The Unforgiving Arithmetic of Pandemic

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Specializes in Too many to list.

http://www.vatican.va/news_services/or/or_eng/text.html#4

Well worth the read.

Dr. Fedson is a retired American physician living in France. He has long worked on the epidemiology of influenza and influenza vaccination, first as a Professor of Medicine at the University of Virginia and later as Director of Medical Affairs for Aventis Pasteur MSD. He has served on several American and World Health Organization (WHO) committees on influenza immunization, and was instrumental in establishing the Influenza Vaccine Supply (IVS) International Task Force and the Macroepidemiology of Influenza Vaccination (MIV) Study Group. He clearly knows the influenza vaccine industry from the inside. He also knows that the arithmetic for a pandemic is simple: you can only treat the victims of a pandemic if effective vaccines and medications are widely available. For 90% of the world's population, this won't be the case.

With the current swine H1N1 pandemic influenza virus, as with the H5N1 avian flu and 1918 pandemic viruses, deaths have been prominent among the 15- to 45-year old adults. These deaths have been associated with a severe immune reaction, often called a "cytokine storm." For more than five years, Fedson has been calling for urgent and sharply focused research to determine whether drugs that reduce inflammation or modify the host response the way that the body responds to infection or injury could be used to manage the pandemic. Focusing on inexpensive generic drugs that are readily available, even in developing countries, could address the inequity already being seen, and could save millions of lives in the current and in future pandemics.

(hat tip flutrackers/St.Michael]

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http://www.vatican.va/news_services/or/or_eng/text.html#4

Well worth the read if only for the discussion on therapies that might work other than the few antivirals that we are using now.

(hat tip flutrackers/St.Michael]

The only thing I can think of when they say, "other drugs to reduce inflammation" is steroids and NSAIDS. Is there any others?

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Specializes in Too many to list.
The only thing I can think of when they say, "other drugs to reduce inflammation" is steroids and NSAIDS. Is there any others?

Wow, I did not realize that all of that "other" stuff was on that link! Sorry about that, but I do not know how to just include the interview with Fedson only without copying the whole long interview.

Specifically Fedson is talking statins, and I think that I also heard of one of the antidiabetic drugs mentioned elsewhere, but I will have to try and track down that info.

Here is more on what Fedson has to offer as a solution:

http://afludiary.blogspot.com/2009/02/fedson-on-meeting-challenge-of-pandemic.html

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Specializes in ICU, Telemetry.

What scares me (re: cytokine storm) is that it tends to make people need vents. We don't have that many "vent beds" in the country. Our hospital has 12, with 30 "portables" -- and we've got 40,000 people in the county. If 1 percent of the people in the county catch H5N1 and needed vents -- that's 450 people. Even if they were split up over the course of an outbreak, we're still going to have more people than we do vents (or people qualified to monitor someone on a vent, but don't get me started on lack of cross training...). If the crap hits the fan, we're going to have dozens of patients who don't have a vent, and won't live without one.

Now that's an horrifying calculation. Who do you give a vent to? Who gets the "black" tag, and what do you use to decide? Age? Co-morbidity? "Worth to the community?"

What happens when someone brings a gun in to make sure their mom or dad gets a vent? And puts a gun to your head and tells you to unhook someone else?

Think about the most self centered, self serving, "there's nobody in the hospital but me/my SO/my kid/my parent" person who's ever come to your hospital. How far would they go to keep the person they loved most in the world alive....?

That's the kind of crap that keeps me awake...

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What scares me (re: cytokine storm) is that it tends to make people need vents. We don't have that many "vent beds" in the country. Our hospital has 12, with 30 "portables" -- and we've got 40,000 people in the county. If 1 percent of the people in the county catch H5N1 and needed vents -- that's 450 people. Even if they were split up over the course of an outbreak, we're still going to have more people than we do vents (or people qualified to monitor someone on a vent, but don't get me started on lack of cross training...). If the crap hits the fan, we're going to have dozens of patients who don't have a vent, and won't live without one.

Now that's an horrifying calculation. Who do you give a vent to? Who gets the "black" tag, and what do you use to decide? Age? Co-morbidity? "Worth to the community?"

What happens when someone brings a gun in to make sure their mom or dad gets a vent? And puts a gun to your head and tells you to unhook someone else?

Think about the most self centered, self serving, "there's nobody in the hospital but me/my SO/my kid/my parent" person who's ever come to your hospital. How far would they go to keep the person they loved most in the world alive....?

That's the kind of crap that keeps me awake...

YUP, we have been worrying about the same thing. No surge capacity in our medical system. Here is another thing that could happen, 3 or 4 very sick kids show up at the ER needing vents, one is the governors child, who do you think will get the vent? Even if there is a protocol it will go out the window when the CEO shows up and starts demanding special treatment for their friends and family. They already do it all the time. Most nurses have been threatened with the "I know people" thing in good times, wait now that bad times are here and see what happens. Then of course, like you say there is the guy with the gun.
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Specializes in Too many to list.

Nerdtonurse,I think that you meant swine flu, right? I know, I sometimes type the wrong one myself especially when I read some of the studies like this one that makes comparisons between the 1918 flu and bird flu, H5N1.

Here is Dr. Fedson's research paper. He may be on to something here. Please read it to understand why he recommends what he does.

http://www3.interscience.wiley.com/cgi-bin/fulltext/122455801/HTMLSTARTW?CRETRY=1&SRETRY=0

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Specializes in Too many to list.

Btw, all of the links in this thread come via the research and generous assistance of my colleague and friend, Fla Medic over at Avian Flu Diary. He is ever so much better at finding the things that I can barely remember. Thanks, Mike!

Commentary from Dr. Grattan Woodson over at flutrackers in response to the Fedson paper. For those of us too tired to read the research, Dr. Woodson has done a neat summary.

http://www.flutrackers.com/forum/showpost.php?p=248995&postcount=4

Dr. Woodson is known for his work on teaching people to take of sick family members at home:

http://www.birdflumanual.com/resources/Home_Influenza_Treatment/files/Good%20Home%20Treatment%20of%20Influenza/Default.asp

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Specializes in Too many to list.

Research Into Antiviral/NSAID Cocktail

Oramar, you were right about the NSAIDS. Nerdtonurse, steroids did not work for bird flu patients. Don't know if this is the case for swine flu or not.

Hey, this worked in mice!

http://afludiary.blogspot.com/2008/06/research-into-antiviralnsaid-cocktail.html

Scientists infected mice with the bird flu virus and then began treatment 48 hours post-infection with a combination of zanamivir (Relenza) and two types of NSAIDS (Non-Steroidal Anti-Inflammatory Drugs).

Survivability increased 4-fold with this cocktail over zanamivir alone.

The NSAIDS used were celecoxib (Celebrex) and mesalazine, an NSAID used for inflammatory bowel disease.

Steroids, which reduce inflammation but also inhibit the body's immune system, were tried early on with SARS and experimentally with bird flu, but in the end did not improve long-term survivability. NSAIDS have a similar anti-inflammatory effect, but don't weaken the immune system.

The scientists involved in this study are hopeful this research will lead to clinical trials of this drug cocktail.

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