Will you work during a Pandemic?

GooeyRN, ADN, BSN, CNA, LPN, RN · Jun 19, 2009

The original scenerio was working WITHOUT gloves, masks, gowns, etc. Basically, an automatic death sentence.

ssing45 · Jun 19, 2009

wiht or without pay..im willing to work during pandemic..it doesnt matter what happens to me, what matters is you have help and save thousands..anyways hiding yourself from all the diseases doenst guarantee you wont have one..we are nurses..we have work during disasters annd holidays..if you cant take this kind of life, then probably nursing is not for you..

How very noble of you but...

1. Nurses are taught not to judge anyone else's circumstance, have you forgotten?

2. If you get sick and die how can you help thousands? You'll be dead.

Laidback Al · Jun 19, 2009

...and 4th with proper precautionary measures and im sure vaccines, mask etc are given before you work or volunteer so i dont think we will easily get sick so that means i still be able to take care of others..answer me this..what if there is an outbreak of something and no one to pay you, would you help knowing you know about health???

Having carefully followed the JIT (Just In Time) world wide economic distribution system, I think it is highly unlikely that there will be enough PPE for all HCWs once hospitals and medical facilities are overwhelmed. Similarly, I doubt there will be enough vaccine available, even for all the HCWs that are willing to be vaccinated.

The news report are unclear, but it seems to me that there are hospitals and medical facilities that are already being overrun by the "worried well" as well as real H1N1 cases. The only thing that has allowed the pandemic to progress this far without much panic is the low reported death rates. But the analysis at FluTrackers suggests H1N1 associated deaths are being under reported in the USA and possibly around the world.

I appreciate you noble intentions, marslarks. But if you can't protect yourself from becoming infected, how will you be able to help those who are.

lamazeteacher · Jun 19, 2009

The original scenerio was working WITHOUT gloves, masks, gowns, etc. Basically, an automatic death sentence.

Please don't make erroneous statements like that last one! Too many health horror movies on the market, I think.........

That scenario has been miscommunicated. Go to the OP, CDC's updates showing the low incidence of reported H1N1 and the relatively few deaths resulting from it. As some one pointed out in some post on this thread, gloves, goggles, and gowns are only used if a splash of blood/body fluids is anticipated, in the instance of deep open wound dressing changes; and if dressing supplies run out, it will be long before newly mass ordered PPEs do.

What is more likely, is that frightened, undereducated health care employees may, in their frustration, stockpile PPE in their cars, where it could get dirty, and then the amount of supplies ordered in large quantities in anticipation of another possibly more lethal wave of H1N1, the shelves holding such equipment would empty much sooner. We all know that petty theft of hospital supplies is a growing problem. If you see any of that going on, you need to report it. Theft is theft - no excuse for it! :nono:

Girl Scout · Jun 19, 2009

Please don't make erroneous statements like that last one! Too many health horror movies on the market, I think.........

With how the OP phrased it, the situation was very bleak. The OP isn't about H1N1, it's about H5N1, which has a very high fatality rate, still.

lamazeteacher · Jun 19, 2009

well, here are the latest cdc stats:

synopsis:

during week 23 (june 7-13, 2009), influenza activity decreased in the united states, however, there were still higher levels of influenza-like illness than is normal for this time of year.

two thousand seven hundred sixty-five (38.7%) specimens tested by u.s. world health organization (who) and national respiratory and enteric virus surveillance system (nrevss) collaborating laboratories and reported to cdc/influenza division were positive for influenza.
over 98% of all subtyped influenza a viruses being reported to cdc were pandemic influenza a (h1n1) viruses.
the proportion of deaths attributed to pneumonia and influenza (p&i) was slightly above the epidemic threshold.
one influenza-associated pediatric death was reported and was associated with pandemic influenza a (h1n1) virus infection.
the proportion of outpatient visits for influenza-like illness (ili) was below the national baseline. one of the 10 surveillance regions reported ili above their region-specific baseline.
eleven states reported geographically widespread influenza activity, six states and puerto rico reported regional influenza activity, the district of columbia and 13 states reported local influenza activity, and 20 states reported sporadic influenza activity.

national and regional summary of select surveillance components

hhs surveillance regions*

data for current weekdata cumulative for the seasonout-patient ili†% positive for flu‡number of jurisdictions reporting regional or widespread activitya (h1)a (h3)novel a (h1n1)a (could not be subyped)¥a(unsub-typed)bpediatric deathsnationnormal38.7 % 18 of 527,8242,17012,31642813,07910,39771region inormal38.3 % 4 of 65201511,542131,3028001region iielevated35.5 % 3 of 3277137592161,4927119region iiinormal37.5 % 3 of 61.3132131,35306691,3609region ivnormal19.7 % 2 of 8828117351411,8971,2116region vnormal52.6 % 2 of 61,6531905,7261295551,32611region vinormal14.1 % 0 of 576816589854,0792,60814region viinormal12.0 % 0 of 4498601591134505290region viiinormal29.7 % 1 of 6526216745571,5014986region ixnormal12.9 % 3 of 41,0616276802279869014region xnormal23.2 % 0 of 4380294270323366641

* hhs regions (region i: ct, me, ma, nh, ri, vt; region ii: nj, ny, puerto rico, us virgin islands; region iii: de, dc, md, pa, va, wv; region iv: al, fl, ga, ky, ms, nc, sc, tn; region v: il, in, mi, mn, oh, wi; region vi: ar, la, nm, ok, tx; region vii: ia, ks, mo, ne; region viii: co, mt, nd, sd, ut, wy; region ix: az, ca, guam, hi, nv; and region x: ak, id, or, wa)

† elevated means the % of visits for ili is at or above the national or region-specific baseline

‡ national data are for current week; regional data are for the most recent three weeks

includes all 50 states, the district of columbia, and puerto rico

¥ the majority of influenza a viruses that cannot be sub-typed as seasonal influenza viruses are pandemic a (h1n1) influenza viruses upon further testing

u.s. virologic surveillance:

who and nrevss collaborating laboratories located in all 50 states and washington d.c. report to cdc the number of respiratory specimens tested for influenza.

during the 2008-09 season, influenza a (h1), a (h3), and b viruses have co-circulated in the united states. on april 15 and 17, 2009, cdc confirmed the first two cases of pandemic influenza a (h1n1) virus in the united states. as of june 19, 2009, 21,449 confirmed and probable infections with pandemic influenza a (h1n1) virus and 87 deaths (24 in individuals less than 25 years and 63 deaths in adults 25 years of age older) have been identified by cdc and state and local public health departments. reporting of pandemic influenza a (h1n1) viruses by u.s. who collaborating laboratories began during week 17 (week ending may 2, 2009). the results of tests performed during the current week are summarized in the table below.

week 23no. of specimens tested7,149no. of positive specimens (%)2,765 (38.7%)positive specimens by type/subtype influenza a2,759 (99.8%) a (pandemic h1n1) 2,263 (82.0%) a (subtyping not performed) 429 (15.5%) a (unable to subtype) 24 (0.9%) a (h3) 21 (0.8%) a (h1) 22 (0.8%) influenza b6 (0.2%)

during week 23, seasonal influenza a (h1), a (h3), and b viruses co-circulated at low levels with pandemic influenza a (h1n1). over 98% of all subtyped influenza a viruses being reported to cdc this week were pandemic influenza a (h1n1) viruses.

the increase in the percentage of specimens testing positive for influenza by who and nrevss collaborating laboratories may be due in part to changes in testing practices by health care providers, triaging of specimens by public health laboratories, an increase in the number of specimens collected from outbreaks, and other factors.

view who-nrevss regional bar charts| view chart data | view full screen antigenic characterization:

cdc has antigenically characterized 1,635 seasonal human influenza viruses [947 influenza a (h1), 171 influenza a (h3) and 517 influenza b viruses] collected by u.s. laboratories since october 1, 2008, and 144 pandemic influenza a (h1n1) viruses.

all 947 influenza seasonal a (h1) viruses are related to the influenza a (h1n1) component of the 2008-09 influenza vaccine (a/brisbane/59/2007). all 171 influenza a (h3n2) viruses are related to the a (h3n2) vaccine component (a/brisbane/10/2007).

all 144 pandemic influenza a (h1n1) viruses are related to the a/california/07/2009 (h1n1) reference virus selected by who as a potential candidate for pandemic influenza a (h1n1) vaccine.

influenza b viruses currently circulating can be divided into two distinct lineages represented by the b/yamagata/16/88 and b/victoria/02/87 viruses. sixty-five influenza b viruses tested belong to the b/yamagata lineage and are related to the vaccine strain (b/florida/04/2006). the remaining 452 viruses belong to the b/victoria lineage and are not related to the vaccine strain.

data on antigenic characterization should be interpreted with caution given that antigenic characterization data is based on hemagglutination inhibition (hi) testing using a panel of reference ferret antisera and results may not correlate with clinical protection against circulating viruses provided by influenza vaccination.

annual influenza vaccination is expected to provide the best protection against those virus strains that are related to the vaccine strains, but limited to no protection may be expected when the vaccine and circulating virus strains are so different as to be from different lineages, as is seen with the two lineages of influenza b viruses. antigenic characterization of pandemic influenza a (h1n1) viruses indicates that these viruses are antigenically and genetically unrelated to seasonal influenza a (h1n1) viruses, suggesting that little to no protection would be expected from vaccination with seasonal influenza vaccine.

antiviral resistance:

since october 1, 2008, 988 seasonal influenza a (h1n1), 172 influenza a (h3n2), and 529 influenza b viruses have been tested for resistance to the neuraminidase inhibitors (oseltamivir and zanamivir). nine hundred ninety-one seasonal influenza a (h1n1) and 179 influenza a (h3n2) viruses have been tested for resistance to the adamantanes (amantadine and rimantadine). one hundred eighty-eight pandemic influenza a (h1n1) viruses have been tested for resistance to the neuraminidase inhibitors (oseltamivir and zanamivir). one hundred forty-two pandemic influenza a (h1n1) viruses have been tested for resistance to the adamantanes (amantadine and rimantadine). the results of antiviral resistance testing performed on these viruses are summarized in the table below.

isolates tested (n)resistant viruses,

number (%)isolates tested (n)resistant viruses, number (%)oseltamivirzanamiviradamantanesseasonal influenza a (h1n1)988983 (99.5%)0 (0)9916 (0.6%)influenza a (h3n2)1720 (0)0 (0)179179 (100%)influenza b5290 (0)0 (0)n/a*n/a*novel influenza a (h1n1)1880 (0)0 (0)142142 (100%) *the adamantanes (amantadine and rimantadine) are not effective against influenza b viruses.

antiviral treatment with either oseltamivir or zanamivir is recommended for all patients with confirmed, probable or suspected cases of pandemic influenza a (h1n1) virus infection who are hospitalized or who are at higher risk for seasonal influenza complications. the pandemic influenza a (h1n1) virus is susceptible to both neuraminidase inhibitor antiviral medications zanamivir and oseltamivir. it is resistant to the adamantane antiviral medications, amantadine and rimantadine. additional information on antiviral recommendations for treatment and chemoprophylaxis of pandemic influenza a (h1n1) infection is available at http://www.cdc.gov/h1n1flu/recommendations.htm

in areas that continue to have seasonal influenza activity, especially those with circulation of oseltamivir-resistant seasonal human influenza a (h1n1) viruses, clinicians might prefer to use either zanamivir or a combination of oseltamivir and either rimantadine or amantadine to provide adequate empiric treatment or chemoprophylaxis for patients who might have seasonal human influenza a (h1n1) virus infection.

pneumonia and influenza (p&i) mortality surveillance

during week 23, 7.0% of all deaths reported through the 122-cities mortality reporting system were due to p&i. this percentage is slightly above the epidemic threshold of 6.9% for week 23.

view full screen influenza-associated pediatric mortality

one influenza-associated pediatric death was reported to cdc during week 23 (arizona). this death was associated with a pandemic influenza a (h1n1) virus infection. the death reported this week occurred during week 23 (the week ending june 13, 2009). since september 28, 2008, cdc has received 71 reports of influenza-associated pediatric deaths that occurred during the current influenza season, six of which were due to pandemic influenza a (h1n1) virus infections.

of the 34 children who had specimens collected for bacterial culture from normally sterile sites, 14 (41.2%) were positive; staphylococcus aureus was identified in nine (64.3%) of the 14 children. one of the three children with confirmed pandemic influenza a (h1n1) infection had a specimen collected from a normally sterile site; bacterial cultures were negative. four of the s. aureus isolates were sensitive to methicillin and five were methicillin resistant. twelve (85.7%) of the 14 children with bacterial coinfections were five years of age or older and 10 (71.4%) of the 14 children were 12 years of age or older. an increase in the number of influenza-associated pediatric deaths with bacterial coinfections was first recognized during the 2006-07 influenza season. in january 2008, interim testing and reporting recommendations were released regarding influenza and bacterial coinfections in children and are available at (http://www2a.cdc.gov/han/archivesys/viewmsgv.asp?alertnum=00268).

view full screen influenza-associated hospitalizations

laboratory-confirmed influenza-associated hospitalizations are monitored in two population-based surveillance networks: the new vaccine surveillance network (nvsn) and the emerging infections program (eip).

during october 12, 2008 to may 30, 2009, the preliminary laboratory-confirmed influenza-associated hospitalization rate for children 0-4 years old in the nvsn was 3.85 per 10,000. because of case identification methods utilized in this study, there is a delay from the date of hospitalization to the date of report.

view full screen

during april 15, 2009 – june 13, 2009, the following preliminary laboratory-confirmed overall influenza associated hospitalization rates were reported by the eip (rates include type a, type b, and confirmed pandemic h1n1):

rates for children aged 0-23 months, 2-4 years, and 5-17 years were 0.92, 0.22, and 0.16 per 10,000, respectively. rates for adults aged 18-49 years, 50-64 years, and = 65 years, the overall flu rates were 0.07, 0.09, and 0.23 per 10,000, respectively.

*this value represents an age group-specific average influenza rate from october 1 to april 30 from the 2005-06, 2006-07, and 2007-08 influenza seasons.

**note: the scales for the 0-23 month and the >= 65 years age groups differ from other age groups.

view full screen outpatient illness surveillance:

nationwide during week 23, 1.8% of patient visits reported through the u.s. outpatient influenza-like illness surveillance network (ilinet) were due to influenza-like illness (ili). this percentage is below the national baseline of 2.4%.

view ilinet regional charts | view chart data |view full screen

on a regional level, the percentage of outpatient visits for ili ranged from 0.5% to 4.7%. one of the 10 surveillance regions reported an ili percentage above their region specific baseline (region ii). ili decreased during week 23 in six of 10 regions compared to week 22.

geographic spread of influenza as assessed by state and territorial epidemiologists:

the influenza activity reported by state and territorial epidemiologists indicates geographic spread of both seasonal influenza and pandemic influenza a (h1n1) viruses and does not measure the severity of influenza activity.

during week 23, the following influenza activity was reported:

widespread influenza activity was reported by 11 states (arizona, connecticut, delaware, hawaii, maine, new jersey, new york, pennsylvania, rhode island, utah, and virginia).
regional influenza activity was reported by puerto rico and six states (california, georgia, illinois, massachusetts, minnesota, and south carolina).
local influenza activity was reported by the district of columbia and 13 states (alabama, colorado, maryland, michigan, new mexico, north carolina, oklahoma, tennessee, texas, vermont, west virginia, wisconsin, and wyoming).
sporadic activity was reported by 20 states (alaska, arkansas, florida, idaho, indiana, iowa, kansas, kentucky, louisiana, mississippi, missouri, montana, nebraska, nevada, new hampshire, north dakota, ohio, oregon, south dakota, and washington).

view full screen

--------------------------------------------------------------------------------

a description of surveillance methods is available at: http://www.cdc.gov/flu/weekly/fluactivity.htm

page last updated june 19, 2009.

what you should know about …

info for health professionals

HippyGreenPeaceChick · Jun 19, 2009

Over Reacting on the part of the WHO

rockenmomRN · Jun 19, 2009

I personally think this is all hype in order for pharmacutical companies to sell more flu vaccines next year.

Oh and "lamazteacher" i'm sure you'll have alot of opinions about what i said. I stand behind what i said earlier...no PPE, no workie work for me.

GooeyRN, ADN, BSN, CNA, LPN, RN · Jun 19, 2009

The original scenerio was not specifically H1N1.

MAISY, RN-ER, BSN, RN · Jun 20, 2009

Anyone providing ER care HAS BEEN WORKING IN A PANDEMIC! However, already there are reasons not to trust one's facility. In my ER if you become ill with flu like symptoms you must take off two weeks, HOWEVER that is 14 sick days (or whatever) and punitive action is taken for over 3 days sick time and you are written up. Lovely right?

So for all the stupid adults that come in hacking all over us, and the kids who are sick and are coming in EVEN AFTER SEEING THE PEDIATRICIAN, and they are told to rest, rehydrate, and medicate for fever BUT THEY DO NOT AND THEN NEED EMERGENT CARE FOR DEHYDRATION-THANKS PARENTS! The RNs are getting sick too and working that way because we are so short staffed!

People have been impatient, ridiculous, demanding, and outright argumentative when other people are taken ahead of them. No one has a grandma anymore. Everyone comes to the hospital for a belly ache and mild flu symptoms. I can't stand the media, and I can only imagine if this was a truly horrible illness. It would be anarchy!

So for those of you not on the front line, you haven't got a clue. People have been occasionally like animals, pushing, shoving, screaming, and evil. I am more sure than ever I will not go in unless I know I am going to die then what the hell! I know I am coming on strong, but I am sure we will require protection from the public, they won't want just help, they'll want miracles. Not only the sick will die, but those with the ability to heal will probably need mob control protection just to operate safely.

Sorry for the downer, but I am sick of this already.

Laidback Al · Jun 20, 2009

I personally think this is all hype in order for pharmacutical companies to sell more flu vaccines next year.

I don't think the parents, children, relatives, friends, etc. of the dozens of healthy vibrant adults and children that have died from H1N1 would agree that this pandemic is a conspiracy by pharmaceutical companies.

DeepFriedRN · Jun 20, 2009

lamazeteacher, the OP was written in reference to an H5N1 outbreak, and was written over a year ago. Many of the people answering the question are answering it as it was presented in the OP, and we are aware that the current situation is not extremely deadly at present.

As to those who feel that they'd be OK being martyred to the cause, well, to each their own, I guess. Not this nurse. I will work if the environment is safe(i.e. there is adequate PPE, and I and my family will be as safe as is possible in such a situation). It's not asking too much. Not much else to say.

Will you work during a Pandemic?

Nurses, would you go to work during a Pandemic?