemic, than seeing for yourself the way a virus such as H5N1 is changing. When you begin to see why some strains of this virus have developed Tamiflu resistance, you then can begin to understand some of why the recent cases in Egypt have all died. This is the type of information that we, as nurses, need to comprehend.

As I began to study some of the science of influenza, albeit in a very, very basic way, I began to realize that there is a very serious problem that we are going to be facing as nurse/caregivers. The historical data indicates that we will be facing a pandemic, and that we are overdue for this to happen. The state and federal panflu plans do not specify the virus, but they do expect that this will occur. I have talked to my state's Dept of Health about these plans, and they do take this threat seriously.

If the historical precedent holds, then nurses will be at the forefront of this health crisis. I would like to suggest that it is far better to consider this now, rather than later. There are many aspects of preparedness that need to be faced. I am asking for your assistance and support to help all of us to educate ourselves in whatever way works.

http://www.msnbc.msn.com/id/12375868

Indigo

BTW, this webcast from the CDC is taking place today at 2PM. Hopefully, it will be archived somewhere:

http://afludiary.blogspot.com/2007/0...bcast-feb.html

rn/writer, RN · Feb 1, 2007

I want to know what all of this data could mean to me, not only as a nurse, but also as a person.

I can appreciate the complexity of the subject matter, but I think you're missing an opportunity to educate us and bring us up to speed in a user-friendly fashion.

This isn't to be critical of you or your efforts. You have obviously gone to great lengths to research a topic that has captured your interest. I have to tell you, though, it hasn't captured mine. And it won't if my only source of information is the links you have been posting.

The most useful links are the ones that lead to short articles in everyday language. Some of the links don't work. But the ones that fry my brain are the highly technical accounts that presume a certain level of familiarity with the subject matter, a familarity I'm not even close to having. The report on the recent Senate hearing, for example, was mind-numbing.

Instead of overwhelming us with information, it would probably be much more effective if you could distill what you have learned and present it to us in an elemental form the way newswriters do. Set the context, give us the highlights, and tell us why we should care. THEN provide a couple of links for back-up and further reference.

I can interpret each piece of information for readers, but would it not be better to educate colleagues to interpret for themselves what the information is saying, rather than anyone having to take my word for it?

Ideally, this is true. But we aren't there yet. If you don't start small and work to create an interest, you might as well be teaching a course that no one has signed up for.

Many years ago, I had to take Microbiology during the summer. This was an eighteen week class squeezed into six weeks. That would have been challenging enough, but the instructor for our community college class really should have been teaching at a grad school level. In her desire to impart a wealth of knowledge and a love of the subject, she went into far more detail than any of us needed or could absorb. As a result, the syllabus went out the window. We ended up having an excruciating amount of information on some topics and next to nothing on others. She was frustrated because she had so much to share. We were overwhelmed and unhappy because her immense ability and phenomenal grasp of science were far more than we were ready or able to handle. Although we all passed, we felt that in her effort to give us so much, she had actually short-changed us and given us less than we needed.

The most complex of subjects can be explained in simple terms. No, you can't capture all the details and nuances, but those are lost on the ininitiated anyway. Tell us, person to person, in down to earth speech the most important things we need to know. Add details in small doses. Check, now and then, to see if we're getting it. Ask what we want to know.

By providing us with mountains and mountains of hard-to-access data (no one can say you're not thorough), you're in effect answering questions that haven't yet been asked.

Pique our interest. Draw us in. Don't "dumb down" necessarily, but de-mystify the subject so that we can get past the jargon into the meat of the matter.

None of this is meant to be critical of you or your concerns. Only to encourage you to meet us where most of us are right now. Channel your efforts into creating an awareness and and interest that we don't yet possess.

indigo girl · Feb 1, 2007

I will make an honest effort to present in a simpler form. It takes a different mind-set to do so, but I am not unwilling. It would be helpful to have feedback in a timely manner, however. I had no clue that you were even reading this stuff, Miranda since I never heard from you or any moderator on this subject before until now more than two threads later.

The fact that I am still standing and responding should indicate the seriousness of this subject. It is not a matter of academic interest. This information is critically important to all of us. If I have not conveyed that to you, then I stand corrected. Of course, I could give this information differently, you only had to ask.

I just listened today to the first planned audio webcast from the CDC that was designed to educate the media and thus, their audiences about what the national response is going to be in the event of a pandemic flu event. Secretary Levitt, of HHS, and the head of the CDC presented some of the national plan.

What does this mean to you as a person? First, you need to know that though the threat of a pandemic is not imminent, the government considers it to be inevitable. It would be irresponsible for them to not prepare for the arrival of a novel influenza virus. These plans will affect your community and you as an individual.

There are many interventions, and some of them have serious consequences. Dismissing students for example, affects school lunch programs for poor students. This has to be addressed. No society has ever had the opportunity to look at, and plan for a pandemic in advance of its arrival. It looks like we are going to be the first to be able to do this.

The hurricane category model is being used to represent how severe a pandemic is presenting as, and that will determine the interventions that are necessary. On a scale of one to five, with one being the least severe and five being the most severe, the 1957 and 1968 pandemics were a two. They will be looking at case fatality ratio (number of infected that die), rapidity of spread, and attack rate (how many people each person infects) to determine the category of the pandemic.

You can expect to hear public service announcements from HHS, CDC and other government agencies regarding panflu preparedness very soon. They said quite clearly that waves of infection may last up to 12 weeks. If that is the case, I think that you as an individual should be prepared to feed your family from your stored goods for that length of time as a minimum. If you don’t have a well, you must store water also if you can.

You should know that many of the interventions that we will be using now are about the same as we had in 1918. Those are the kind of interventions that are being planned. Why? Because they helped to reduce mortality in past epidemics. Social distancing, good handwashing, covering your cough (cough into your sleeve), early closure of schools, prohibiting public gatherings, etc. We have no vaccine to a novel virus, not enough PPE, not enough antivirals, and in the case of H5N1, the virus has developed resistance in some of its strains to some of our current antivirals. Interventions will be critical because they are really all we have right now. They are designed to slow the spread of a flu virus and buy time because there is no vaccine, and there will not be one until at least 6 months into a pandemic.

Interventions will be initiated by triggers. The first case of a novel flu virus in a community is a trigger. If we are just dealing with a low category virus, then the simple things like handwashing, covering coughs, staying home if sick, isolating the sick to decrease spread would be all that is needed. In a category 5, the same interventions with the addition of early closure of schools, isolation of contacts, prohibiting public gatherings, social distancing etc would be initiated. A category 5 virus would be one with a high rate of transmission, and high mortality.

The public may have to be at home for 12 weeks or more with no kids at the mall. There are plans in place for businesses to have employees work from home if possible. Difficult decisions must be made. No one is taking the effects of these interventions lightly. They will err on the side of caution initially until they know more because that is the only way to reduce mortality. They will not wait until there is a high mortality rate to act. They will use early and layered levels of intervention.

Families will need to know how to care for their sick loved ones at home. This was mentioned but not discussed. I think that they will provide further infomation at some point. Local communities will be practicing and preparing. Government is already doing so.

I found it interesting that one of the first questions by the first reporter, which did not get answered to my satisfaction, was about the NINE cases of pediatric flu in Alabama. I did not know that there were 9 cases. The CDC director sort of dodged giving a clear answer about which virus did this, though they must have that info in their data base. Someone will have to ask them again next week at the CIDRAP Conference. And, clearly not all of those kids had prior exisiting conditions. Why do we need to know this?

Consider this, prior to 1918, there were small groups of people getting a flu that was not as fatal as the 1918 version. It was the same virus just not as lethal yet. Is that what is happening now? Or is one of the current seasonal flu viruses picking up some virulent segments from a more deadly virus? We don’t get to know the answer because they have not chosen to tell us. So we have to keep asking those questions.

What does all of this mean to you as a nurse? As nurses and family members, you may have to make a choice. Who is your primary responsibility? Will the category level of the pandemic make a difference in your decision?

I hope that this information will be helpful. Please ask if there is anything that is not clear.

Editorial Team / Admin · Feb 1, 2007

Hello, indigo girl,

I never heard from you or any moderator

(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.

rn/writer, RN · Feb 2, 2007

I guess part of the problem was that I wasn't reading much of the earlier posts. I tried, but then my eyes would glaze over and I'd do a hasty exit.

I got more out of the post you just made than all the rest put together.

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?

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?

Apart from laying in provisions, what else can an individual do?

Thanks for simplifying. It makes a big difference.