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.
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.
Another child, age 4 has been infecteted with bird flu. This is the 19 case since January 1st. I wonder how the WHO's research study is going there. They are supposed to be investigating why most of the new cases this year have been toddlers, and most of them survived while the adults that are infected, die.
The Egyptian health ministry says the boy is from the Nile Delta region and has been in contact with sick poultry.
His condition is described as stable. Since bird flu in Egypt first appeared in 2006, there have been 70 cases of infection and 26 people have died.
Egypt is the country worst affected by bird flu outside of Southeast Asia, with a spate of new cases since spring.
The boy who is from Sharqiya province was taken to a local hospital suffering from high fever and flu symptoms, an official from the health ministry told the Egyptian news agency Mena.
Later he was transferred to Cairo where he tested positive for the H5N1 strain of bird flu and received anti-viral drug treatment.
I keep seeing people everywhere I go, coughing and acting sick. The cough I had is productive, despite the Tamiflu I was on (finished day before yesterday), and the Doxycycline (finished yesterday).
Unavoidable situations requiring my presence occurred yesterday, and I believed the CDC's statement that 8 days into this thing, I wasn't communicable. However they said earlier that having any s/s meant communicability.......
Combined with economic needs heightened by the financial scene, this situation is spreading because people can't afford to stay home, if they still have jobs and it's mild enough to allow them to work. Perfect for spreading it around!
I'm also scared that mutations of the H1N1 and H5N1 are going to destroy humanity as we know it, despite our best efforts to keep it at bay. Extreme measures that need to be taken, won't happen (like closing down airports for a period of time, so people can't travel, which is an eventuality that is unacceptable to political folks) is all that woud save us from that.
It's getting so surrealistic, that I'm feeling like I'm in the middle of a TV drama in installments, that will end badly for humankind.....
Too soon to say what will happen. I heard an interview yesterday that said it's a 50/50 chance in that virologist's opinion, that this virus will return in the fall.
Seriously, nobody knows what will happen. All we have to offer is the lessons from history, and what we see that other flu viruses have done. They are however, completely unpredicatable, everyone does agree on that.
We live in interesting times, and are getting to watch in real time this historical event of the unfolding of a novel flu virus. Maybe it will just go away.
Hope for the best. Plan for worse, and if you do that, you can stop wearing yourself out worrying knowing that you have done all that you can do. Let it go.
Even though the CDC announced that schools would not be closed for H1N1 cases, these New York schools are closing due to increased absenteeism. The schools are being closed as a mitigation strategy to slow transmission of this very contagious virus.
The patient in critical condition may have a pre-exisitng condition that made him more vunerable. I expect that more info will be available later.
Tonight Mayor Michael Bloomberg of New York City held a press conference where he announced that three schools in the city would be closed for up to 1 week due to a high level of absenteeism among the students who are said to have flu-like symptoms.
Four students in one of the schools have tested positive for the A/H1N1 virus, and hundreds of students are reportedly out sick across these three schools.
We also learned tonight that the assistant principal of a Queens middle school is on a ventilator, and in critical condition, diagnosed with the H1N1 `swine flu’.
It is difficult to believe that they are seeing seasonal flu. It is past the season for that. It is also hard to believe that they would keep a school open considering the number of absences. What happened to mitigation strategies designed to slow the spread of infection?
What are they thinking?
I hope that there are no pregnant staff working in that school.
The hallways are pretty empty today at Travis Elementary near the Woodland Heights. Of the 712 students there, 242 are out sick.
"We are working closely with the City Health Department which has identified seven cases of type A (REGULAR) flu. It is suspected, however, that the majority of the students are being affected by some sort of viral illness. We do not know how many of the 242 are out due to parental concern and we understand that."
This is the 20th case since January 2009, and it's only May.
A three-year-old Egyptian boy has contracted the highly pathogenic H5N1 bird flu virus, the 71st case in the populous Arab country, the state-run news agency MENA said on Friday.
It is the second case in as many days in Egypt, which has seen a surge in infections this year.
A spokesman for the Health Ministry said the boy showed symptoms including a high temperature after coming into contact with domestic poultry, MENA reported.
The boy, from Mahalla in the Nile Delta north of Cairo, was in a stable condition in hospital and being treated with Tamiflu, the spokesman added.
Those of us who believe in teachable moments are hoping that the new director will engage in them. It is fine to try to keep people calm as long as you don't understate the potential seriousness of a new flu virus to the point that it becomes a nonissue. It does not bode well for transparent communication when leaders tend to minimize rather than provide real information.
Yesterday Obama named a new CDC Director, New York Cithy Health Commissioner Dr. Thomas R. Frieden, an infectious disease specialist (drug resistant TB) who worked at CDC prior to going to New York in 2002. Frieden has long been rumored to be at the top of Obama's short list, so this wasn't a surprise, but the impressive performance on the swine flu outbreak of Richard Besser as Acting Director suggested to some he might get the job. Besser may be relieved he didn't:
At the C.D.C., [Frieden] will inherit a host of immediate and long-term problems, including a looming decision about whether and how to produce a swine flu vaccine. Health experts say the agency must resolve serious morale and organizational issues even as the administration struggles to overhaul the nation's health care system. (Gardiner Harris and Anemona Hartocollis, New York Times)
...Frieden has been in the spotlight around swine flu. I've seen him nodding in agreement as Mayor Bloomberg tried to bring calm in the worst way: by constantly minimizing the seriousness of the illness. Yesterday I saw Frieden[do] the same thing. Flu is always a potentially serious disease. This was a teachable moment for seasonal flu that was missed. Besser didn't engage in this, to his credit.
Still, we remain optimistic, but the jury is still out. CDC took on (and carried) a lot of water during the Bush years. It remains to be seen if Frieden will activate the sump pumps or just try to turn a foundering boat in his own preferred direction.
There is a link to a video that takes about 20 minutes to watch.
When it comes to being proactive on the pandemic threat, you'd have to go a long way to find a health department more engaged than Seattle-King County's Public Health.
You don't have to live in the Pacific Northwest to appreciate, and utilize, their hard work.
Although it doesn't appear (at this time) that we are facing a reprise of the 1918 pandemic, even a mild to moderate pandemic can cause major societal disruptions and claim millions of lives around the world.
This is an excerpt written for April 27 from a diary kept by a married couple, both physicians in Mexico. It gives us a glimpse into how difficult it must have been to work during that time period in a hospital in Mexico, at least from the physician's point of view.
Personal documentation of this type of event is important.
Reading this, and seeing what is happening in the US, there is such a disconnect. It's almost like we are talking about two different diseases. Why is that?
The number of cases increases significantly every day. The number of fatalities is also increasing. I know of at least three doctors who are said to have died from swine flu. There is great fear among the medical community. We know that the situation is very serious and that we are at high risk of infection.
But we are more scared of carrying it into our homes and infecting our loved ones. One of my colleagues who was exposed chose to stay in a hotel rather than run the risk of infecting her daughters.
These fears are getting worse as we realise that it is not possible to get anti-viral drugs from pharmacies and that in the health sector they are being delivered little by little.
The government says that it has antiviral drugs available to treat a million cases but we do not have easy access to these, even though we are part of the health sector.
I believe that home test kits will be necessary to prevent additional exposure of others at doctors' offices and ERs. Many people go to be tested/treated earlier than the 3rd or 4th day, when testing is more accurate. Unless Tamiflu given those patients, blocks a positive result, the patient could be given the kit and taught how to use it, just like stool for occult blood (and certainly easier than that one).
Most patients who are employed need to tell their employer that they were tested, to verify their absences, and the Employee Health nurse (in big companies) could get started investigating departments where s/s are occurring more than in others, and discouraging intradepartrment mingling; and provide N95 masks (for those in whose department the number of positive tests is impressive) with proper fitting techniques.
Then if there are many positive reports, the CDC investigators would need to come out...........
Some companies might shrink from having attention focused on them, but their insurance providers wouldn't be happy if they didn't do everything they could, to prevent serious complications involving hospitalization and possible deathof their employees and themselves, attenuating the situation.............
Let's start a thread asking any Employee Health nurses here, to contribute their experiences, absenteeism at their worksite, etc.
While community spread of the A/H1N1 virus is obviously taking place in North America (Mexico, US, and Canada), it has yet to be `documented' in any of the other 5 WHO (World Health Organization) regions of the world.
Doing so would probably force the WHO to declare a Pandemic Alert Level 6, which is a step a number of nations are lobbying against (or at least hoping to delay).
Japan, which is part of the WHO's Western Pacific Region, appears to be teetering on the brink of documenting community spread of the virus.
They have 3 students, none of which have traveled abroad, testing positive for the virus. Three positive cases aren't enough to declare community spread, of course.
But it does significantly raise concerns.
Authorities in Kobe said they would temporarily close at least 75 schools and kindergartens and cancel festivals and other public events in some districts of the city, where fear of an outbreak was growing rapidly.
"It's totally beyond our imagination," said Seiichi Sakurai, of the city's health and welfare bureau. "The virus entered the country undetected. I'm afraid the infection may have already spread further."
"It's totally beyond our imagination," said Seiichi Sakurai, of the city's health and welfare bureau. "The virus entered the country undetected. I'm afraid the infection may have already spread further." Quote from "in-Japan"/indigogirl
This is really a "tongue in cheek" remark" - a little comic relief on the brink of incredible pandemicry.
When I was in Japan (25 years ago), I was writing a paper on women's attitudes toward health care in their country. The only surprise I had was in Japan, when I visited the Japanese Cancer Society.
A doctor headed that agency, which was quite service based, rather than research or educational. I asked him how often women found their breast cancer in his country, and if they examined their own breasts. He looked highly perplexed, and said, "You see, we don't concern ourselves with women's diseases. Men have great risk for stomach cancer, and that is our focus".
I only hope women in Japan have convinced their health care system to count their cases of reportable communicable diseases!
I did have the luck to meet an American who was a "talk show" host, spoke Japanese that was indistinguishable from native Japanese (they have tricky turns of phrases that reveal foreigners). She told me about her women callers' concerns. They were never about themselves - always about sons, husbands, brothers, fathers, etc.
That permeated their health care, as the traditional women who didn't leave the country for their education, thought their needs for health care weren't more worthy than the needs of their family's. In other words, if it was dinner time and she went into labor, a Japanese woman would finish her preparations, set the table, and wait until the meal was over before announcing that it was time for the baby to come....... With their high pain tolerance, it's a wonder any had their babies in hospital.
Men can voice discomfort and so they may seek care with the flu. Women will be quiet and stay home if so advised. They are obedient!
According to our tour guide, that may have been fortunate, as Japanese hospitals at that time had lower standards than ours....... 'nuff said?
indigo girl
5,173 Posts
Egypt - Case #70 - Bird Flu
http://news.bbc.co.uk/2/hi/middle_east/8049585.stm
Another child, age 4 has been infecteted with bird flu. This is the 19 case since January 1st. I wonder how the WHO's research study is going there. They are supposed to be investigating why most of the new cases this year have been toddlers, and most of them survived while the adults that are infected, die.