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.
The folks at the flu boards have been concerned about health care professionals for some time and they are especially uneasy about the various scenarios that could unfold when A/H1N1 eventually meets up with H5N1. One lacks lethality. The other lacks transmissibility. Each virus could aquire the other's very worst trait.
Since you indicated that you have seen "Becoming Self-Sufficient" previously, you may recall that one of my main concerns is the effect that absenteeism could have on our supply chains. Therefore, I advocate a very throrough and systematic stockpiling of everthing you could possibly need to become self-sufficient within your own home for a certain period of time. Presently, my message is to prepare for one full year of very hard times. This level of personal preparedness would not only help to sustain your family during the predictable supply chain disruptions that will occur during a severe pandemic, but if you eventually determine that you must "shelter in place" in order to remain safe, then venturing out of your home to risk shopping will not be a viable option, even if there are goods on the shelves.
I hope you find my discussion of PPE to be of particular relevance to health care professionals. I remain strongly opposed to the notion that N-95 respirators can provide adequate protection for those who are in close contact with flu patients. My discussion points out the deficiencies of the N-95 and it advocates N-100 disposables and P-100 reusables as essential respiratory protection for close work.
Although my on-line time is usually devoted to pandemic planning over at PFI, I will drop by AN occassionally to see if anyone has specific questions that might arise from a close reading of "Becoming Self-Sufficient".
The folks at the flu boards have been concerned about health care professionals for some time and they are especially uneasy about the various scenarios that could unfold when A/H1N1 eventually meets up with H5N1. One lacks lethality. The other lacks transmissibility. Each virus could aquire the other's very worst trait.
Since you indicated that you have seen "Becoming Self-Sufficient" previously, you may recall that one of my main concerns is the effect that absenteeism could have on our supply chains. Therefore, I advocate a very throrough and systematic stockpiling of everthing you could possibly need to become self-sufficient within your own home for a certain period of time. Presently, my message is to prepare for one full year of very hard times. This level of personal preparedness would not only help to sustain your family during the predictable supply chain disruptions that will occur during a severe pandemic, but if you eventually determine that you must "shelter in place" in order to remain safe, then venturing out of your home to risk shopping will not be a viable option, even if there are goods on the shelves.
I hope you find my discussion of PPE to be of particular relevance to health care professionals. I remain strongly opposed to the notion that N-95 respirators can provide adequate protection for those who are in close contact with flu patients. My discussion points out the deficiencies of the N-95 and it advocates N-100 disposables and P-100 reusables as essential respiratory protection for close work.
Although my on-line time is usually devoted to pandemic planning over at PFI, I will drop by AN occassionally to see if anyone has specific questions that might arise from a close reading of "Becoming Self-Sufficient".
Good luck to everyone.
Yes, thanks a bunch, Indigo Girl has directed me to read your publications several times, really appreciate what you do. I am worried about the downsizing of health care capacity over the last 10 years. No one seems to remember this but me but we had very heavy flu year in 1999/2000. The hospital capacity was pushed to the limits at the time but it held, just barely held and it wasn't even pandemic conditions. I was working the floors at the time and the hospital where I worked was also pushed to the limits and it has since been shut down. Also I was working during the Hong Kong flu epidemic of the late 60s and remember that hospital being pushed to the limit at the time also, that hospital is also gone. Inaddition to losing a lot of hospital and bed capacity in my own area we have also lost a lot of hospitals and hospital beds around the country. Add that to the accelerated downsizing that is going on right now and I am concerned. Someone has to divert some of the attention being paid to vaccines and mask(not that these things aren't important) to hospital capacity. They need to call all the unemployed nurses back to work, they need to hire those new graduate nurses that don't have jobs and get them oriented. Why? Because it is more than likely, that before the vaccines are in wide spread use we are going to have a major outbreak. Hospital management is very focused on the bottom line and last quarter profits of their individual facility. They don't seem to be into seeing the big picture. Our political leadership seems to be assuming our current medical system while being very stretched will handle a pandemic, oblivious to the real situation.
"........h1n1's case fatality rate is still higher {than it is for seasonal flu} but {it is} lower than 1918, so cause for some concern with all eyes turned toward the immediate, murky future. but together, life would get rough for a little bit."
quote from
apologies for inserting my grammatical corrections.....
the 1918 "spanish" flu was bad, but then there were no antibiotics to treat secondary infections/pneumonia, everyone! we don't know if that flu was h1n1 (probably not), as this is a new version. comparing that terrible event in medical history really is "apples and oranges". when the two pandemics are spoken about as being similar, it terrifies anyone who has heard of the 1918 scourge. let's leave that alone, and focus on modern science versions of what's to come, shall we? :plsebeg:
The 1918 flu certainly was H1N1, Dr. Webster and others have reconstructed the virus.
Yup, swine flun is less deadly. But............
It is less deadly with early treatment with Tami, vents, and there was that gut who they treated with ECMO.
When the Tami runs out ( How much has your state stockpiled?), the vents are all in use, what then?
The Holy Grail is vax. OK, lets look at that.
There is one,1,uno,vax plant in the US. We rely on overseas plants. Most have clauses that state they must first supply their home countries before sending any to us.Our one plant will eventually make enough, in 5-6 years.Yeah.
Our antibiotics are also made overseas. What happens when that supply line crashes?
Our modern medicine can do amazing things, but keep running with sick HCW, no meds. limited supplies? I don`t hold out much hope.
The 1918 flu certainly was H1N1, Dr. Webster and others have reconstructed the virus.
Yup, swine flun is less deadly. But............
It is less deadly with early treatment with Tami, vents, and there was that gut who they treated with ECMO.
When the Tami runs out ( How much has your state stockpiled?), the vents are all in use, what then?
The Holy Grail is vax. OK, lets look at that.
There is one,1,uno,vax plant in the US. We rely on overseas plants. Most have clauses that state they must first supply their home countries before sending any to us.Our one plant will eventually make enough, in 5-6 years.Yeah.
Our antibiotics are also made overseas. What happens when that supply line crashes?
Our modern medicine can do amazing things, but keep running with sick HCW, no meds. limited supplies? I don`t hold out much hope.
Yup, that I have been trying to point out, that even in a heavy flu year like 1999/2000 hospital capacity, staff and equipment were pushed to the limits. Next time, may be this fall, there will be a lot less of everything.
"A Phase Six pandemic declaration is based on the sustained worldwide spread of H1N1, not the severity of illness caused by the virus" stated HHS President
I am not aware of the source of Dr. Webster's information. Please refer me to the site where you saw that "Spanish" flu was A/H1N1, as it couldn't be, due to common knowledge that this pandemic flu virus is "novel", completely new to scientists.
Many antibiotics used here, are made in Canada, a country not perceived as "overseas". They know that we rely on them for sufficient production to treat people here, and had plenty of time since April 2009 when this began, to produce as much as would be needed, by us as well as their own people, who of course have priority.
Tamiflu is being produced in this country. Read the NIH and CDC news posts about that, to see that there is no reason to monger fear. It has been stockpiled nationally (not by states) in numbers sufficient to treat everyone in the USA.
You need to site your sources and read more, Wren. Then you'd have hope!
Wren is correct, the "spanish flu" was avian H1N1 (not the same H1N1 as today, as this is swine).
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.
In short, no, the current H1N1 is not the very same H1N1 of 1918. It is in the reassortant lineage, instead. The H1N1 of 1918 seems to be long gone, but its legacy maintains a foothold.
Apologies if I wasn't clear earlier when I was comparing current pandemic conditions to 1918 conditions. I've seen a lot of people attempting to incite panic by saying that the current pandemic could be as bad as the 1918 one. The truth is, nobody knows what's in store; and the truth also is that pandemics, while terrible, are not a surprise attack like an F5 tornado. You get warning, and these days, you get way more warning than anybody's ever had.
The truth is, at the time I posted what I did, the CFR for the current H1N1 was worse than seasonal flu, but nowhere near the 1918 flu. My comparison was to pandemics, not to H1N1's. If someone reads into that that they should be terrified and run for the hills, I apologize, but it's not really what I intended when I wrote it.
I think there is a huge tendency in far too many people (unfortunately) to be or stay terrified of this bug when, with sensible precautions and careful planning, there is no reason to feel that helpless and hopeless. Medicine and communication and even common sense have blazed into new territory since 1918. We are far more prepared now than ever.
If you're worried, that's good. Worry and fear help turn on the natural tendency to flee dangerous situations or hide. It helps us naturally separate the ill from the healthy in order to maintain the community, and educate people about how to not get sick. However, too much fear is irrational and I've seen irrational fear spread in communities faster than bugs ever did, and become their own pandemic (remember GRID?).
The thing is I am not panicked until I know we aren't trying to halt it at our facility. I know that if one of my patients has a wound, not healing, a temp, drainage, etc. I want to know if it is MRSA--so it can be treated, and so I can protect myself. The key is prevention. Stop something at its source. No we don't have to test every person, but we can isolate suspected cases on our floors and protect ourselves, therefore our coworkers, and our own families. I am informed, so I do not panic thinking of a pandemic, but I am not so casual with knowledge as to not want to protect myself.
quoted from a part of the first resource given by girl scout. it greatly augments the knowledge i had and i appreciate being directed to it. thank you, girl scout.
"in 1918, the cause of human influenza and its links to avian and swine influenza were unknown. despite clinical and epidemiologic similarities to influenza pandemics of 1889, 1847, and even earlier, many questioned whether such an explosively fatal disease could be influenza at all. that question did not begin to be resolved until the 1930s, when closely related influenza viruses (now known to be h1n1 viruses) were isolated, first from pigs and shortly thereafter from humans. seroepidemiologic studies soon linked both of these viruses to the 1918 pandemic (8). subsequent research indicates that descendants of the 1918 virus still persists enzootically in pigs. they probably also circulated continuously in humans, undergoing gradual antigenic drift and causing annual epidemics, until the 1950s. with the appearance of a new h2n2 pandemic strain in 1957 ("asian flu"), the direct h1n1 viral descendants of the 1918 pandemic strain disappeared from human circulation entirely, although the related lineage persisted enzootically in pigs. but in 1977, human h1n1 viruses suddenly "reemerged" from a laboratory freezer (9). they continue to circulate endemically and epidemically."
This is a translation as you can see. Another five year old child infected, and this is getting very strange. Why all these kids being infected? And why are these cases mild, not that we are complaining, but it feels ominous...Something is wrong with this picture.
...the Ministry of Health announced today, Wednesday, No. 81 of human infection from bird flu of a child named Ziad Abdel Hamid Mohamed, aged 5 years and months, the major facility Kulain, province of Kafr el-Sheikh, said Dr. Abdel Rahman Shahin, official spokesman of the Ministry of Health.
وقال شاهين إن بداية ظهور الأعراض على الطفل كانت يوم 15 من الشهر الجارى، دخل على إثرها أمس، الثلاثاء، مستشفى حميات كفر الشيخ وهو يعانى ارتفاعا فى درجة الحرارة ورشح عقب تعرضه لطيور يشتبة فى إصابتها بمرض أنفلونزا الطيور، لافتاً إلى أنه فور الاشتباه فى إصابته بالمرض تم إعطاؤه عقار التاميفلو، وحالته المرضية مستقرة، وجارى تحويله لمستشفى منشأة البكرى.
Sahin said that the onset of symptoms the child had been on 15 this month... on Tuesday, the hospital admitted suffering Kafr al-Sheikh, a rise in temperature and after being nominated for the birds suspected of being infected with bird flu, he said, adding that once suspected of being infected with the disease was given the drug Tamiflu, and a stable condition and is being transferred to a hospital facility Bakrie.
Dr Dave
2 Posts
Indigo Girl,
The folks at the flu boards have been concerned about health care professionals for some time and they are especially uneasy about the various scenarios that could unfold when A/H1N1 eventually meets up with H5N1. One lacks lethality. The other lacks transmissibility. Each virus could aquire the other's very worst trait.
Since you indicated that you have seen "Becoming Self-Sufficient" previously, you may recall that one of my main concerns is the effect that absenteeism could have on our supply chains. Therefore, I advocate a very throrough and systematic stockpiling of everthing you could possibly need to become self-sufficient within your own home for a certain period of time. Presently, my message is to prepare for one full year of very hard times. This level of personal preparedness would not only help to sustain your family during the predictable supply chain disruptions that will occur during a severe pandemic, but if you eventually determine that you must "shelter in place" in order to remain safe, then venturing out of your home to risk shopping will not be a viable option, even if there are goods on the shelves.
I hope you find my discussion of PPE to be of particular relevance to health care professionals. I remain strongly opposed to the notion that N-95 respirators can provide adequate protection for those who are in close contact with flu patients. My discussion points out the deficiencies of the N-95 and it advocates N-100 disposables and P-100 reusables as essential respiratory protection for close work.
Although my on-line time is usually devoted to pandemic planning over at PFI, I will drop by AN occassionally to see if anyone has specific questions that might arise from a close reading of "Becoming Self-Sufficient".
Good luck to everyone.