S. Korea Lifts Bird Flu Restrictions

 

# 2015

 

 

Three months after it began, South Korea has sounded the all-clear over the bird flu outbreaks that spread across that nation in April.   The last reported outbreak was in mid-May, and so if no further outbreaks occur, that nation will be declare `bird-flu free' in mid August.

 

 

Of course, in countries previously affected by bird flu, being declared free of the virus is often just a transitory phase. 

 

 

Interestingly,  South Korea is laying the blame for the outbreak on `migratory birds or foreign workers and tourists who visited China or Vietnam'.   

 

This is curious because no explanation for why a possible human vector might be suspected has been provided.   Migratory birds, of course, are often mentioned as possible vectors. 

 

 

This from the Straits Times.

 

 

June 30, 2008

S. Korea lifts all restrictions imposed in wake of bird flu outbreaks

SEOUL - SOUTH KOREA has lifted restrictions imposed to curb an outbreak of bird flu which led to the culling of more than eight million birds, the agriculture ministry said on Monday.

 

It said curbs on the movement of birds, people and vehicles were lifted in all districts hit by avian flu as of Sunday.

 

South Korea has culled more than eight million birds since April 1. This year's outbreak is the country's worst with damage estimated at 200 billion won (S$260 million).

 

No confirmed case has been reported since May 12, the ministry said.

 

'If no new cases are reported, we will declare the country free of the disease in August,' a ministry spokesman said.

 

In the country's 2003-2004 outbreak 5.28 million birds were culled, while a 2006-2007 outbreak resulted in 2.8 million birds being destroyed.

 

South Korea hopes to proclaim itself free of the disease in mid-August and report it to the World Organisation for Animal Health, according to the ministry.

 

Under the organisation's regulations, a country can officially declare itself free of the disease if no new cases of bird flu have been found for three months.

 

The ministry said it suspected this year's bird flu outbreak was caused by migratory birds or foreign workers and tourists who visited China or Vietnam.

 

 

Curious, indeed.

Remembering 1918 - An Oral History

 

 

# 2114

 

 

 

 

The Spanish Flu of 1918-1919 may be the least mentioned major event of the last century in popular culture.   That is in songs, movies, television shows, and novels.

 

As a bit of a movie buff, particularly very old movies, I constantly  look for references to the great pandemic, but almost never find them.  

 

There are a great many movies about the events of that era - World War I, the wildness of the roaring twenties - even the sinking of the Titanic . . .  but the influenza that ravaged the world and killed tens of millions gets practically no mention at all. 

 

It is as if the survivors collectively wiped it out of their minds, fearing that even mentioning it would bring bad luck - or perhaps a return of the pandemic.

 

I can personally think of no other reason that the events of 1918-1919 have been so thoroughly wiped from our collective consciousness.  It was simply too horrific to remember.

 

A notable exception was the short novel  Pale Horse, Pale Rider by Katherine Anne Porter  published in 1939.  It doesn't appear to have ever been made into a movie, although in the 1960's a television play with the same name was produced.  I've been unable to obtain a copy, so I am unsure if it is about the same subject.

 

 

As a young paramedic in the 1970's, I was lucky enough to have met, and to have talked to many survivors of the Spanish Flu.  A great many of my patients were teenagers or young adults in 1918, and on routine calls (nursing home transfers, mostly) they would often talk about `the old days'.

 

Occasionally, the subject of 1918 would come up.  It was obviously a major trauma for most of them, even nearly sixty years after the fact.   When they did talk about that time, it was in hushed tones.

 

 

 

Just about all of those of that generation are gone now.  My father, now 83, was born six years after the Spanish Flu, and can remember very little talk about it growing up.   It just wasn't mentioned.   Anyone old enough in 1918 to have much remembrance would have to be at least 95 years old by now.

 

 

And so we forgot.   As a nation, and as a world.  

 

 

We spoke not of it in books or movies, nor in television or song.   We banished its remembrance and silently prayed it would never return.

 

 

Perhaps that is why it is so hard for most people today to accept the possibility that it could happen again.  

 

We don't remember the last time.

 

 

Luckily, there are a few serious historical references to 1918.  

 

 

John Berry's Book,  The Great Influenza  is of course well known today.    The HHS has put together a  good website chronicling the events of 1918 as well.

 

 

 

This morning I ran across a video which utilizes photos from the Library of Congress (and other sources) along with  audio from Charles Hardy's excellent Talking History  segment on the impact of the Spanish Flu on Philadelphia.  Recorded in the early 1980's, there were still many survivors of the flu left to interview.

 

 

 

This video, entitled  The Killer Within,  is hosted on both  Youtube, and You Remember That  (among others I suppose).   It runs about 9 minutes, and while disturbing, is well worth the time to view. 

 

 

 

A longer (and arguably better)  retrospective comes from the Charles Hardy Talking History show  I remember When, which runs about 34 minutes.  In it you will hear much about how the influenza was treated in 1918 and the impacts on society.  

 

 

 

"I Remember When: What Became of the Influenza Pandemic of 1918." (1983)
Real Media. MP3. Time: 34:51.
"What Became of the Influenza Pandemic of 1918" was also part of Hardy's I Remember When series. Initially aired on January 18, 1983, it focused on the worst pandemic of the Twentieth Century and its impact on Philadelphia, the hardest hit of American cities.

 

 

Both of these presentations are extremely well done and well worth your time.

Japan, China, And South Korea Plan Flu Drill

 

# 2113 

 

 

 

Pandemic plans are all well and good, but they don't mean much until you test them.   While drills are sometimes oversold to the press, they are essential to figure out what works, and what needs work.

 

Anything that facilitates the sharing of  information, a stated goal of this drill, can only be a good thing in a crisis.    It is hoped that the lessons learned from this drill will result in the creation of new guidelines for use during a pandemic.

 

This from the Yomiuri Shimbun.

 

 

 

 

 

Japan, China, S. Korea plan flu outbreak drill

 

The Yomiuri Shimbun

The government has decided to conduct its first joint drill with China and South Korea, possibly in October, to prepare against the possibility of an outbreak of new strains of influenza, according to sources.

 

 

Through the joint drill, the three countries hope to determine whether the sharing of information among them and their quarantine measures are satisfactory, using the results of the drill to establish new guidelines.

 

 

The Japanese government also plans to conduct joint drills with domestic medical institutions and local governments and to determine if these entities nationwide are fully prepared for a possible outbreak.

 

 

H5N1 avian influenza virus is said to have mutated into a new strain of influenza that can be passed on to humans. Many experts say such an outbreak would occur in Asia, where many people are reported to have been infected with the H5N1 virus.

 

 

Many people and items move among the three countries, as do many migrating birds. For this reason, the countries decided that cooperation was essential to prepare against possible outbreaks.

 

 

According to the Health, Labor and Welfare Ministry, the government is currently discussing the details of possible scenarios for the drills with the two other countries and related entities. The drills are expected to take place in October after the Beijing Olympic Games have finished.

 

 

The government has announced it will urge Japanese nationals living or traveling abroad to return home immediately from a foreign country in which there is an outbreak of any new influenza strain.

 

 

The basic premise of the joint drill will be that a new strain of influenza breaks out in one of the three countries.

 

 

Through the drill the government aims to confirm the effectiveness of measures already taken to strengthen the nation's quarantine system. For example, the government will see whether quarantine officials are able to determine if passengers are infected with the new strain at four airports designated to accept chartered flights carrying Japanese nationals living or traveling in one of the countries at the time of an outbreak.

(Jun. 30, 2008)

For Those With Nothing Better To Do

 

# 2012

 

 

I'll be appearing again on Radio Sandy Spring's  Infectious Disease hour tomorrow, between 4pm and 5pm, EDT.    They usually rebroadcast the show again between 7pm and 8pm the same night.

 

 

The show - coming out of the Atlanta, Georgia area - is best heard on streaming audio on the Internet.  The show will be archived for later listening on their site.

 

The show airs on Monday, June 30th, at 4pm ET.  The topic (I hope) will be the new proposed pandemic guidelines issued by the HHS for facemasks, respirators, and antivirals.

 

The interview will be streamed live on the Internet, and will also be archived for later listening.

 

 

Sharon Sanders, editor of Flutrackers will do the first twenty or thirty minutes of the show and then the rest of the hour will consist of a conversation between the host, David Moxley, and myself. 

No Good Deed Goes Unpunished

 

# 2011

 

 

A minor soap opera with major implications has been going on in Pakistan the past couple of days.   

 

 

As my readers are well aware, officials of the Pakistani Poultry Industry apparently carry significant sway with some Pakistani government officials. 

 

Together, they've been very protective of the industry.

 

Three days ago news broke that a provincial livestock officer has been suddenly transferred as `punishment' for revealing that bird flu had broken out at a farm in the Swabi district. 

 

This is from Pakistan's Dawn newspaper.

 

 

 

 

PESHAWAR: Official made scapegoat in bird flu controversy

By Ashfaq Yusufzai

PESHAWAR, June 26: The provincial government has transferred an official of the livestock department from Swabi to Mardan as punishment for allegedly disclosing that H5N1 strain of bird flu influenza had been detected in a poultry farm of the district, sources told Dawn.

 

They claimed that on the advice of a local MPA, who favoured the poultry farm owners, Basic Livestock Officer Mohammad Ibrahim was made a scapegoat for revealing the information and “transferred within a day as the process usually takes a month”.

 

Earlier, the livestock department had conducted a test of poultry samples at the National Research Institute Islamabad that reportedly detected H5N1 virus in the poultry samples taken from a poultry farm in Tordher, Swabi.

 

In contrast to this report, the Poultry Association Swabi claimed that they had conducted a similar test of the poultry sample at the Poultry Research Institute Rawalpindi, which identified the virus as H5N9, which was not dangerous for human beings.

 

 

I reported on the testing by the Poultry industry here, and thus far, there is nothing but their statement to support their claim. 

 

 

 

The immediate, and very public, punishment of this livestock officer for revealing the Truth  is no doubt intended as a signal to others who might be similarly inclined.    A shot across their collective bows, warning them to keep their mouths shut.

 

This sort of suppression of the truth isn't exactly new, nor is it exclusive to Pakistan.  It happens all over the world.  

 

The stakes here, however, are enormous.   Turning a blind eye to outbreaks of H5N1, or disguising them as something more `convenient'  places the world at risk.  

 

Fortunately some officials, including representatives from WHO, have come to the defense of District Livestock officer Dr Mohammad Ibrahim.  

 

This from yesterday's Dawn Newspaper.

 

 

 

 

SWABI: WHO, federal secy against livestock officer’s transfer

 

By Our Correspondent

SWABI, June 28: The World Health Organisation and the federal secretary for agriculture want cancelled the transfer of the district livestock officer to make the drive against bird flu in Swabi more result-oriented after detection of H5N1 in a poultry farm in the district’s Tordher village a week ago.

 

Sources told Dawn on Saturday that the federal secretary, WHO officials and all staff concerned stood against what they called the unjust transfer.

 

District livestock officer Dr Mohammad Ibrahim was made ‘scapegoat’ for his action against a bird flu-hit poultry farm which was immediately closed and about 2,000 birds were culled by officials of livestock and the WHO with the help of the local administration. Poultry farmers, however, have rejected reports of bird flu detection in the district as wrong.

 

When contacted, Dr Zia, WHO chief for the National Programme for Control and Prevention of Avian Influenza in the NWFP, told Dawn by phone from Peshawar that the transfer of the livestock officer was disturbing because under his supervision acquiring samplings from the H5N1 detecting region was vital.

 

“He was threatened with dire consequences when we reached for culling last Sunday. Despite the threat from poultry farm owners he moved forward and completed the culling operation within no time,” said Dr Zia.

 

“The H5N1 is very dangerous and the transfer of the livestock officer was a conspiracy. This was not the time to target him on the political ground and keeping in mind the track-record of H5N1 it is high time of coordination and cooperation to get rid of the virus.”

 

 

As we watch on this quiet Sunday morning, with little or no bird flu news to report, we should remember that many nations are not terribly transparent when it comes to reporting outbreaks. 

 

In addition to attempts by local officials to suppress bird flu news in Pakistan, we also have Indonesia which no longer reports incidents in `real time', and China - where the Olympics are just over a month away - that has never been a leader in transparency on this issue.

 

Many other countries simply don't have a testing or surveillance program.  This is particularly true in sub-Saharan Africa.  

 

So yes, the news is quiet.   And perhaps that's an accurate reflection of recent bird flu activity.  I hope so.

 

But in a world where expedience often trumps the truth, it is sometimes hard to know for sure.

Catching Up With The Nurses Poll

# 2110

It has been nearly 6 weeks since I last reported on the nurse's poll - ongoing on the Allnurses.com forum - asking if nurses would work without full protective PPE's (Personal Protective Equipment - masks, gowns, gloves, etc.) during a pandemic.

There are now more than 320 comments, and almost 1100 respondents to the poll. That is an increase of 300 votes since we last looked in.

Previous reports can be found here, here, and here.

While the polling question asked is whether nurses would work `during a severe pandemic with a shortage of PPE's', it is quite obvious from the responses that many nurses would be reluctant to work even with protective gear.

Many nurses have families, often including small children at home, and they believe their first duty is to their loved ones. Some fear being `locked down' inside a hospital, and unable to leave for weeks. Others fear taking the virus home if they are allowed to leave.

The comments are well worth reading in their entirety, particularly if you are a hospital administrator, charge nurse, or pandemic planner.

Although the numbers remain roughly the same as in late April, there has been a slow but steady downward drift in the percentage of nurses willing to work during a pandemic (ostensibly without PPE's). In April the number was 50.46% and now, with the addition of more than 500 votes, that number has eroded to 47.08%.

(click to enlarge)

With 30% of respondents saying `NO, I won't work', and another 23% undecided, the healthcare system could see substantial absenteeism before any nurses or techs are physically affected by the flu.

The assumption is 40% absenteeism due to illness or caring for an ill loved one. If this is subtracted from a pool of HCW's (Health Care Workers) already reduced by nearly 50%, then the number available to work could drop to 30% - that at a time when patient loads would be at their absolute highest.

If staff levels drop too far, it is possible that many of those who initially decided to remain would decide leave once they saw the impossibility of the situation.

If hospitals want to stay open, and not turn into modern day Bedlam's, they need to find ways to protect, and reassure, their staffs. Too few appear to be openly preparing for a pandemic, despite the ample warnings provided by the government.

The newly proposed pandemic guideline Proposed Considerations for Antiviral Drug Stockpiling by Employers In Preparation for an Influenza Pandemic , strongly recommends that very high, and high risk healthcare workers be provided 12 weeks of Outbreak Prophylaxis (Tamiflu) during a pandemic wave.

How many facilities will follow this recommendation is unknown.

Many facilities haven't stockpiled enough PPE's (masks, gowns, gloves, goggles) to last more than a week or two into a pandemic wave. It is hard to envision them rushing out to stockpile expensive antivirals.

Sadly, I've heard from several nurses that their places of employment `actively discourage' talking about pandemic preparations - that "it isn't good for their career".

This sort of attitude only engenders more mistrust among the staff, and will likely increase absenteeism during a pandemic. We need more openness, not less.

It is a big job preparing for a pandemic, particularly for hospitals, nursing facilities, and emergency response agencies. PPE's in large quantities are expensive. Even at today's wholesale price, 12 weeks prophylaxis of Tamiflu would run about $500 per employee.

And then there is the problem of storage and security. Roche's RAPP plan helps with some of these difficulties, but the price remains steep. The minimum order under that plan is 2500 courses, or at today's price - about $165,000 ($6 reserve + $60/course x 2500)

That's a heavy hit for any employer.

There will, of course, be some nurses who will work even without outbreak prophylaxis or adequate PPE's. But their ability to provide decent care will quickly erode as their patient loads go up and the number of staff goes down.

And hospitals do not run just with doctors, nurses, and techs.

Without adequate support staff; housekeeping, laundry, cafeteria/ kitchen, maintenance, clerical, lab, and security - many of whom may be reluctant to work during a pandemic - the ability of any facility to function is in question.

Hospitals and other health care facilities need to begin to talk openly to their employees about their pandemic plans. Some of them apparently are, but many are not. And that includes their support staff, as well.

They have a stake in this too.

Employee's deserve to know how their facility will protect them during a crisis, and they need to know how far along their preparedness is. Each department should be represented at the planning table, and they should be encouraged to solicit input from others in their department.

By being inclusive, sharing both the problems and decision making in their pandemic plan with their staff, health care facilities are far more likely to keep staff on hand during a crisis.

It isn't enough to say you have a pandemic plan, you need to share it as well.

Is the plan all on paper, with plans to purchase items at the last minute? Or are supplies currently being physically stored? Are there plans to buy or reserve antivirals? If so, who will get them? What about enhanced security during a crisis? What about extra patient supplies (IV's, disposables, meds)?

These, and many more questions, need to be answered publicly. And if the answers are not realistic ones that protect the staff, better solutions need to be found.

If hospital administrator's ignore the problems, or only discuss them behind closed doors out of earshot of their staff, they risk losing the confidence and support of their employees during a crisis.

And if that happens, they will have no one to blame but themselves.

The Ball Is In Our Court

 

# 2109

 

 

This month of June has been relatively quiet when it comes to reports of bird flu around the world.   How much of that is genuine quiescence of the virus, and how much is simply a lack of governmental reporting, is hard to know. 

 

There has been bird flu news, however.  Big news.

 

Here in the United States the government has publicly put the preparedness ball in our court.  

 

Us;  American citizens - individuals, families and business owners 

 

We, the people.

 

 

While the message has always been that the government can't do it all in a pandemic, and that people need to prepare - over the past month the HHS has become far more specific in their recommendations.

 

 

Next week (July 3rd) will end the public comment period for three important proposed pandemic guidelines directed at individuals and business owners.

 

 

 

 

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Notice of Availability of Draft Guidances To Assist in Preparation for an Influenza Pandemic

AGENCY: Office of the Secretary, Health and Human Services.

ACTION: Notice of Availability.

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

SUMMARY: The Department of Health and Human Services (HHS) is seeking public comment on three draft guidances:

 

• Interim Guidance on the Use and Purchase of Facemasks and Respirators by Individuals and Families for Pandemic Influenza Preparedness;

• Proposed Guidance on Antiviral Drug Use during an Influenza Pandemic

•  Proposed Considerations for Antiviral Drug Stockpiling by Employers In Preparation for an Influenza Pandemic.

 

The draft Guidances are now available on the HHS Web site
http://aspe.hhs.gov/panflu/antiviral-n-masks.htm

DATES: Submit comments on or before July 3, 2008.

 

If you have not yet read these interim guidance documents, you really should.  And you still have a few days left in which you can send your comments to the HHS.

 

 

The first guideline listed Interim guidance on the use and purchase of facemasks and respirators by individuals and families for pandemic influenza preparedness  has a much stronger recommendation for the home stockpiling, and use, of facemasks and respirators than we've seen before.

 

 

Key messages:

1. The first and most important steps in reducing one’s risk of pandemic influenza are to limit close contact with others as much as possible and to practice good hygiene.  These measures should be used at all times, regardless of whether a facemask or respirator is worn. 
2. When a person cannot avoid being in a crowd during an influenza pandemic – for example, because they must commute to work on public transit – but has no specific expectation of encountering a sick person, they should use a facemask.
3. When it is necessary to have close contact with someone who is ill with pandemic influenza – for example, to give care to a family member – one should use an N95 respirator or equivalent certified by the National Institute of Occupational Health and Safety (NIOSH) and consider specifically using a respirator model that also is cleared by the U.S. Food and Drug Administration (FDA) for use by the general public in public health medical emergencies.
4. Ill persons should use a facemask when they must be in contact with others.

 

<snip>

 

Settings where respirators and facemasks should be used will depend on the potential for exposure to infectious persons:

• A facemask is recommended when exposure in a crowded setting occurs with persons not known to be ill.  An example would be exposure on a crowded bus or subway while commuting to work during a pandemic.  Because ill persons are advised to stay home during a pandemic, contacts in most public settings will be with persons who are not ill.  However, it is prudent to wear a facemask because one may encounter people who are infectious but not yet ill.

 

• A facemask also is recommended for use by ill persons when they must be in close contact with others.  The facemask will trap the wearer’s secretions and reduce the risk to other persons.  Close contact between ill persons and others should be limited as much as possible.  However, such contact will occur when the ill person is being cared for at home or if they need to leave home to access medical care or manage other necessities.  Ill persons do not need to wear a facemask when they are not in close contact with others

 

• A respirator is recommended for use in settings that involve close contact (less than about 6 feet) with someone who has known or suspected influenza illness.  In non-occupational settings, the most common use for a respirator would be in a household where someone has influenza.  One person should be responsible for taking care of the ill individual and that person should wear a respirator during those contacts.  The Centers for Disease Control and Prevention (CDC) will be issuing guidance on home care of an ill person, which will be posted on the internet at www.pandemicflu.gov.    

 

 

Families can use this guidance as the basis for making decisions about purchasing respirators and facemasks as part of household pandemic preparedness.  Although not all households will have someone who becomes ill with influenza during a pandemic, because one cannot predict in which households an infection will occur, it would be reasonable for each household to stockpile some respirators that can be used, if needed, when caring for an ill family member. 

 

With proper precautions, a single caregiver can use the same respirator several times over a day for brief care visits with the same ill person in the household,[2] so a stockpile of 20 respirators per household would be reasonable.  Decisions on stockpiling facemasks and the number to obtain would depend on a family’s situation and their expectation of the need for close contact in crowded settings during a pandemic. 

 

Pandemic outbreaks in communities may last 6 to 12 weeks.[3]  Persons who cannot avoid commuting on public transit may choose to purchase 100 facemasks for use when going to and from work.  An additional supply of facemasks also could be purchased for other times when exposure in a crowded setting is unavoidable or for use by an ill person in the home when they come in close contact with others.[4]

 

 

The cost of a box of 20 N95 respirators is about $15 - $30 and the cost of a box of 50 facemasks is about $10 - $20.  Therefore, the total cost to a family to purchase the recommended number of respirators and facemasks would be about $35 - $70.

 

 

Strong recommendations, but ones that I support.

 

I've long advocated that private individuals have masks (see  Who Was That Masked Man?  and Any Mask In A Viral Storm), even if the science wasn't clear as to how effective they would be (it still isn't). 

 

 

Masks make sense as a part of system of `layered'  levels of protection, which will also include social distancing, covering coughs, having the sick stay home, and frequent handwashing, among others.  

 

 

               *                *                 *                  *  

 

The second document is the HHS's Proposed Guidance on Antiviral Drug Use during an Influenza Pandemic.     Here the working group has determined that the number of courses of antivirals the United States needs on hand for a pandemic would be at least 195 million. 

 

Roughly 2.4 times more than the government intends to purchase.

 

They urge that the private sector, mostly businesses - but `families and individuals as appropriate'  - stockpile the rest. 

 

This would provide:

 

• 6M doses for deployment overseas to try to stop an outbreak
• 79M treatment courses for the infected here in the United States
• 103M courses to provide prophylaxis for healthcare and emergency service workers
• 5M courses for outbreak control in Nursing homes, prisons, and other closed settings
• 2M courses for people who are severely immuno-compromised

 

 

With an anticipated Federal and State Stockpile (currently lagging behind the goal) of 81 million courses, this means that the private sector would have to make up the 114 million course shortfall.

 

A `course' is defined as 10 pills, which currently sells for about $60 when purchased wholesale, or nearly $100 when purchased retail.

 

If that sounds like a lot of Tamiflu, well . . it is.    Nearly 7 Billion dollars worth at wholesale prices.

 

But wait.  There's more.

 

 

In addition to the 195 million courses outlined in this document, the authors point out that more than 150,000  American lives could be saved if households had antivirals available for PEP, or Post Exposure Prophylaxis.

 

There are basically three uses for antivirals:

 

• Treatment of those infected
• Outbreak Prophylaxis for people who are likely to be exposed
• PEP (Post Exposure Prophylaxis) - giving antivirals to those exposed, but not yet symptomatic to prevent infection.  

 

 

The idea behind PEP is that if one household member is stricken by pandemic flu, the rest of the household is at greatly increased risk of catching, and spreading the virus.   By giving each of them a 10-day prophylactic course of Tamiflu, it is believed that many of these infections can be prevented.

 

The working group falls short of actually recommending household PEP, explaining:

 

Despite these potential benefits, however, further work is needed to assess the feasibility of this strategy and identify approaches for purchasing and stockpiling the antiviral drugs to support its implementation.  Therefore, the working group makes no recommendation for household antiviral PEP at this time.

 

To implement household PEP would require another 106 million courses of antivirals, bringing the total needed to just over 300 million courses.

 

Obviously the costs of such preparations would be very steep, but not as steep as the cost of going into a severe pandemic ill prepared.    Whether that is enough to motivate employers and individuals to act, before a pandemic erupts, is unknown.

Certainly the Federal government could do things to encourage this stockpiling, including relaxing the rules for prescriptions, and finding ways to lower the price so that  individuals can buy at wholesale prices.

 

Roche's announcement yesterday of their RAPP (Roche Antiviral Protection Program)  may help some large companies acquire antivirals for their employees, but does nothing for individuals and small to medium sized businesses.

 

 

               *                *                 *                  *  

 

 

The third guidance document, Proposed Considerations for Antiviral Drug Stockpiling by Employers In Preparation for an Influenza Pandemic ,  strongly recommends that certain employers provided Outbreak Prophylaxis for their employees.

 

Outbreak Prophylaxis is defined as a daily preventative dose of an antiviral for the duration of exposure.   Assuming a 12 week pandemic wave, then each employee would need in excess of 80 doses. 

 

Prime among the candidates for Outbreak Prophylaxis are health care workers, as they are atop OSHA's (Occupational Safety and Health Administration) risk pyramid.

 

 

Occupational Risk Pyramid for Pandemic Influenza

Very High Exposure Risk:

• Healthcare employees (for example, doctors, nurses, dentists) performing aerosol-generating procedures on known or suspected pandemic patients (for example, cough induction procedures, bronchoscopies, some dental procedures, or invasive specimen collection).
• Healthcare or laboratory personnel collecting or handling specimens from known or suspected pandemic patients (for example, manipulating cultures from known or suspected pandemic influenza patients).

High Exposure Risk:

• Healthcare delivery and support staff exposed to known or suspected pandemic patients (for example, doctors, nurses, and other hospital staff that must enter patients' rooms).
• Medical transport of known or suspected pandemic patients in enclosed vehicles (for example, emergency medical technicians).
• Performing autopsies on known or suspected pandemic patients (for example, morgue and mortuary employees).

Medium Exposure Risk:

• Employees with high-frequency contact with the general population (such as schools, high population density work environments, and some high volume retail).

Lower Exposure Risk (Caution):

• Employees who have minimal occupational contact with the general public and other coworkers (for example, office employees)

 

 

To assist employers in deciding if their employees need antiviral outbreak prophylaxis, the HHS has created this chart:

 

 

Appendix 2

 

 

The CDC recommends outbreak prophylaxis for Very High, or High risk employees.   This includes nearly all caregivers and emergency response personnel. 

 

They also recommend that employers of essential employees working in critical infrastructure `strongly consider'  outbreak prophylaxis.

 

 

While this is certain to be expensive, it is only right that the people who we expect to take the highest risks during a pandemic get the best protection we can afford them.  

 

 

Hospitals unprepared to protect their very high and high risk employees with PPE's and antiviral outbreak prophylaxis during a pandemic may find that many of these workers won't be willing to work under those conditions.  

 

It's not as if they can claim they weren't warned. 

 

 

 

               *                *                 *                  *  

 

 

While these are all proposed guidances, they signal a significant sea change in the government's policy.  An admission that the private sector must shoulder a larger share of the preparedness burden than we've heard previously.  

 

 

The responsibility for preparing for a pandemic is not the government's alone, it is a shared responsibility between government and the private sector - including individuals. 

 

 

Like it or not, the ball has been placed squarely  in our court. 

 

 

What we do with it may well determine how well our nation comes out of the next pandemic.

Roche Offers Companies Option To Reserve Tamiflu

 

# 2108

 

 

 

The United States government is encouraging (but not mandating) that the private sector consider stockpiling antivirals for health care, and other critical infrastructure employees in anticipation of an influenza pandemic.   

 

 

The following decision chart comes from the Proposed Considerations for Antiviral Drug Stockpiling by Employers In Preparation for an Influenza Pandemic released earlier this month by the  HHS.   

 

 

 

 

 

 

Roche Laboratories, the manufacturer of the antiviral Tamiflu (oseltamivir), has put together a program that they hope will eliminate some of the obstacles preventing private companies from stockpiling the drug in case of a pandemic.

 

 

 

Called RAPP, or the Roche Antiviral Protection Program, this new initiative was unveiled today in a joint telebriefing with the HHS (Department of Health and Human Services) and Roche Laboratories.

 

 

Present on the Teleconference were :

 

· Bill Hall, news director for the HHS

· George Abercrombie, president and CEO, Hoffmann-La Roche Inc.

· Mike McGuire, vice president of anti-infectives, Hoffmann-La Roche Inc.

· Tevi D. Troy, deputy secretary, U.S. Department of Health and Human Services (HHS)

· Bruce Gellin, M.D., director, National Vaccine Program Office; chair, Task Force on Influenza Preparedness, HHS

· Robin Robinson, HHS

 

 

 

 

 

 

 

Under the RAPP plan, companies can arrange to `reserve'  stockpiles of Tamiflu, to be held by Roche and delivered on demand, for a yearly fee.

 

 

This fee, $6 per 10-pill-course,  would not apply to the purchase price of the drug - it would only reserve it for purchase when needed at whatever is the `current wholesale price'.

 

 

Companies would still need to arrange in advance to have doctors examine employees and write prescriptions for the medications.   Roche believes that the antiviral can be shipped to just about anywhere within 48 hours of placing an order.

 

 

 

The big advantages to this program would seem to the the assurance that companies won't end up stuck with expired antivirals, and eliminating the need for businesses to properly store and protect a stockpile. 

 

 

It also eliminates a big up-front expenditure.  Companies can decide each year whether to renew or opt out of the plan.

 

 

 

While announced jointly by the HHS and Roche, this is strictly a Roche initiative.  The HHS openly applauds this program, but is not directly involved with it.  

 

 

 

For now, Roche is limiting applicants to those who will order 2500 courses or more, although they stated in the telebriefing that they are interested in dealing with companies of all sizes to prepare for a pandemic.

 

 

Currently, this program is only available in the United States, but Roche has plans to expand it globally. 

 

 

While the focus of this teleconference was to launch the RAPP program, Deputy Director Troy of the HHS also said a few words about the need for all sectors ("all households, all businesses") to prepare for a pandemic. 

 

 

He encouraged local governments, businesses, and individuals to share in the responsibility for planning for a pandemic.

 

 

We also learned that the deadline for states to participate in the Federal government's subsidized antiviral purchase plan has been extended to the end of the year.  

 

 

Roche laboratories maintains a website with decision making tools for businesses to help them analyze their antiviral needs. 

 

It is located at www.pandemictoolkit.com

Pandemic Drill In Laurel Maryland

 

# 2107

 

 

 

Finding, and refining, new solutions for unique problems is one of the goals of a pandemic drill.   You don't know if something that looks good on paper will work until you test it.

 

Laurel, Maryland officials tried out a unique way of monitoring households affected by pandemic flu in a drill held on the 18th of June.    

 

Instead of knocking on every door, or relying on telecommunications that might be down, officials distributed hundreds of placards to households to display on their front door or window. 

 

Residents could display the number of ill in a household, along with the total number of inhabitants.

 

Monitoring crews, equipped with wireless PDA's and binoculars, drove the neighborhoods and entered in the information which was used to print Rx labels for needed medications.

 

While perhaps not appropriate for all neighborhoods (apartment buildings would be problematic, I should think), this sort of approach would seem to eliminate some of the dangers, and bottlenecks, of approaching each household individually.

 

The State's office of Preparedness and Response will analyze reports from this drill over the next 60 days to determine how effective, and practical, this approach is.

 

This from Gazette.net.

 

 

 

 

Thursday, June 26, 2008

Pandemic flu drill tests city’s readiness

Lessons from ‘very important’ excercise could be applied to other disasters

by Elahe Izadi | Staff Writer

 

 

A pandemic flu has hit hundreds of homes in Laurel, forcing families to stay indoors and quarantine themselves. That was the scenario on June 18 when police officers, city officials and about 85 volunteers participated in the city’s pandemic flu drill. The drill, which tested Laurel’s ability to respond to such an emergency, was part of statewide drill of responding to a 5- to 12-week-old pandemic flu epidemic.

 

The group was briefed in the Laurel City Council Chambers before heading out in police cars, armed with electronic devices and bright yellow vests. Their mission was to identify residents with a highly infectious influenza strain and get them the medications they need before the flu spread any more.

 

The city sent placards to 800 homes in three neighborhoods - Ashford, Laurel Hills and section one of the Villages at Wellington. About 300 homes participated, a larger-than-anticipated turnout, Flemion said.

 

Residents randomly chose to display placards that either said they were infected or not infected. Infected homes also listed the number of residents and who was sick.

 

Volunteers in police cars used binoculars to read the information, which they marked down in a Juno, a personal digital assistant. The Internet-capable device instantly transmitted the information to Information Technology professionals back at the emergency center set up at the Laurel Armory, who printed medication labels for infected residents. A point of distribution was then set up for infected residents to pick up medication.

 

Before, the process of documentation was all done by hand with paper that had to be taken back to the emergency operations center, Flemion said.

 

(Cont.)

Supari On NAMRU-2

 

# 2106

 

 

 

Crof, over at Crofsblog, is supposed to be on a 10 day vacation, but he has managed to post a blog or two each day anyway.   If you haven't been stopping by on a daily basis, you should.

 

Last night he posted on Indonesian Health Minister Supari's claim that NAMRU-2 (our Naval Medical Research Unit) stationed in Jakarta since the early 1970's, is of no benefit to the Indonesian people.

 

A hat tip to Crof for finding this article on Antara News.

 

 

 

6/25/08 14:56

Namru-2 is of no benefit to Indonesia, outspoken minister says

Jakarta (ANTARA News) - Health Minister Siti Fadilah Supari refused to respond to written questions posed by the House of Representatives` Commission I to her on the presence of the US Navy`s medical laboratory Namru-2 in Indonesia.

 

"To me, nothing needs to be explained because the presence of Namru-2 is obviously of no benefit to Indonesia," the minister said in a working meeting with the House`s Commission I here on Wednesday.

 

In the meeting led by Commission I Chairman Theo L Sambuaga, Minister Supari said she was very disappointed about a visit House Commission I members had made to the Namru-2 laboratory last Wednesday (June 18).

The visit was useless because Namru-2 had done nothing in the interest of research in Indonesia, she said.

(cont. )

Dr. Osterholm At The Vancouver Conference

 

# 2105

 

 

 

 

Dr. Michael .T. Osterholm, director of CIDRAP (Center for Infectious Disease Research and Policy), has never shied away from discussing - in stark terms - the worst ramifications of a severe pandemic.   

 

This bluntness has earned him some critics along the way, but also a great many admirers. 

 

Yesterday Dr. Osterholm appeared at a pandemic conference in Vancouver, where he warned that the deadliest danger from a pandemic will stem from a failed infrastructure and the economic chaos that will follow.

 

 

First the article, then some discussion.

 

 

 

 

 

Economic chaos will kill more than pandemic, expert warns

 

Katie Mercer, Canwest News Service

Published: Wednesday, June 25

 

VANCOUVER - During an influenza pandemic, freighters will be docked, medications will be scarce and people will starve, a leading international expert told a conference Wednesday.

 

"More people will likely die from this than from the pandemic," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

 

North American pandemic planning hasn't factored in its dependency on Asian markets, Osterholm told attendees to the "Are You Ready for a Pandemic?" conference.

 

The impending pandemic will most likely originate in Asia, the "roulette table" for serious H5N1 flu virus genetic mutations that cause pandemics, warned Osterholm. If that happens, trade supply lines will die along with the influenza's victims, he added.

 

Osterholm's apocalyptic warnings have lauded him the "Chicken Little" of influenza pandemics by some. Panicked and angry e-mail responses to his appearance on Oprah last year single-handily shut down his university's computer server.

 

But international influenza researchers predict the next pandemic will be similar to the 1918-19 Spanish Flu, which killed more than 40 million people.

 

The next pandemic will be global in just weeks and will last 12 to 18 months, Osterholm said, although noting that the economic effects will be instantaneous.

 

The problem is that pandemic planning in North America has been based on all other factors such as trade and electricity being normal, but that won't be the case, said Osterholm.

 

(Continue reading. . . )

 

 

In the interest of full disclosure, I am an unabashed fan of Dr. Osterholm.

 

No, I've never met him, but I do admire his willingness to publicly entertain the possibility of a worst-case scenario, and his ability to do so calmly and professionally.  

 

Unfortunately, what Dr. Osterholm has been saying for the past three years are things that many people would prefer be left unsaid. 

 

As a society we like to maintain the fiction that `all's well', and that if a crisis erupts, we will be ready.    It's good for morale, it's good for the economy . . . and that's good for politicians. 

 

But the truth is, a severe pandemic - one with a CFR (Case Fatality Ratio) of over 2% and a moderately high attack rate -  would put economic and logistical  stresses on our world unlike anything we've ever seen.  

 

Dr. Osterholm's warnings are not farfetched under that scenario.  

 

Granted, we could get lucky with the next pandemic.  We could see a low CFR, or a low attack rate.   It could be a Category 1 or 2  pandemic instead of a Category 5.   

 

 

But planning for a mild pandemic is about as smart as taking a knife to a gunfight. 

 

 

Like it or not, we need to seriously consider and explore the worst case scenarios.   And we need to do so publicly, not just behind closed doors.

 

 People need to know what they may be facing sometime in the future.

 

Not because these things are fated to happen, but because we dare not risk everything on them not happening.

Pakistani Poultry Industry Disputes Govt Tests

 

# 2104

 

 

In an interesting turn of events, the Swabi Poultry Association (SPA) in Pakistan is disputing government tests that confirmed the presence of the H5N1 virus in chickens at a Swabi poultry farm several days ago.

 

The SPA insists that the poultry were infected with H5N9, not the H5N1 bird flu virus, and is demanding the government repeat the tests.

 

It should be noted that Pakistani Poultry Industry spokesmen have a history of being less than forthright about H5N1 bird flu, downplaying the dangers at every turn.  

 

This report from last February is but one example. 

 

Whether this is another example of over zealous protection of their industry, or a real instance of misidentification of the virus by government labs, is impossible to know at this time.

 

 

Thus far, there has been no reported response from Pakistani authorities.

 

 

 

 

Swabi Poultry Association says H5N9 mistaken for H5N1

 

Staff Report

SWABI: Swabi Poultry Association (SPA) on Wednesday staged a protest demonstration against District Livestock and Dairy Development Department and National Research Institute (NRI), Islamabad, for what they called ‘mistaking an H5N9 strain for H5N1’ that caused bird flu.

 

The authorities had detected H5N1 strain at a poultry farm in Swabi three days ago and ordered immediate closure of the farm and culling of 2,000 birds.

 

The association’s office-bearers said that they had conducted their own test at the Poultry Research Institute (PRI), Rawalpindi, where the strain was identified as H5N9.

 

The association’s president, Zabiullah, demanded that the government constitute an impartial committee that should take samples for fresh tests. He warned that if the government failed to listen to their demand till June 30, they would hold a hunger strike camp in front of the NWFP Assembly.

Climate Change, Environment, And Disease

 

 

# 2103

 

 

 

Most of us tend to take a rather simplistic view about how epidemics and pandemics arise.   We assume a single virulent pathogen gets introduced into a susceptible population and then spreads rapidly.   

 

 

But the question arises, why today and not yesterday?  Or why tomorrow, and not today?

 

There are multiple (and quite nasty) pathogens circulating in this world of ours, and yet they are held at bay  - at least most of the time.  

 

 

Are there other factors at work here?

 

 

Scientists at scientists at the University of California, Davis, the University of Illinois and the University of Minnesota believe they may have found at least one contributing factor. 

 

 

 

In their study:

 

Citation: Munson L, Terio KA, Kock R, Mlengeya T, Roelke ME, et al. (2008) Climate Extremes Promote Fatal Co-Infections during Canine Distemper Epidemics in African Lions. PLoS ONE 3(6): e2545. doi:10.1371/journal.pone.0002545

 

. . . the authors propose  climate change, or extremes in weather, as a contributing factor in the generation of some disease outbreaks.

 

Here is the abstract from the PloS One article (reformatted for readability).   It is a fascinating study. 

 

Extreme climatic conditions may alter historic host-pathogen relationships and synchronize the temporal and spatial convergence of multiple infectious agents, triggering epidemics with far greater mortality than those due to single pathogens.

 

Here we present the first data to clearly illustrate how climate extremes can promote a complex interplay between epidemic and endemic pathogens that are normally tolerated in isolation, but with co-infection, result in catastrophic mortality.

 

A 1994 canine distemper virus (CDV) epidemic in Serengeti lions (Panthera leo) coincided with the death of a third of the population, and a second high-mortality CDV epidemic struck the nearby Ngorongoro Crater lion population in 2001. The extent of adult mortalities was unusual for CDV and prompted an investigation into contributing factors.

 

Serological analyses indicated that at least five “silent” CDV epidemics swept through the same two lion populations between 1976 and 2006 without clinical signs or measurable mortality, indicating that CDV was not necessarily fatal.

 

Clinical and pathology findings suggested that hemoparsitism was a major contributing factor during fatal epidemics. Using quantitative real-time PCR, we measured the magnitude of hemoparasite infections in these populations over 22 years and demonstrated significantly higher levels of Babesia during the 1994 and 2001 epidemics.

 

Babesia levels correlated with mortalities and extent of CDV exposure within prides. The common event preceding the two high mortality CDV outbreaks was extreme drought conditions with wide-spread herbivore die-offs, most notably of Cape buffalo (Syncerus caffer).

 

As a consequence of high tick numbers after the resumption of rains and heavy tick infestations of starving buffalo, the lions were infected by unusually high numbers of Babesia, infections that were magnified by the immunosuppressive effects of coincident CDV, leading to unprecedented mortality.

 

Such mass mortality events may become increasingly common if climate extremes disrupt historic stable relationships between co-existing pathogens and their susceptible hosts.

 

 

 

The authors have shown what they believe to be a direct link between climatic conditions, co-infections, and a highly pathogenic outbreak of a disease not usually associated with a high mortality rate.

 

 

Canine Distemper Virus (CDV) is rarely fatal in lions, yet two documented outbreaks in recent years have yielded up to a 40% mortality rate.  

 

Both were preceded by a severe drought.   Water Buffaloes were left debilitated by these climatic conditions, and in their weakened state became easier prey for lions, and at the same time suffered heightened (Babesia ladened) tick infestations.

 

Lions, who often have low levels of Babesia Leo, and tolerate it without ill effects, suddenly were exposed to Babesia sp., and began to suffer from its effects.   

 

Concurrently, CVD which is normally mild in African Lions, spread through the population - weakening the lions and allowing the Babesiosis infection to bloom -  resulting in a high mortality rate.

 

A complex and circuitous chain of events leading to an epidemic.

 

 

As the authors point out, this may have ramifications that go well beyond the lions of the Serengeti. 

 

If extreme weather events become increasingly frequent owing to global climate change, the consequent synchronization of proliferating pathogens or their vectors may cause disease to become a major threat to historically stable populations that had previously coexisted with multiple viral and parasitic pathogens.

 

 

It may be that a warmer climate will help introduce vectors, such as ticks and mosquitoes, to areas that currently don't suffer from them.   Tropical diseases such as Malaria, or Dengue may one day affect population centers where they are currently unknown.

 

Shifting patterns of rainfall or drought, along with temperature changes, could also affect the geographic spread  and prevalence of some diseases.   And as we've seen in this study, co-infections of one pathogen could exacerbate the symptoms of another.

 

Obviously, the interaction between climate, extremes in weather, and disease is a complex field where we've still got a lot to learning to do. 

EID: Virus Transfer During PPE Removal

# 2102

Health care workers are no doubt aware that they must follow a strict procedure when removing PPE's ( Personal Protective Equipment; gloves, gowns, mask, goggles) after having contact with an infectious patient.

There is, after all, the possibility of contaminating oneself taking off this gear.

That's why there are specific protocols established for PPE removal, as is shown in the CDC poster below.

Researchers at the University of North Carolina Chapel Hill, North Carolina and the Wake County Human Services, Raleigh, North Carolina have recently published a study in the CDC's Journal of Emerging Infectious Diseases that seriously calls into question the effectiveness of these protocols.

The link to the study is:

Casanova L, Alfano-Sobsey E, Rutala WA, Weber DJ, Sobsey M. Virus transfer from personal protective equipment to healthcare employees’ skin and clothing. Emerg Infect Dis. 2008 Aug; [Epub ahead of print]

The rationale for this study (slightly reformatted for readability) is given below, followed by some discussion.

We evaluated a personal protective equipment removal protocol designed to minimize wearer contamination with pathogens. Following this protocol often resulted in virus transfer to hands and clothing. An altered protocol or other measures are needed to prevent healthcare worker contamination.

Caring for patients with communicable diseases places healthcare workers (HCWs) at risk. Infected HCWs may not only incur serious illness or death themselves but may spread infection to others. Methods to prevent HCW infections include vaccination (1), hand hygiene (2), and isolation of patients with communicable diseases (3).

A key aspect of patient isolation is proper use of personal protective equipment (PPE) to protect HCWs from pathogen exposure during patient care. PPE includes use of barriers (gowns, gloves, eye shields) and respiratory protection (masks, respirators) to protect mucous membranes, airways, skin, and clothing from contact with infectious agents (3).

The importance of PPE was underscored in the recent outbreak of severe acute respiratory syndrome (SARS). HCWs accounted for ≈20% of cases (4); failure to properly use PPE was a risk factor for HCW infection (5).

This outbreak raised concern that HCWs could contaminate their skin or clothes with pathogens during PPE removal, resulting in accidental self-inoculation and virus spread to patients, other HCWs, or fomites.

What follows in this study is a detailed explanation of how 10 volunteers properly donned PPE's, and then selected surfaces of these barriers were inoculated with a non-pathogenic virus.

Sites of contamination were as follows: front shoulder of gown, back shoulder of gown, right side of N95 respirator, upper right front of goggles, and palm of dominant hand.

Participants then performed a routine medical task (taking blood pressure) on a mannequin, then removed their PPE's using the CDC protocol.

The study participants were then tested to see if they had transferred this virus onto their hands, face, or scrubs.

The results are surprising.

(click to enlarge)

Ninety Percent of the volunteers ended up with detectable levels of the virus on their right hand, and seventy percent contaminated their left hand.

A full 100% contaminated their scrub shirts, and roughly 75% contaminated their scrub pants.

While contamination does not necessarily equate to infection, and there are always questions about viral load and how long a pathogen can remain viable on different surfaces, these findings clearly show that the current protocols need improvement.

The authors of this study conclude that the current protocol for PPE removal is inadequate to protect the wearer, and that new guidelines need to be developed (again reformatted for readability):

Developing and validating an algorithm for removing PPE that prevents contamination of the skin and clothes of HCWs are key to interrupting nosocomial transmission of infectious agents.

These experiments demonstrate that the current CDC algorithm is insufficient to protect HCWs from contamination during PPE removal.

However, options that might prevent such contamination do exist, including double gloving, use of surgical protocols for PPE removal, and PPE impregnated with an antimicrobial agent.

I confess that the levels of contamination found in this study truly surprised me. The PPE removal was done with the CDC chart in plain view, and without the stress, fear, and fatigue that would likely accompany an infectious disease outbreak.

So this study was conducted under the best conditions.

Above all, this study highlights the need for handwashing (or the use of alcohol sanitizer) immediately after removing one's gloves.

Double gloving, as suggested by the authors, would allow the wearer to remove the outer glove layer (contaminated in this study) before removing gowns, goggles, and masks.

Surgical PPE protocols call for tucking the gown sleeves underneath one's gloves. In this protocol for removal, goggles and mask are removed and then the gown and gloves are peeled off together, thus avoiding touching the outside of PPE's with ungloved hands.

During a pandemic, or any other infectious disease outbreak, PPE's will be vital equipment to protect caregivers. They aren't perfect, and neither are those who will don and remove them. But they can afford a high level of protection when used properly.

This study highlights the need for better protocols so that health care workers can be better protected while doing their jobs.

My personal kudos to the authors of this study, I suspect they may well end up saving some lives with this important work.

A Hat tip to Ironorehopper on Flutrackers for posting this study.

Lifelines In A Pandemic

 

# 2101

 

 

A severe pandemic could affect a third or more of the world's population over the span of just a few months.  As we saw in the pandemic of 1918 -many patients that survived often required a long convalescence.  

 

Weeks, sometimes months.

 

And to survive the flu, you needed someone to nurse you along. Someone to keep you hydrated, clean, and fed, and to help you with your meds.

 

Often simple, but life saving, interventions.

 

Things were different ninety years ago.  Most people lived their entire lives very close to where they were born.  We were not yet a mobile society.   It was common for several generations of a family to all live under the same roof.   People knew their neighbors, because often they'd been neighbors all their lives.

 

The result was that most people had a much stronger social safety net, made up of friends and relatives, than they do today. It was a different world.  A different dynamic.  

 

And it likely helped to save lives during the Spanish Flu.

 

Often neighbors and family members nursed the sick, even at the risk of personal exposure.  They brought food and water to affected households.  They even took in the children from homes being visited by `the Spanish Lady'.  

 

No, it wasn't universal. 

 

There are stories of people starving in their homes because people were afraid to approach a `sick house'.   Undoubtedly there were many who did not receive help from friends or relatives.

 

But many people did.   And that had to have contributed to their survival.

 

 

Today, with millions of people either living alone, or as the sole competent caregiver in a household (single parent, guardian, etc.),  a large segment of our society is at a significantly heightened risk during a pandemic.

 

 

The US Census bureau tells us that 27 Million Americans live alone. 

 

 

But that is only part of the story.  Millions more are single parents with small children, or are elderly couples who would have difficulty caring for one another in a crisis, or are caring for an aging or disabled relative.

 

 

As we've seen with H5N1, and the Spanish Flu of 1918, a novel influenza virus has the potential - in a matter of hours - to completely disable a healthy adult.  

 

 

Without competent and diligent care their odds of survival go way down.

 

 

Hospitals won't be able to take them all in.  Not even close.  The most optimistic figures I've seen have 10% of those infected being treated in a hospital. 

 

Most pandemic plans figure on only 5%. 

 

We are told repeatedly by the Federal government that each community must prepare for a pandemic, and that individuals bear a good deal of the responsibility to prepare as well.  

 

 

It is  unlikely, in a severe pandemic, that the Federal, State, or local government is going to be able to come to your rescue.

 

 

The term  YOYO  (You're On Your Own) is often used on the flu forums to describe how things will be during a pandemic.   A slightly cynical, albeit reasonably accurate, appraisal of how many people expect to have to deal with a pandemic.

 

 

Michael Leavitt, Secretary of HHS, put it another way:

 

"Any community that fails to prepare with the expectation that the federal or state government will rescue them will be tragically mistaken." - Michael Leavitt  June 08, 2006

 

 

Unfortunately, many communities are slow to prepare.  Money is scarce, and a consensus that this needs to be done now, is lacking.  

 

 

To get through a severe pandemic we need to change from this concept of YOYO  to that of WOOO  : 

 

 

We're On Our Own.

 

 

 

That's right, we need to be thinking in terms of `WE' ; families, friends, and neighbors banding together to survive a pandemic.    

 

Not just individuals or single families.

 

 

 

I know it goes against the grain, at least here in America. 

 

We are a mobile society. We rarely know our neighbors like our parents did 40 years ago. We seldom live in the same town where we grew up and where our family is.   We tend to go through life with blinders on, at least as far as our neighbors are concerned, simply because it is easier not to get involved.

 

 

We've become a nation of isolationists.  And I'm as guilty as the next guy.

 

 

But during a pandemic, we either reject this modus operandi, or we accept tremendous avoidable losses.   

 

 

Perhaps, even our own.

 

 

 

Each of us need, in advance, to make `Flu Buddies'.    And not just people who live alone, although they are at the greatest risk.

 

 

An arrangement with one or more people (or families) that you will come to their aid during a crisis, and that they will come to your's if needed.    For most, these `buddies' will probably be family members, good friends, or neighbors. 

 

People we care about.  

 

Although presumably some may be included in your `flu circle' simply because of their proximity to you.

 

If someone on your `buddy list' gets sick, they will have buddies to help them through it.  Someone to fetch medicine, bring food and water, and make sure they take their meds.   It could literally save someone's life

 

And that `someone' could be you.  Or maybe your family, if you are incapacitated or dead.

 

 

The way I figure it, really good friends and neighbors are exceedingly hard to find. That makes them worth protecting and preserving during a pandemic (or any other crisis), even at some personal risk to yourself. 

 

 

Now - before a pandemic erupts - you can be `prepping buddies'.   Families or friends can sometimes get better deals pooling their resources and buying in bulk.   And while you are at it, you can share knowledge as well.

 

 

By banding together now, you can help encourage your `flu buddy' to prepare before a crisis arrives.   And a `flu buddy' isn't just handy for a pandemic.  

 

 

We live on a violent planet, with earthquakes, floods, hurricanes, and tornados.   Bad things happen, often without warning.  Having a trusted `buddy'  you can call on in an emergency is the world's best insurance.

 

 

 

 

 

There can be great community strength and resilience if we work together. Cooperation can be a powerful, lifesaving force if we will just unleash it.

 

 

Of course, there is a certain amount of personal risk involved in helping a friend or neighbor during a pandemic.   You may be exposed to the virus, you may even contract it.   If you share food, or water, or medicine . . . you will have less for yourself.

 

All true. 

 

And it can be a hard sell convincing someone who is healthy to tend to someone with an infectious disease.  But there is truly no safe place you can run, no safe place you can hide in a pandemic.  

 

There is risk even if you do nothing to help others. 

 

 

Using PPE's (masks, gloves), being diligent about handwashing, and limiting direct exposure to the absolute minimum can greatly reduce the chance of infection.   The risk is not zero.   But it can be mitigated.

 

 

The bottom line is - We either put aside these fears, and work together in a crisis, or we accept whatever losses a pandemic brings.  

 

 

No, as an individual, it's true you can't save the world. 

 

 

But if you are willing to try, you can sometimes save a small piece of it.