Pandemic Awareness/Preparation

Nurses COVID

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It has been my own personal project to follow H5N1 for the last 3 years simply because it interests me. Attracted to this type of information like a magnet, I've been watching this relatively new influenza virus to see where it will go, how it will change itself, and possibly change our world. I have followed its country by country outbreaks, and watched for the important viral mutations such drug resistance or changes that allowed it to more specifically target mammals.

Keeping in mind at all times that we will be cleared impacted as HCW, as well as being members of our communities, and having families of our own to care for, I wanted to start the new year by opening a single focused pandemic thread that would also look at what we are doing nationally to prepare for a future pandemic. Is this the virus to spark the next pandemic? No one can answer that question. We can look back at the past to the last few pandemics, and in particular to the most devastating one in 1918, and extrapolate useful information about them, but we can not predict the future. We can only make comparisons with our situation now, and learn what worked to lessen morbidity and mortality in those past events. And, we can look at those other viruses, and compare them with what we are seeing now. For example, H5N1 is a Type A virus. We know that all pandemics are caused by Type A viruses. It is also an avian virus. The deadly 1918 virus, H1N1 was also an avian virus.

For this thread, as in the previous threads, I will be making use of news sources, scientific studies, govt bulletins such as the MMR, as well as flu forums and blogs devoted to this subject for my sources. Because press information, particularly the foreign press, is not always available for later access when I am looking back to check recent historical information, the use of these blogs and forums are important because archived information quoting the media and all other sources is always fully and easily available there with no worries about information disappearing or no longer being available. They also fully document their sources or I would not be using them.

With this link from Avian Flu Diary, a well researched source that I highly recommend, we can read the words of outgoing HHS Secretary Leavitt on our state of preparedness. Leavitt has done an admirable job during his tenure, but admits that there is much left to do.

http://afludiary.blogspot.com/2009/01/hhs-releases-6th-pandemic-planning.html

afludiary.blogspot.com said:

A scant 33 months ago, I sent my first message about a race that HHS had just begun. As I said then, it was a race against a fast-moving virulent virus with the potential to cause an influenza pandemic. Since then, we have mobilized experts and resources across the country and around the world. I now send you this final message, as I look back at the unprecedented progress we have made in energizing a national pandemic influenza preparedness movement in those 33 months.

Today, many people mistakenly think influenza pandemics are a thing of the past, but influenza has struck hard in the era of modern medicine – much harder than most people realize. And it will strike again. Pandemics are hard things to talk about. When one discusses them in advance, it sounds alarmist. After a pandemic starts, no matter how much preparation has been done, it will be inadequate.

Does a virus that seems to only have a mortality rate of about 6% (my calculations from various media reports) really have the potential to become a pandemic? I am not being argumentative here, I am really curious. Does anyone know what the mortality rate was of other major pandemics? I also wonder if that percentage is not actually even lower because of the possibility that many mild cases were not reported and recovered at home without medical intervention. Any thoughts?

A CFR (Case Fatality Rate) of 6% would be devastating. The 1918 pandemic only had a CFR or mortality rate of about 2.5%. But your 6% calculation is mostly likely wrong. There are no confirmed deaths from H1N1 Swine Flu outside of Mexico. The number of deaths attributable in Mexico to this virus are uncertain. As you know people die everyday from a variety of causes especially in a arge metropolitan are such as Mexico City. Finally, and most importantly, we have no way of knowing how many people in Mexico are actually infected. There could be many many asymptomatic cases.

REQUEST FOR INFORMATION - Mexico Nurses and Health Care Workers

Here are some quotes from posters at a BBC site about the Swine Flu situation in Mexico. Can anyone on this forum corroborate these comments about the extent of infections and number of deaths. Thank you.

http://news.bbc.co.uk/2/hi/talking_point/8018428.stm

I work as a resident doctor in one of the biggest hospitals in Mexico City and sadly, the situation is far from "under control". As a doctor, I realise that the media does not report the truth. Authorities distributed vaccines among all the medical personnel with no results, because two of my partners who worked in this hospital (interns) were killed by this new virus in less than six days even though they were vaccinated as all of us were. The official number of deaths is 20, nevertheless, the true number of victims are more than 200. I understand that we must avoid to panic, but telling the truth it might be better now to prevent and avoid more deaths.

Yeny Gregorio Dávila, Mexico City

I'm a specialist doctor in respiratory diseases and intensive care at the Mexican National Institute of Health. There is a severe emergency over the swine flu here. More and more patients are being admitted to the intensive care unit. Despite the heroic efforts of all staff (doctors, nurses, specialists, etc) patients continue to inevitably die. The truth is that anti-viral treatments and vaccines are not expected to have any effect, even at high doses. It is a great fear among the staff. The infection risk is very high among the doctors and health staff.

There is a sense of chaos in the other hospitals and we do not know what to do. Staff are starting to leave and many are opting to retire or apply for holidays. The truth is that mortality is even higher than what is being reported by the authorities, at least in the hospital where I work it. It is killing three to four patients daily, and it has been going on for more than three weeks. It is a shame and there is great fear here. Increasingly younger patients aged 20 to 30 years are dying before our helpless eyes and there is great sadness among health professionals here.

Antonio Chavez, Mexico City

Specializes in Too many to list.

Monday's CDC Teleconference

http://afludiary.blogspot.com/2009/04/mondays-cdc-teleconference.html

Clearly, the possibility of a second wave of infection in the fall when our regular flu season begins again, has the CDC worried. The

virus could be quite different by then and possibly more virulent.

If I had travel plans for Mexico, I would reshedule.

Dr. Richard Besser, Acting Director of the CDC, indicated that the Swine Flu is acting like any ordinary flu, and that many contacts of those known to be infected are presenting with respiratory infections.

Presumably some of those will be Swine Flu, as well.

The State Department will issue a Travel advisory for Mexico later today, urging people not to go there unless they have urgent business.

The feeling is that the situation in Mexico is `fluid' and they are doing this out of an abundance of caution.

By the same token, Dr. Besser stated that the EU Health Minister's call for travel restrictions to the US is `premature', given the small number of cases here and the mild symptoms reported.

The HHS is releasing roughly 11 million doses of antivirals to the states, or about 25% of the Federal stockpile. They will hold the remainder in reserve until they can determine the severity of this outbreak.

Regardless of what the WHO decides today or tomorrow about Global Pandemic Threat Levels (current at 3), the CDC will take an aggressive and forward leaning stance on this outbreak.

Individuals need to stay informed, practice good `flu hygiene' (handwashing, staying home if sick, not kissing people in greeting, etc), and consider how they will handle events if they must work from home, or their children's school is temporarily closed.

There is still much the CDC doesn't know about this virus, and one of the big things they are trying to determine is why the death toll in Mexico from this virus appears so high.

While the CDC is preparing `seed stocks' for a possible vaccine, no decision to manufacture one has been made. Current flu vaccines are not expected to be effective against this H1N1 strain.

The next week or so should provide more answers regarding the spread, and severity, of this virus.

Dr. Besser cautioned that, with the end of the Northern Hemisphere's flu season, we could see a reduction in cases over the summer but that the virus could easily return in the fall.

So, I go to mexico on May 9th. If I get an RX from my doctor for Tamiflu to take with me is it even available at the pharmacies? Or is it all stockpiled and so not avialable?

So much uncertainty. If everyone gets it are they then immune?

Not sure about availability of Tamiflu. However, here's an article you're bound to find interesting;

http://money.cnn.com/2005/10/31/news/newsmakers/fortune_rumsfeld/

Specializes in Too many to list.

WHO: Phase IV

http://afludiary.blogspot.com/2009/04/who-phase-iv.html

As expected, the WHO finally raised the Pandemic threat level to Phase 4. I will let this link explain what it means.

If the goal of this phase is containment, I think that the horse is already out of the barn. CDC said on Sunday that they could not contain it.

Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause "community-level outbreaks."

The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic.

Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted.

Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

The goal of moving to level 4 is containment, or limiting the spread of the virus. Containment may not be possible, but there are ways to slow the spread, and that may involve travel advisories, distributing antiviral medications, and asking people to isolate themselves if sick.

Specializes in floor to ICU.

Thanks Indigo for the updates!

Specializes in Clinical Research, Outpt Women's Health.

Yes - thanks for the updates!

Specializes in School Nursing.

my hope is in the lord !

praiser :heartbeat

Specializes in School Nursing.

If anyone wants a glimpse at how the general public is reacting, read the comments on WebMD's forum on this topic. It is very scary. Some of the comments are downright ignorant. I thought about posting to try and correct some of the misconceptions, but there are so many of them it is pointless! You would think since they have internet access they would at least make an effort to find out the CORRECT info on this topic before posting to a public forum!

http://blogs.webmd.com/breaking-news/2009/04/swine-flu-symptoms-pandemics-and-more.html

Specializes in Too many to list.

Non Pharmaceutical Interventions

http://afludiary.blogspot.com/2009/04/tale-of-two-cities.html

This is what is being done now in Mexico City. If our case load increases, expect these to be implemented here.

NPI's are Non Pharmaceutical Interventions; things that people can do to slow the spread of a virus other than taking antivirals or having a vaccine.

Through the use of these NPI's it is hoped that the rate of transmission, and the number of people simultaneously sickened, can be dramatically cut during a pandemic.

During the 1918 Pandemic, some cities instituted strict public health ordinances. They closed schools, movie houses, pool rooms, restaurants . . even churches.

Those cities that took these measures generally saw much lower levels of death and illness.

For NPI's to work during a pandemic, you need to be prepared to implement them.

That means educating yourself and your family, and laying in any supplies you might need (alcohol gel, facemasks, N95s) before a crisis.

Today in Mexico City health officials appear to be taking a page from the St. Louis experience, and are ordering restaurants, pool halls, gyms, sports clubs, swimming pools closed.

Specializes in Too many to list.

Three New Swine Flu PSA's From The CDC

http://afludiary.blogspot.com/2009/04/three-new-swine-flu-psas-from-cdc.html

The Public Health message is simple and effective. Check the videos out.

Health officials are concerned about a new influenza virus of swine origin that's spreading from person to person. Officials are acting to combat this threat, but the outbreak could grow. Prepare now.

Check with local leaders, schools, employers, and other community groups about their plans regarding an outbreak in your community. It's important for everyone to know what to do about swine flu.

Store a two-week supply of food and water. Have two weeks of your regular prescription drugs at home. Keep health supplies on hand, including pain relievers and cold medicines.

Health officials are concerned about a new flu virus of swine origin spreading from person to person. To help fight swine flu, cover your nose and mouth with a tissue when you cough or sneeze, then throw the tissue away. Wash your hands often with soap and water, especially after coughing or sneezing. Stay home if you're sick and limit contact with others to keep from infecting them.

Specializes in Too many to list.

http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/apr2809breaknews-jw.html

CIDRAP is going to be doing daily updates on the Swiine Flu outbreak. Here are a few notes from today.

California Gov. Arnold Schwarzenegger declared a state of emergency in California over swine flu today, as Los Angeles County officials investigated two deaths as possibly related to the virus, according to a Reuters report.

The Obama administration is asking Congress for a $1.5 billion supplemental appropriation to deal with the swine flu outbreak, Sen. Tom Harkin, D-Iowa, announced at a Senate committee hearing on the outbreak today.

The Food and Drug Administration (FDA) yesterday authorized emergency use of influenza medicines and the rRT-PCR Swine Flu Panel diagnostic test for response to the swine flu virus outbreak. The move allows use of the drugs in younger children and permits a broader range of health professionals, including public health officials and volunteers, to distribute the drugs.

GlaxoSmithKline has geared up production of zanamivir (Relenza), and Roche has increased production of oseltamivir (Tamiflu) in response to the swine flu outbreak. The new virus has shown sensitivity to both of the drugs. [Apr 28 Bloomberg News story]

US Agriculture Secretary Tom Vilsack said yesterday that animal health surveillance has shown no swine flu infections in US swine.

The United Nations Food and Agriculture Organization (FAO) said yesterday that it appointed an expert team to determine if the new swine H1N1 virus has a direct connection to pigs and deployed a team of animal health experts to Mexico to help the government assess the epidemiologic situation in the pig production sector.

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