Pandemic Awareness/Preparation

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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.

Specializes in Too many to list.
lamazeteacher said:
My goodness, indigogirl:

You translate to English from Egyptian, as well as reading every possible article on flu, pandemics, etc.? You are superhuman!

No! It's those amazing folks at flutrackers as well as all of the other flu forums for doing the translating. I would never have the time. They have been doing this stuff for years regarding bird flu. We owe them a hugh debt for volunteering their time. We have learned so much about what influenza does because of them. Even the govt (CDC) and WHO visits those sites for the free information.

But, thanks for the compliment, LOL!

Specializes in Too many to list.

Bird Flu Still Out There in the Environment

Tuva, Siberia: H5N1 discovered in dead wild birds

This is a translation about migratory birds found dead in Siberia. They were subtyped H5. Because they are 100% dead, and because they are migratory birds which do not die from low pathogenic viruses for the most part, we can safely bet that this is highly pathogenic H5N1, bird flu. If there are any farms in the area, they will be alerted to protect their domestic flocks, and will most likely be testing for bird flu as well. They say there are 4.5 million poultry in the vicinity so they have much to be concerned about. Looks like they are revaccinating some. Hopefully the virus has not drifted too far away from the vaccine that they are using.

This has happened elsewhere.

www.flutrackers.com said:

The alarming news came from the republic of Tuva. In Ovyurskom area on Lake Ubsa Nour case occurred on wild birds - the specialists Россельхознадзора found 58 corpses. Studies have shown - in 7 samples out of 22 identified bird flu virus A, subtype H5.

- On June 18 in the Novosibirsk region of influenza disease in poultry has not been registered, - told «Komsomolke» in Rosselkhoznadzor. - Nevertheless, in high-risk areas in the SFD is listed more than 4.5 million head of poultry. Vaccines undergo more than 4 million animals revaccinated nearly 240 thousand heads.

Preventive measures to avoid possible drift and spread of bird flu are continuing.

This should be a reminder that nurses and other HCP are not invincible...

Novel Influenza A (H1N1) Virus Infections Among Health-Care Personnel --- United States, April--May 2009

From MMWR: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5823a2.htm

Quote

CDC received 48 reports of confirmed or probable novel influenza A (H1N1) infection among HCP from 18 states. Detailed information on health-care exposures was obtained for 26 cases (18 confirmed and eight probable) reported from 11 states (Table 1). Dates of illness onset ranged from April 23 to May 4. Job type was available for 25 HCP: five registered nurses (20%), four nursing assistants (16%), four physicians (16%), and 12 persons in 10 other occupations. Two (8%) of these infected HCP were hospitalized, one of whom reported having underlying medical conditions. Neither hospitalized HCP was admitted to an intensive-care unit; no HCP died. Among the 16 HCP for whom such information was available, eight had been vaccinated for seasonal influenza since September 2008.

Specializes in Too many to list.

New Flu Vaccine Approved - For Dogs

https://www.nytimes.com/2009/06/30/health/30flu.html?_r=2&ref=health

Yes, I know they are only dogs! They are still important!

Actually this is significant because this particular virus, H3N8 has already jumped species once. It's a big jump from horses to dogs, but it did it. What's to stop it doing another jump?

www.nytimes.com said:

There is a new flu virus going around. It initially looked quite lethal, and caused panic. Now it is clear that it has killed relatively few victims-and many of those have underlying conditions. It is particularly dangerous to be the possessor of a pushed-in nose-that is, to be a Pekingese, a pug or a Shi-Tzu.

It is the H3N8 dog flu. The virus, scientists believe, jumped from horses to dogs at least five years ago, but it has never infected a human.

Last week, the United States Department of Agriculture announced that it had approved the first vaccine for it.

While fears of a flu pandemic among humans have shifted from the lethal H5N1 avian flu to the relatively mild H1N1 swine flu, the H3N8 canine flu has been a quiet undercurrent in the United States, rarely discussed except among veterinarians and dog owners in the few areas where it has struck hard: Florida, New York City's northern suburbs, Philadelphia and Denver.

In line with the virologists' adage that the only predictable thing about flu viruses is that they are unpredictable, the dog flu has baffled those following it.

"I don't think we know what this virus is going to do yet," said one of its discoverers, Dr. Cynda Crawford of the University of Florida veterinary school.

When Dr. Crawford began studying it in January 2004, it had come to her notice as a mysterious cough and pneumonia that killed a third of the greyhounds at a Florida dog track. By the next year, she had found it in seven states and had shown that it could be passed by dogs who just rubbed noses on the street or shared a water dish, and that humans could carry it on their clothes. There was a brief flurry of fear that it would kill 1 percent to 10 percent of the country's 70 million dogs.

It has proved about as deadly as Dr. Crawford predicted. She estimates that by itself, it kills 5 percent of the dogs that catch it. Add the deaths at shelters that eliminate the virus by killing all their dogs and disinfecting their cages, and the total mortality rate is 8 percent.

(By contrast, the mortality rate of the 1918 Spanish flu in humans was about 2 percent.)

But it has not spread nearly as vigorously as she expected. It has now been found in 30 states, but almost exclusively in settings where dogs live closely together: shelters, pet stores, kennels and dog schools. Because the owners of these establishments have learned to turn away sick dogs just as school principals facing swine flu send home sick children, the disease's progress has been slowed.

"Probably over 10,000 dogs have been infected," Dr. Crawford said, "but I can't say whether it's 20,000 or 30,000. In a population of 70 million, that's a drop in the bucket."

Dr. Edward J. Dubovi of the veterinary school at Cornell University, another discoverer of the virus, said it is "probably not as well adapted to dogs as it could be." It took five mutations to let it jump to dogs from horses, where it had circulated for 40 years.

Another mutation or two "could make it a very serious issue," he said, but at the moment, "it takes a certain density of dogs to keep it going."

Some veterinarians have found that the dogs that tend to die from it are the "brachycephalics"-dogs with short snub noses.

Just as obesity has proved dangerous to human flu victims because of the weight on their chests, being bred to have a short, bent respiratory tract is dangerous for dogs.

"It really puts a strain on their ability to breathe," Dr. Crawford said. "They can't move air in and out of their lungs."

(hat tip PFI/pixie)

Specializes in Too many to list.

Indonesia: Eight more suspected H5N1 cases, and a possible death

https://crofsblogs.typepad.com/h5n1/2009/07/indonesia-eight-more-suspected-h5n1-cases-and-a-possible-death.html

Lest we forget, bird flu is still killing people. There is the danger that it will co-infect someone with swine flu and acquire the ability to be more transmissible. It is present in some of the wild birds on three different continents thus far.

crofsblogs.typepad.com said:

Via Bird Flu Information Corner, a translated report from Gala Media.com: Sukabumi, West Java ::: Eight more bird flu suspects under observation. Excerpt:

Gumilar (7), resident of Kp. Bungur Pandak RT 03/05 Desa Bojong Kembar, Kecamatan Cikembar, is being treated in Sekarwangi Cibadak regional hospital as bird flu suspect patient. Victim showed body temperature up to 37℃ and had severe flu in only 24 hours. "He's still suspected to contract bird flu infection. We're worrying his clinical condition, now his temperature has reached 37℃ and the signs are worsened, " said the Head of Infectious Disease Eradication and Environmental Health (P2MPL), Health Service of Sukabumi, Dadang Sucipta.

Dadang also mentioned that dozens of chickens found suddenly dead around victim's neighborhood prior to the victim's illness.

"Dead chickens found within 200 meters radius from victim's house," he added.

Despite of Gumilar's case, Dadang and his team has observed other eight locals who developed the similar signs. They are Ma Anah (90), Een (40), Ma Ihat (60), Ujang Sadeli (15), Ade (40), Ningsih (50) and Resti (18). They are having severe flu and fever after the death of the chickens.

In another post, BFIC carries a translated report from Tempo Interaktif about the death of a 22-year-old man with suspected H5N1.

NHS braced to axe surgery and breaks as swine flu spreads

https://www.theguardian.com/world/2009/jul/16/swine-flu-nhs-special-measures

There have now been predictions by officials in the UK that their death toll could be 1 in 200, or 65,000 in a 2nd wave. They seem to be stepping up and getting actively ready for whatever happens in a month+. Numbers and estimates like these have been flying around in the British press for weeks. Haven't seen much like that in the US, mostly just urged to remain calm and keep washing our hands.

Specializes in Clinical Research, Outpt Women's Health.

WOW! It seems like such a non-factor here. No one even talks about it...

CrunchRN said:
WOW!! It seems like such a non-factor here. No one even talks about it...

I've noticed that, too. We're told to be vigilant and be concerned, but not alarmed, but there really seems to be no official guidance, no vocal speculation, no official contingency planning that's being made widely known. There are no mass campaigns to educate people, no fliers and pamphlets showing up on everyone's doorstep, no push to ask citizens to prepare and understand what may be happening very soon. Now is the time for us to have those things, and it's time to dispense with the rhetoric and politics and start talking about reality. The longer they evade the issue, the more people will be confused and panicky when this really does come back and is worse.

Girl Scout said:
I've noticed that, too. We're told to be vigilant and be concerned, but not alarmed, but there really seems to be no official guidance, no vocal speculation, no official contingency planning that's being made widely known. There are no mass campaigns to educate people, no fliers and pamphlets showing up on everyone's doorstep, no push to ask citizens to prepare and understand what may be happening very soon. Now is the time for us to have those things, and it's time to dispense with the rhetoric and politics and start talking about reality. The longer they evade the issue, the more people will be confused and panicky when this really does come back and is worse.

Agreed. It seems like any time this subject comes up at work, people are dismissive of it. I get the impression that many if not most of even my coworkers are oblivious to the very real possibility (IMO it's a probability) that this flu may come back with a veangence in the fall. I understand that the gov't doesn't want to panic people, but how much worse will the panic be if they haven't really warned people of the threat, and it does happen? I have prepared personally, with a couple weeks worth of supplies and meds (have that stuff anyway, I'm in earthquake country). But I know hardly anyone else that has. What are all these people going to do? The gov't can not possibly take care of everyone. And I don't see any real planning, at least not on a community or hospital wide level; not where I'm at anyhow. I've got a sinking feeling about the coming flu season. People are NOT prepared, and nobody is warning them to get that way. The British system being readied sounds sensible and workable. Why is our country not addressing this in some similar way? So many questions, so few answers. And not much time left.

Wait in cars, flu symptom patients are told

Quote

Wait in cars, flu symptom patients are told

By Marjory Inglis, health reporter

NHS TAYSIDE defended its swine flu response last night after patients with symptoms were told to wait in their cars before being escorted in to a Dundee health centre wearing masks.

Doctors and nurses wearing protective gowns, masks and gloves met patients in the car park at Wallacetown Health Centre on Monday and issued them with face masks in a bid to avoid spreading infection.

One health worker said, "It is a bit Victorian what they are doing."

A mother in Wallacetown car park last night said the whole reaction to swine flu was "over the top" and hinted that not everybody was suffering as badly as they might make out.

However, a Broughty Ferry mother said the situation was "terrifying" for young children.

She said in one local practice anyone with symptoms that doctors want to check out in person are told they have to come to the venue between five and six o'clock when the routine surgery is over.

"They are met by a doctor and nurse wearing masks and gowns and rubber gloves," she said.

The mother said if patients called the practice and staff were "pretty sure" over the phone the diagnosis was swine flu, they were advised to send somebody to pick up a prescription.

"A nurse friend told me that if they are not sure and worried it could be tonsillitis or pneumonia, they have to see these patients in order to make sure they are not misdiagnosing over the phone," she added.

The woman added, "That is when they are turning up and being met by staff wearing masks and gowns and gloves."

An NHS Tayside spokeswoman defended measures taken to prevent the spread of the virus.

She said, "The out-of-hours service at Wallacetown was extremely busy over the public holiday on Monday with 191 calls to the service, which is three times more than we would usually see on a public holiday.

"A number of these calls were from patients who had flu symptoms and a small number of them were asked to come to Wallacetown to see a doctor.

"Due to the number of people in the waiting room we took the precaution of sending doctors and nurses to collect patients from their cars and bring them in to an isolated treatment room.

"The doctors and nurses followed appropriate infection control measures and gave these patients masks which were worn in to the health centre. These temporary additional infection control measures were to help reduce the potential spread of the virus and worked well.

"However as the number of potential H1N1 infections may increase over the coming weeks, we will be looking at how we can continue to manage the developing situation."

credits Hogweed

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