UK: Researchers Plan `Big Brother' Flu Experiment

 

 

# 2503

 

 

Despite its prevalence, our knowledge about how influenza is transmitted from one person to the next is based more on supposition, than science.  We honestly don't know how well facemasks or social distancing will work to prevent the spread of the virus.

 

Researchers in the UK are about to begin a bold experiment where they hope to answer some of these questions. 

 

They plan to recruit volunteers to live for a week under a microscope in a series of controlled `Big Brother' style environments -  where they will introduce a mild influenza virus (H3N2) into the population in order to see how it spreads.

 

Volunteers will be paid roughly £3,000 ($4,592) for the week long study. 

 

This from The Financial Times.

 

 

 

 

Scientists plan ‘Big Brother’ flu experiment

By Andrew Jack

Published: December 1 2008 02:47 

British researchers plan to recruit 200 volunteers to be infected with flu while living together during week-long experiments, in order to deepen understanding of how to tackle a pandemic.

 

In a groundbreaking Big Brother-style trial, recruits will be divided into groups of half a dozen. They will spend their time sleeping, eating and socialising in specially adapted hotels under constant camera observation and medical supervision.

 

The aim is to gather information on how and how easily they contract flu from each other and the effectiveness of hand washing, face masks and keeping their distance to prevent infection.

 

Jonathan Van-Tam, professor of health protection at the University of Nottingham, who is helping develop the trials, said the studies reflected how much remains unknown about flu transmission, nearly two centuries after medical journals began discussing the issue.

 

“Transmission is poorly understood and hotly debated,” he said. Disagreement remained on such as whether flu was contracted by airborne particles or via surfaces touched by hand.

 

(Continue . . .)

PPE's: How Much Is Enough?

 

 

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Earlier this week CIDRAP News reported on a recently published study, in the Journal of Infection Control, on the usage of PPEs (Personal Protective Equipment) during a 24-hour pandemic simulation in the UK.

 

 

Hospital pandemic drill reveals major supply challenges

 

Robert Roos News Editor

Nov 25, 2008 (CIDRAP News) – Hospital workers who followed official infection control guidelines for pandemic influenza for 1 day used 10 times as many gloves as usual, generated three times as much clinical waste, and found that many tasks took longer than normal, according to a new report.

 

(Continue)

 

None of these findings should come as any surprise, although they do help to quantify things a bit.   This drill took place in November of 2006, and used infection control guidelines issued in 2005, which required:

 

"Healthcare workers (HCWs) to wear gloves, a plastic  apron or gown, and a surgical mask when coming within 3 feet of pandemic flu patients.

 

They recommend the use of an FFP3 respirator (equivalent to a US N-99 respirator, designed to stop 99% of small airborne particles) and eye protection during aerosol-generating procedures"

 

One of the key findings was that basic PPE (surgical masks, gowns, gloves) use was higher than expected, but the quantity of high-level PPEs used was much lower than expected.   

 

A finding that may be driven more by the arbitrary rules of this exercise, than by reality.

 

Quite frankly, the level of protective gear worn by many of the participants in this exercise (surgical mask, gloves, gown) was considerably lower than many HCW's would expect in a pandemic.

 

The question becomes, when it comes to PPE's for HCW's during a pandemic. How much is enough?

 

What little science we have on this issue does little to support the notion that medical/surgical masks are reasonably protective against airborne viruses. 

 

 

The following is from the NIOSH Science blog, Influenza Pandemic and the Protection of Healthcare Workers with Personal Protective Equipment, published on March 31st of this year. (Slightly reformatted for readability)

 

 

Medical masks are loose-fitting coverings of the nose and mouth designed to protect the patient from the cough or exhaled secretions of the physician, nurse, or other healthcare worker.

 

Medical masks are not designed or certified to protect the wearer from exposure to airborne hazards. They may offer some limited, as yet largely undefined, protection as a barrier to splashes and large droplets.

 

However, because of the loose-fitting design of medical masks and their lack of protective engineering, medical masks are not considered personal protective equipment.

 

 

The take away point here is that NIOSH, the National Institute for Occupational Safety and Health, doesn't consider medical masks to be PPE's.  

 

 

In the aftermath of SARS, where a number of HCW's became infected (and several died) as a result of tending to patients, the CDC issued interim guidance on the use of PPEs when dealing with SARS patients.

 

A NIOSH-certified, disposable N95 respirator is sufficient for routine airborne isolation precautions. Use of a higher level of respiratory protection may be considered for certain aerosol-generating procedures (see Infection Control Precautions for Aerosol-Generating Procedures on Patients Who Have SARS).

 

SARS, which had a R0 (basic reproductive number) of roughly 3.0, was about as infectious as influenza. The CDC's minimum recommendation is for an N95 mask, along with gown, gloves, eye protection and hand hygiene.

 

Personal protective equipment appropriate for standard, contact, and airborne precautions (e.g., hand hygiene, gown, gloves, and N95 respirators) in addition to eye protection, have been recommended for health-care workers to prevent transmission of SARS in health-care settings (see the Infection Control and Exposure Management page).

 

 

 

And in this  after-action study of the SARS outbreak in Toronto, we learn that HCW's had about a 6% chance of infection for every shift they had contact with SARS patients. 

 

 

Loeb M, McGeer A, Henry B, Ofner M, Rose D, Hlywka T, et al. SARS among critical care nurses, Toronto. Emerg Infect Dis [serial online] 2004 Feb 2004 [date cited].  http://www.cdc.gov/ncidod/EID/vol10no2/03-0838.htm

 

To determine factors that predispose or protect healthcare workers from severe acute respiratory syndrome (SARS), we conducted a retrospective cohort study among 43 nurses who worked in two Toronto critical care units with SARS patients.

 

Eight of 32 nurses who entered a SARS patient’s room were infected. The probability of SARS infection was 6% per shift worked.

 

Assisting during intubation, suctioning before intubation, and manipulating the oxygen mask were high-risk activities. Consistently wearing a mask (either surgical or particulate respirator type N95) while caring for a SARS patient was protective for the nurses, and consistent use of the N95 mask was more protective than not wearing a mask.

 

Risk was reduced by consistent use of a surgical mask, but not significantly. Risk was lower with consistent use of a N95 mask than with consistent use of a surgical mask. We conclude that activities related to intubation increase SARS risk and use of a mask (particularly a N95 mask) is protective.

 

And lastly, the CDC's Interim guidance on the use and purchase of facemasks and respirators by individuals and families for pandemic influenza preparedness,  where aerosol generating procedures like intubation are unlikely to occur, we get this:

 

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.  <snip>

 

• 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.  <snip>

 

 

Here in the United States, the question of what constitutes adequate PPE's for HCW's during a pandemic is a question being addressed by the CDC, NIOSH, OSHA, and other agencies.  

 

A final determination has yet to be issued.

 

 

Whatever they decide, the perception of HCW's about the effectiveness of these measures will ultimately determine how willing they are going to be to work during a pandemic. 

 

 

Frankly, given the evidence, reserving respirators (like N95, N99, or FFP3) and eye protection only for aerosol-generating procedures isn't likely to be viewed positively by most HCW's.

 

And even if you could convince HCWs to accept surgical/medical masks as PPE's, the likely attrition rate due to illness among HCW's would probably be a show-stopper.   

 

The problem, of course is, PPE's are expensive, bulky to warehouse, and are uncomfortable to wear for long periods of time.   

 

Surgical/Medical masks are relatively cheap, and don't restrict breathing like the N95 and N99 masks do.

 

Few hospitals keep more than a week or two worth of PPE's on hand.  They've followed the J-I-T (just in time) Inventory system that everyone else has. 

 

When they run low, they order more.  It saves money, and is a system that works great as long as the supply chain remains intact.

 

Getting health care facilities to invest in adequate PPE's, before a pandemic erupts, is a difficult `sell'.   They believe they can wait until a pandemic is imminent, before taking action. 

 

Most PPE's, however, are manufactured offshore.  A great many come from China, and the Far East.    During a pandemic, the global demand for these supplies will far outstrip their manufacturing capacity, and supply line issues are likely to further restrict their availability.

 

The study that led off this blog indicates that PPE usage could be 10x's normal during a pandemic.  Unless greater supplies are stockpiled before a pandemic, many facilities will run short in a matter of days.

 

Today, the issue is dollars and cents.  

 

Once a pandemic begins, the issues will become HCW's lives, and the ability of many health care facilities to operate.   

 

If we wait until that happens to try to solve this problem, it may be too late to do anything about it.

Japan Changes Focus on Pandemic Plan

 

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UPDATED:    A hat tip to SophiaZoe posting on the Flu Wiki.   She points out that the .53% CFR, and the stated 640,000 deaths, only works if the percentage is based on the entire population (128 Million) of Japan, not on those infected.

  

Assuming a 25% attack rate, this would make the CFR slightly over 2%.   This should teach me not to blog until I've fully consumed my first quart of coffee.

 

Nice catch, SZ.   Thanks.

 

 

 

 

 

Earlier this year Japan released their pandemic planning assumptions, and they were basically the same as we use here in the United States. 

 

In Japan's Pandemic Assumptions Released, I blogged:

 

The pandemic scenario envisioned by the Japanese government closely matches the United States, and some European nation's, pandemic assumptions.

 

Roughly 40% absenteeism, an attack rate of 25%, and a CFR (case fatality ratio) of 2%.

 

Of course U.S. officials are quick to point out that while this would be a severe scenario, comparable to the 1918 Spanish Flu, it isn't the worst-case scenario.  

 

Yesterday, the Mainichi Daily News carried a story telling us that the focus of pandemic planning is changing in Japan, and that once again provided their pandemic assumptions.  

 

 

This time, however, the expected fatality rate (CFR) is given as 0.53%, a 75% reduction over the earlier rate.  (See Update above)  Why this change was made isn't stated in the article.

 

Pandemic assumptions are nothing more than guesses, of course.   Educated guesses - but guesses none-the-less.  No one knows what the next pandemic will serve up.   We could see another repeat of the mild 1968 pandemic, or a return of the horrors of 1918.

 

The assumptions used by the United States federal government are based on the known severity of the 1918 pandemic in the U.S.  In various countries around the world, and for reasons not well understood, the CFR varied from well under 1% to 10% or higher.

 

The really big change in the Japanese plan is a move away from strict containment (which was unlikely to work, anyway), to limiting the spread of the disease and limiting it's social and economic impact.  

 

Details of of exactly how they plan to do that, presumably, will be released once the plan is approved.

 

 

This story from the  Mainichi Daily News.

 

 

 

New flu outbreak plan emphasizes limiting spread

 

(Mainichi Japan) November 29, 2008

 

A new influenza outbreak emergency plan has been drafted by the government, with emphasis moved away from strict containment and prevention of a new type of flu virus to limiting the spread and damage of any epidemic.

 

The new plan, announced on Friday, has two main goals: controlling the spread of infection and minimizing its effects on health; and preventing social and economic breakdown. It will be formally approved early next year following a public feedback session.

 

In addition, proposed measures submitted by specialist Ministry of Health, Labor and Welfare committees and other groups have been upgraded to 10 guidelines, which "provide us with a general outline for any counter-epidemic policy," says the Cabinet Office.

 

The new plan covers nine topics, including vaccination, medical care and preservation of social and economic functions. While recommending that all those infected during the early stages of an epidemic are hospitalized, the new policy for medical treatment requires that patients not in immediate danger be discharged later to provide beds for the seriously ill during the main infection phase. There are also policies for pre-pandemic vaccination, depending on vaccine efficacy, and a recommendation to increase stockpiles of the drug Tamiflu to treat 45 percent of the population.

 

The assumed scale of the epidemic is an infection rate of 25 percent, with a 0.53 mortality rate leading to a maximum of 640,000 deaths. By week 5 of the pandemic, around 101,000 people are predicted to be hospitalized daily, and 40 percent absent from work.

Assam To Begin Cull of 30,000 Birds

 

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Reacting much faster this year than the West Bengal authorities did last December, teams of cullers are expected to fan out over dozens of small villages in Assam State in North Eastern India, and cull all poultry within 5 km of the recently discovered H5N1 outbreak.

 

Surveillance over the next few weeks should tell them if they have succeeded in containing this outbreak.

 

 

 

 

 

'About 30,000 poultry to be culled in Assam'

Guwahati, Nov 28: About 30,000 chickens and ducks will be culled in Assam during the next four days as an outbreak of bird flu in poultry has been reported in the state, an official said.

 

"The entire culling process is expected to be completed in three to four days as our teams are visiting each and every household in the area. We estimate there could be some 30,000 poultry birds in the area where culling is currently underway," said Manoranjan Choudhury, deputy director of the Assam veterinary department.

The Indian health ministry Thursday confirmed outbreak of bird flu after laboratory tests confirmed strains of the deadly H5N1 avian influenza. Sale and purchase of poultry has been banned in the state.

 

Choudhury said about 30,000 chickens and ducks would be slaughtered in about 40 villages of Thakurichuba village, about 40 km west of Guwahati. The veterinary personnel involved in the culling process were being administered the antiviral drug Tamiflu as a precautionary measure.

"The process of culling has already started involving about 20 Rapid Response Teams with seven members in each group led by a veterinarian," he said.

More than 300 birds died in the past one week in the state. Assam's veterinary and animal husbandry department sounded an alert and is maintaining a strict surveillance on farms in the state.

--- IANS

Japan To Double Antiviral Stockpiles

 

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In August we learned that the  UK intends to double their antiviral stockpile (see UK To Double Pandemic Flu Drug Stockpile) to cover 50% of that nation's population.   

 

This is less than the target suggested by the UK's Scientific Advisory Group (SAG), which last November recommended (see How Much Tamiflu Is Enough?) a tripling of their stockpile.

 

The SAG stated that they believed that coverage for 75% of their population is essential if they are to "exert reasonable control over the scale and severity of the national outbreak"

 

Japan, which has announced plans to begin using millions of doses of their soon-to-expire pre-pandemic vaccine early next year (see Japan: Pre-Pandemic Vaccination Priority List) to inoculate high risk workers, has now announced their plan to double their antiviral stockpiles as well.

 

Japan, as you can see, takes the pandemic threat very seriously.

 

The United States currently has roughly 71 million courses (5-day treatments) of antivirals in State and Federal stockpiles. The goal is to reach 81 million courses, although the failure of some states to purchase antivirals puts that target in doubt.

 

The idea that 25% coverage of the population with 5-day courses of antivirals would suffice is based on two early assumptions, both of which are now called into question.

 

 

• The attack rate of a pandemic would be roughly 25%
• The 10-pill regimen of Tamiflu over 5 days is sufficient for H5N1

 

 

It has been widely reported over the past two years that doctors treating H5N1 patients have routinely exceeded the `standard'  10-pills-over-5-days course of Tamiflu.   Research is ongoing to determine if `double the dose, for double the duration', or some other extended regimen isn't a more effective treatment.

 

 

 

In April of 2008, the IOM (Institute of Medicine) issued a report urging the United States to double our antiviral stockpile.  The report, Antivirals for Pandemic Influenza: Guidance on Developing a Distribution and Dispensing Program, may be read online. 

 

 

While antivirals, such as Tamiflu, have been used with moderate success in the treatment of H5N1 infections, in all fairness the decision to increase stockpiles isn't a complete slam dunk. 

 

Antivirals are expensive, and treatment must begin in the first 24-48 hours of infection to have their greatest effects. This would present major logistical problems of early diagnosis and delivery of the medication to patients in a country the size of the United States.

 

Concerns remain that a pandemic virus might quickly acquire resistance to these drugs, rendering them ineffective, as we've seen happen with Amantadine in the past.

 

It becomes a difficult decision on how much reliance to place on these drugs.

 

Still, with little or no vaccine likely in the first six months of a pandemic, antivirals represent one of our few pharmacological options against a novel influenza virus.

 

This story from Bloomberg.  

 

 

 

 

Japan to Double Anti-Flu Drug Stockpile for Pandemic (Update1)

 

By Kanoko Matsuyama

 

Nov. 28 (Bloomberg) -- Japan plans to almost double its stockpile of anti-flu drugs in case of a pandemic that could kill millions of people worldwide, the government said.

 

The country will hold medicine for 45 percent of its 128 million people from 23 percent now, according to guidelines by the Cabinet Office, the ministry of health and other ministries. No timeframe was provided to boost the stockpile.

 

Governments and the World Health Organization are stockpiling medicines in case of an avian influenza pandemic in humans. A flu pandemic could kill 71 million people worldwide and lead to a ``major global recession'' costing more than $3 trillion, according to a worst-case scenario outlined by the World Bank last month.

 

GlaxoSmithKline Plc's Relenza will account for about 10 percent of Japan's supplies and the government will also consider using drugs under development, Yoshinori Ito, a counselor at the Cabinet Office, told journalists in Tokyo today.

 

(Continue . . .)

Assam Tribune: Poultry Tests Positive For Bird Flu

 

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While the tragedy in Mumbai continues to unfold, we get word via the Assam Tribune that samples taken from dead and dying birds  in Thakuria Chuba, in the North Eastern State of Assam, India, have tested positive for bird flu.

 

The exact strain of bird flu is not stated in this article, although it is likely that it is the H5N1 strain. 

 

Culling operations will be conducted within 5km of where the infected birds were discovered.

 

 

 

 

Bird flu detected at Hajo in State

Ajit patowary

GUWAHATI, Nov 27—Dreaded bird flue has struck the State. Official circles here said that the Bhopal-based High Security Disease Diagnostic Laboratory (HSADL) confirmed this evening the outbreak of the disease among the domesticated fowls of Thakuria Chuba of Rajabazar village under Hajo Revenue Circles of Kamrup district. This is the first case of outbreak of the dreaded disease in the State, said the sources.

 

Reports of unusual death of fowls in the area started coming since November 21. Meanwhile, reports of unusual death of fowls have also been received from parts of Sarpara village of Palasbari in the same district. The State Veterinary and Animal Husbandry Department has already sent samples collected from the Palasbari birds to the HSADL, said the sources.

 

Samples collected from the Hajo area were sent to the HSADL on November 23 for confirmation. The experts of the Northeast Regional Disease Diagnostic Laboratory (NERDDL) here collected the samples on November 21 and 22. The NERDDL also conducted preliminary tests on the samples collected on November 21.

 

The Directorate of Veterinary and Animal Husbandry here received reports of unusual death of domesticated birds from Thakuria Chuba, a locality inhabited by 25 families, on November 21. In the locality 87 fowls were reported dead on November 21. Of the birds, 62 were adult ones.
The next day, 66 birds were reported dead (48 adults), followed by 92 (56 adults) on November 23, 20 (12 adults) on November 24, 27 (19 adults) on November 25 and 32 (17 adults) on November 26. It is believed that at present there are around 100 fowls left in the locality, said the sources.

 

Now, since the HSADL has confirmed occurrence of the disease in Thakuria Chuba, culling operations will be taken up in an area of 5-km radius around the locality to create a bird-free zone so as to prevent spread of the disease to other areas, the sources said.

 

On the steps taken so far by the Directorate to prevent spread of the disease to other areas, sources said that immediately after receiving the information of the unusual death of the birds in the locality, a team of experts from the NERDDL headed by the in-charge of the Laboratory, rushed to the spot and took preventive measures and collected bio specimen and tested them at the NERDDL.

 

(Continue . . . )

UK: Worries Over Bird Flu Terrorism

 

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Biological terrorism is nothing new. 

 

In the recent paper, Emerging Infections: A Perpetual Challenge, the authors remind us:

 

The Black Death may also have been associated with one of the earliest recorded examples of bioterrorism. In 1346 a Tartar army besieging the garrisoned Genovese city of Caffa (now Feodosiya, Ukraine) was devastated by plague. The Tartars reacted by catapulting “mountains” (probably thousands) of plague corpses into the city, allegedly transmitting it to the besieged Genovese. 600 years later, during World War II, Japanese troops were less successful in starting a plague epidemic by dropping paper bags filled with infected fleas on Chinese cities.

 

And we saw, in 2001, the chaos and concern that emanated from the mailing of a small number of anthrax laden envelopes here in the United States.  

 

The problem, from a bio-terrorist's perspective, is finding an effective delivery mechanism.  Bird flu, as it stands now, isn't efficiently transmitted between humans, reducing its value as a terror weapon.

 

A terrorist needn't necessarily target human victims, however,  in order to inflict damage on another nation. 

 

Agricultural interests, such as the poultry industry, or farming, could be devastated by the introduction of bird flu, or wheat rust, or some other non-native plant or animal pathogen.  

 

Regardless of how likely it is that terrorists will unleash a deadly pathogen on any of our shores, Mother Nature already has a well established record of serving up deadly, efficiently transmitted, pandemics and epidemics on a regular basis.

 

Whatever the source, we need to be prepared to meet the challenge.

 

 

This report from the Telegraph.co.uk.

 

 

 

 

 

Terrorists could strike Britain by infecting country with bird flu

 

Terrorists could strike Britain by infecting the country with bird flu or Severe acute respiratory syndrome (SARS), a leading group of security experts has warned.

 

By Duncan Gardham, Security Correspondent
Last Updated: 12:15AM GMT 27 Nov 2008

 

A commission led by Lord Ashdown, the former Liberal Democrat leader, identified 27 countries where terror organisations could become a threat to the UK.

 

The report by the Institute of Public Policy Research warns that one of the biggest emerging threats comes from terrorists turning to biological warfare.

 

The assessment comes from the IPPR's Commission on National Security for the 21st century which is chaired by Lord Ashdown and Lord Robertson, the former Secretary General of NATO, and includes Lord Guthrie, the former Chief of the Defence Staff and Sir David Omand, the former security and intelligence coordinator in the Cabinet Office.

 

It says the danger from pandemic diseases such as SARS and Avian Flu is growing and that existing arrangements to respond to serious incidents are inadequate which means "a serious disease outbreak or bio-terrorism incident in the next 18 months could tip the global economy from serious recession into a global depression."

 

The commission warns that the ingredients for sarin gas and mustard gas are easily available, that radioactive materials are in wide use in hospitals and industry and that there are insufficient checks on who is buying biological agents.

 

"This in turn could allow a terrorist to buy genes for use in the engineering of an existing and dangerous pathogen into a new more virulent strain," the report says.

 

(Continue . . . )

Live TV Feed From Mumbai

 

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The terrorist attacks are apparently continuing in Mumbai, although the latest reports indicate that a number of hostages have been rescued.  At least four areas of the city have been attacked.

 

A Live TV feed may be viewed on the Internet  Here.   Reporting is in English.  You will need at least DSL Internet Speed.

 

WARNING: Some of the video feeds are pretty graphic.

 

This is a very sad day for India, and our hearts go out to the victims of this violence.

India: Poultry Deaths In Assam Raise Bird Flu Fears

 

# 2495

 

 

Map Showing Assam Province

 

 

Although we didn't really hear about it until January, 2008, it was just about this time last year that poultry began dying in West Bengal, which led to India's largest outbreak of bird flu to date.

 

Laboratory testing will determine if this outbreak in Assam is due to the H5N1 virus, or some other pathogen.    Results should be known in a day or so. 

 

 

 

Bird flu scare in Assam, 300 poultry dead

Guwahati, Nov 26: More than 300 poultry birds have died in the past five days in some villages in Assam, fuelling fears of bird flu, officials said here Wednesday, adding that a general alert was sounded in the area.

 

A veterinary department official said up to 300 chicken and ducks died an unnatural death in some villages around Hajo, about 35 km west of Assam's main city of Guwahati.

 

"We have sent samples for laboratory tests to Pune and Bangalore for confirmation. We don't know for sure if the poultry deaths were due to bird flu," a veterinary department official said requesting not to be named.

 

Authorities Wednesday imposed a ban on sale of poultry and have sounded a general alert in about 40 villages in a radius of five kilometers from the area where the deaths were reported.

 

"By Thursday we shall be getting the laboratory test reports and maybe we have to start the culling process as there has been large-scale reports of deaths coming in from nearby areas," Kamrup district magistrate R.C. Jain said.

 

"We have imposed a ban on sale and purchase of poultry and have asked people in the area not to consume chicken or duck as a precautionary measure."

 

A general health alert was also sounded in the area. Teams of experts are now camping in the area and were contemplating culling birds as a precautionary measure.

 

Residents of the area said a large number of birds were falling sick.

 

"We saw normal birds dying almost instantly without any symptoms. Now we find some of the poultry in the area a little sick," said Biswa Das, a villager.

UK Hopes For `Business As Usual' During A Pandemic

 

# 2494

 

 

The idea of promoting `business as usual' in the UK during a pandemic has come up before. 

 

Unlike a storm, which might disrupt a region for a day or two, a pandemic wave is likely to linger for many weeks, and several waves might visit over the course of a year or two.   Like it or not, for the good of society, many people will need to find ways to work through a pandemic.

 

Otherwise food production and distribution will halt.  Water and electricity will stop flowing. Communications (phone, Internet, TV, radio) would cease. Health care options will evaporate.  And police and fire personnel will no longer respond.

 

The chain of support personnel needed to make sure these, and other equally vital services, continue is long and not always obvious.  

 

Imagine what happens if the payroll clerk fails to work, or the computer technician that keeps the company's computer system up and running decides to stay home for 3 months?

 

Banks, credit card companies, insurance companies, refinery workers, delivery services, importers and exporters, and dozens of other `background'  businesses will need to function in order to support essential services.

 

Far more people are `essential' to the successful functioning of our society than realize it.

 

The list below comes from an article that appeared in The TimesOnline after the 2007 Winter Willow exercise, outlining the key points of the UK's pandemic plan.

 

Crisis targets

—The aim is to keep the nation open for business

—International flights will not be banned, although airline companies must prevent the sick from travelling

—There are to be no road blocks outside cities

—Ministers do not want armed troops on the streets or afflicted communities treated like 17th century plague villages

—Police will guard antiviral drug supplies and vaccines

—Employers are to stagger working hours so that a reduced public transport system will be able to cope

—Healthy people are expected to go to work. An absenteeism rate of 15-30 per cent is expected in each business including MPs and peers in Parliament, which itself will not close

 

 

 

Today we get a long article in the UK's Northern Echo presenting a history of the 1918 Spanish flu, along with a synopsis of the UK government's pandemic plans.

 

The last few paragraphs give us some clue as to the seriousness that the UK government gives the pandemic threat, and their proposed reactions.

 

 

Don’t panic!

11:26am Wednesday 26th November 2008

 

By Owen Amos »

 

<excerpt>

 

In our globalised world, what chance would we have of containing it? If a few sub-prime mortgages shed trillions off the world’s economy, what chance would we have if 100 million people – that’s people who actually make things – died in a year? If a quarter of Great Britain fell ill, as happened in 1918, 15 million people would need help.

 

That’s why we have a National Director of Pandemic Influenza Preparedness (Professor Lindsey Davies) a Scientific Pandemic Influenza Advisory Committee, a National Framework for Responding to an Influenza Pandemic. That’s why, on November 13, every strategic health authority in England was given more than £1m for “Pandemic Influenza Preparedness”, on top of £35m the UK has thrown in the global pot. In short: we’re scared.

 

IN August, the Government’s National Risk Register put flu pandemic at number one: ahead of coastal flooding, attacks on crowded places and attacks on transport. The report said: “Experts agree there is a high probability of another influenza pandemic occurring, but it is impossible to forecast its exact timing or precise nature of its impact.”

 

Professor Davies hasn’t just been keeping her fingers crossed, though. We have 14 million doses of Tamiflu, the anti-flu drug and “sleeping contracts” for fast-track manufacture of a further 120 million. And, you’ll be glad to hear, we have a plan.

 

The World Health Organisation – which says “the world is now closer to another influenza pandemic than at any time since 1968” – has an alert system. Now, we’re on Level Three – “No or very limited human to human transmission”.

 

If we get to Level Four – “Evidence of increased human to human transmission” – the Government will launch an advertising campaign, telling people to stock up on food, water, and medicine.

 

After the first British case, the Chief Medical Officer, Sir Liam Donaldson, will address the nation by television. How dramatic. The message will, apparently, be “business as usual” – don’t stay at home unnecessarily. If we panic, we’re done for.

 

 

 

Whether governments can convince citizens to work `as usual' during a pandemic is unknown.   It is not likely to be an easy `sell'.  

 

Much will depend upon the severity of a pandemic (CFR or Case Fatality Ratio), the public's perception of the risk (based, largely I should think, on media reporting), and on the success of community and business mitigation efforts.

 

Businesses that have prepared in advance will likely have better luck enticing their employees to work. 

 

That means finding ways of social distancing or creating barriers between workers and the public, providing PPEs and antivirals (where appropriate) to high risk employees, and finding ways to help protect employee's families.

 

In a severe (1918 or worse) pandemic, `business as usual' isn't likely to occur.   People won't be going out to movies, or restaurants, or the shopping mall as they do in normal times.  

 

`Non-essential' retail and service establishments will probably see a dramatic drop in business.   People probably won't be spending money on cars, or new refrigerators, or big screen TVs. 

 

No doubt, these actions will be felt throughout the economy.   The economic hit is likely to be substantial.

 

 

A pandemic is an open-ended crisis, and it could go on for two years, or longer. We won't know it's over until we've gone 6 or 12 months without another wave.    And we won't know how bad the pandemic really was until the last wave has ended.  

 

The high fatality rate of 1918's second and third waves taught us that.

 

As formidable as these problems are, it's not as if we are going to have a choice in the matter. 

 

Dealing with them will not be optional.   

 

`Business as usual' is almost certainly an unachievable goal in a severe pandemic.  I'm sure, despite their announced policy, the UK government is quite aware of that.  

 

But they are right in that we do need to find ways to come as close as possible. 

 

If we allow the underpinnings of society to fail, a pandemic virus will become the least of our problems.

UK Exercise: PPE Usage In A Pandemic

 

 

# 2493

 

 

The problem of assuring adequate PPE's (Personal Protective Equipment) for HCW's (Health Care Workers) during a pandemic has been a subject of discussion in this blog on more than one occasion, including:  

 

What The Well-Dressed HCW Will Be Wearing During The Next Pandemic

Australia: Will Doctors Work In A Pandemic?

Pandemic Issues For Home Health Providers - Pt 3

Catching Up With The Nurses Poll

The HCW Debate (Update)

Canadian Study: Nurses Left Short In A Crisis

 

 

It is one of the great logistical challenges facing the health delivery system during a pandemic, and the availability of PPE's will likely factor heavily in the decision of HCW's as to whether they will work during a pandemic crisis.

 

CIDRAP News has an overview of a new study, just published in the Journal of Infection Control, that reports on a pandemic drill at a UK hospital where the staff followed pandemic infection control guidelines for 24 hours.

 

This study raises some serious issues, which I'll address in a future blog.  For now, the report by CIDRAP editor Robert Roos is well worth reading in its entirety.

 

 

 

Hospital pandemic drill reveals major supply challenges

 

Robert Roos News Editor

Nov 25, 2008 (CIDRAP News) – Hospital workers who followed official infection control guidelines for pandemic influenza for 1 day used 10 times as many gloves as usual, generated three times as much clinical waste, and found that many tasks took longer than normal, according to a new report.

 

The 24-hour exercise in a British hospital also revealed various other challenges, including that hospital workers lacked confidence in their ability to follow infection control guidelines, felt uncomfortable wearing surgical masks, and felt that wearing personal protective equipment (PPE) hindered communication, according to the report, published online by the Journal of Infection Control.

 

"Healthcare in a pandemic situation is not simply a case of applying pandemic influenza infection control guidance to current practice; hospitals need to consider changing the way care and services are delivered," states the report by N. F. Phin of Cheshire and Merseyside Health Protection Unit, Chester, UK, and colleagues.

 

British health authorities issued infection control guidance for pandemic flu in October 2005, the report says. The guidelines call for healthcare workers (HCWs) to wear gloves, a plastic apron or gown, and a surgical mask when coming within 3 feet of pandemic flu patients. They recommend the use of an FFP3 respirator (equivalent to a US N-99 respirator, designed to stop 99% of small airborne particles) and eye protection during aerosol-generating procedures.

 

(Continue Reading. . . )

 

 

Here is the Abstract (slightly reparagraphed for readability):

 

Personal protective equipment in an influenza pandemic: a UK simulation exercise

 

N.F. Phin^a, A.J. Rylands^b, J. Allan^b, C. Edwards^b, J.E. Enstone^c and J.S. Nguyen-Van-Tam^d

^aCheshire and Merseyside Health Protection Unit, Chester UK

^bWirral University Teaching Hospital NHS Foundation Trust, Upton UK

^cHospital Infection Society, London, UK

^dUniversity of Nottingham, Nottingham, UK

Received 14 February 2008; 

accepted 4 September 2008. 

Available online 17 November 2008.

Summary

There is limited experience of both operational and financial impacts that adoption of UK pandemic influenza infection control guidance will have on the use of personal protective equipment (PPE), patients and staff. We attempted to assess these issues from a live exercise in a hospital in north-west England. During this 24 h exercise, all staff on an acute general medical ward wore PPE and adopted the procedures described in the UK pandemic influenza infection control guidance.

 

Teams of infection control nurses observed and recorded staff behaviour and practice throughout the exercise, including staff attitudes towards the use of PPE. Although World Health Organization recommendations on the likely use of high-level PPE (FFP3 respirators) proved to be excessive, more gloves and surgical masks were used than expected.

 

Despite pre-exercise training, many staff lacked confidence in using PPE and following infection control measures. They found PPE uncomfortable, with even basic tasks taking longer than usual.

 

Large quantities of clinical waste were generated: an additional 12 bags (570 L) per day. The estimates of PPE usage within this exercise challenge assumptions that large amounts of high-level PPE are required, with significant implications for healthcare budgets.

 

A programme of ongoing infection control education is needed. Healthcare in a pandemic situation is not simply a case of applying pandemic influenza infection control guidance to current practice; hospitals need to consider changing the way care and services are delivered.

Holiday Housekeeping

 

# 2492

 

 

Sharp eyed visitors will notice a couple of new blogs, and two new sections to my sidebar: `Recommended Reading'  and `Pandemic Information Sites'

 

 

First, added to the `Favorite Blogs' at the top of the sidebar is Claudinne Roe's excellent Avian Influenza Daily Digest Archive.  Once only available to subscribers, this digest of unclassified raw information is now freely available on the web. 

 

 

From the website:

 

Avian Influenza Daily Digest

November 25, 2008 16:00 GMT

This digest is produced by the United States Government, Office of the Director of National Intelligence, Washington DC, USA. Articles and resource documents in this digest are from open sources and unclassified.

 

This digest contains raw open source content and is not an evaluated intelligence product. Readers are encouraged to contribute updates and/or clarifications that will be posted in subsequent issues of the digest. Articles may contain copyrighted material, further dissemination outside government channels may be prohibited without permission from the copyright owners.

 

 

You'll find that not only does Claudinne do a terrific job gathering and presenting these articles, she also puts together some very useful Google earth maps of outbreaks as well.

 

 

 

*          *           *            *            *             *            *

 

The second new blog is Care.org's  What's New In the World Of Pandemic and Avian Flu?     

 

CARE, a humanitarian agency dedicated to fighting global poverty, has been around for more than half a century.   Care provides assistance in some of the poorest countries in the world.

 

CARE has become heavily involved in the fight against avian flu, and they maintain an avian/pandemic flu  blog site.   I've added their blog link to my Flu Forums & Blogs list.

 

 

A sample of some of their recent blog entries includes:

 

 

Tuesday, November 25, 2008

CARE partners with ADPC for training: Community-Based Management of AHI in Asia

 

The Daily Star reports on CARE Bangladesh's AI project

 

Thursday, November 20, 2008

Indonesia says 17 ill patients in Sulawesi not H5N1

 

Wednesday, November 19, 2008

CARE Egypt presents on behalf of CARE International & NGOs at the 6th International Ministerial AHI conference in Sharm El-Sheikh

 

CARE works with government to respond to HPAI outbreak in Lao PDR

 

 

*          *           *            *            *             *            *

 

A new section added to my sidebar is recommended reading.  Of course, the  must-read HHS/CDC community pandemic mitigation guide is included,  but I will also keep recent important scientific papers or other timely documents in this list.  

 

I will add to, and swap out, documents over time.

 

 

 

Recommended Reading

 

• CIDRAP: Pandemic Influenza, Electricity, and The Coal Supply Chain
• NIAID: Emerging Infections: A Perpetual Challenge

 

HHS/CDC Community Pandemic Mitigation Plan

 

*          *           *            *            *             *            *

 

Last, but not least,  I've added a  Pandemic Information Sites  list to the sidebar, where I will put informative or interesting pandemic information links that don't quite fit in other categories.  

 

I've added the American Red Cross, CARE,  APHA, and Save The Children.  More will undoubtedly be added over time.

Thanksgiving Roll Call - 2008

 

  # 2491

 

 

 

 

This is my third Thanksgiving blogging about the pandemic threat.  In November of 2006 I began what has turned out to be a joyous tradition for me - taking the time to publicly acknowledge and thank those working to prevent, or at least mitigate, the next pandemic.

   

Each year I update this essay to include some new people, and to mention friends I've met along the way on this journey through Flublogia.  

 

I find it encouraging that the list grows longer each year.

 

Our regular schedule of doom and gloom will continue shortly. In the meantime, I invite you to take a moment to reflect on those who are out there doing good work to try to avert a disaster.

 

 

 

As we head into this short Thanksgiving Holiday week it is a good time to give thanks to those who are out there, trying to make a difference in this battle against the pandemic flu threat. You may know some of these people by name, and some by the organizations they represent, while others you may not be aware of at all.

 

This is, in no way, a complete list.

 

There are far too many good people, doing good work, to mention them all.

 

But it’s a start.

 

So, in no particular order, a tip of the hat and a world of thanks go to:

 

Michael Leavitt, Secretary of the US Department of Health and Human Services (HHS), for his dedication and passion in spreading the message via his visits to all 50 states, that pandemics happen, and another will happen in the future.

 

Last  year, the HHS under the direction of Secretary Leavitt undertook a bold initiative with the 2007 Pandemic Leadership Blog and Summit.   I was invited to blog, along with a dozen others, in this project. 

 

Since then, Secretary Leavitt has been bitten by the blogging bug himself, and continues to write a regular column here.

 

This year, the HHS invited several bloggers to Washington D.C. to take part in a day-long pandemic tabletop exercise along side representatives from the HHS, CDC, Homeland Security,  State Department, State and local Health Departments, and print and broadcast journalism.

 

At this conference I was delighted to meet and talk with Secretary Leavitt's Science advisor Dr. William Raub, Dr. Dan Jernigan of the CDC, and John Lange, the State Department's Special Representative, Avian and Pandemic Influenza - among others.  

 

As I wrote last March:

 

These people, from the Secretary of the HHS on down, are all very human and likable.  Were it not for their name tags or rank insignia on their uniforms, you'd never have guessed you were speaking with high ranking officials. 

 

 

It was a remarkable experience, and I'd be remiss if I didn't publicly thank Stephanie Marshall, Director of Pandemic Communications for the HHS, and Christina Pearson, HHS Assistant Secretary for Public Affairs, for their work at the HHS and for repeatedly reaching out to members of the online flu community.

 

In January Secretary Leavitt will step down and a new Secretary (reportedly Tom Daschle) will take the reins of the HHS.    Secretary Leavitt will move on to other challenges, but he will be long remembered for his role in starting our nation on the road towards pandemic preparedness.

 

 

 

Dr. Michael Osterholm, Director of CIDRAP, the Center for Infectious Disease Reporting and Policy  at the University of Minnesota.

 

Dr. Osterholm has achieved near rock star status in the flu world, and rightfully so. Before devoting his attentions to CIDRAP, Dr. Osterholm served for 24 years (1975-1999) in various roles at the Minnesota Department of Health (MDH), the last 15 as state epidemiologist and chief of the Acute Disease Epidemiology Section.

 

He is, as they say, a heavy hitter. And his lectures on the threat of an Avian Flu pandemic, his writings, and his appearance on Oprah have brought bird flu awareness to millions of people. Dr. Osterholm has the ability to deliver his ominous message calmly and creditably, and given the subject matter, that is quite an achievement.

 

Readers of this blog no doubt have noticed that I reference the work of CIDRAP often. 

 

The reason is simple: They are very good at what they do.

 

The reporting from CIDRAP News is always first rate, with most of the heavy lifting done by Editor Robert Roos, and news reporter Lisa Schnirring.  Freelance writer and blogger Maryn McKenna is also a frequent contributor. 

 

Maryn's  7-part award winning series on the Pandemic Vaccine Puzzle is an absolute must-read. 

 

CIDRAP also issues comprehensive reports on public health related subjects, such as the recent Pandemic Influenza, Electricity, and the Coal Supply Chain by Nick Kelley, MSPH and Michael Osterholm, PhD, MPH.

 

CIDRAP, of course, is made up of more than just the handful of people I've mentioned.   A more complete list is available here along with their mission statement.

 

 

 

 

 

Dr. David Nabarro, Senior United Nations system Coordinator for Avian and Human Influenza. Formerly one of the worlds top public health officials with WHO (World Health Organization), Dr. Nabarro has led the fight at the UN on the Avian flu front, and has pulled no punches in his assessments of the threat it poses.

 

Dr. Nabarro has fought tirelessly to prepare the nations of the world for a coming pandemic, and given the tangled and often conflicted agendas of international politics, his may be the toughest job of them all. While it often too easy to find faults with organizations like the UN and WHO, Dr. Nabarro proves that there are good and decent leaders out there. And for that, I am particularly thankful.

 

 

 

Dr. Robert G. Webster, perhaps the world’s most famous virologist, and the head of the virology department of St. Jude’s Research Hospital. In addition to his life long study of viral pathogens, and the numerous papers he has produced, Dr. Webster was perhaps the first scientist to recognize the threat of the H5N1 virus in Hong Kong 10 years ago, and is largely responsible for the eradication of the threat at that time. He quite likely saved the world from a pandemic a decade ago.

 

Today, Dr. Webster continues his research, and reminds us of the stark realities of what a pandemic could bring the world. His message hasn’t always been popular, and he has undoubtedly stepped on some toes along the way, but this mild mannered man is a superhero in disguise.

 

The list of doctors and researchers is extensive, and there are many unsung heroes among them. People like Greg Poland of the Mayo Clinic, and John Oxford, Professor of Virology at St Bartholomew’s and the Royal London Hospital, and Richard Webby of St. Judes, among others.   Names you may never have heard of, unless you follow virology closely.

 

There are countless people at the CDC, the NIH, the WHO, FAO, and OIE who are working, mostly anonymously and often in less than optimal conditions, to prevent a pandemic.  Agencies like USAID and UNICEF are also working to help nations around the world combat the avian flu threat. 

 

There are also many NGO's, or non-governmental agencies, like American Red Cross, CARE,  and Save The Children that are working to prevent or prepare for a pandemic as well. 

 

(Each of the aforementioned organizations has a pandemic flu page:  Red Cross,  CARE,  Save The Children.)

 

 

If no pandemic occurs, it will be likely due to their's and other's combined efforts. 

 

 

And there are universities and medical centers around the world; places like the University of Minnesota, St. Judes Research Hospital, UPMC Center For Biosecurity,  and Baylor College of Medicine in Houston which are major sponsors of influenza and emerging infectious disease research - along with many others.

 

 

And in local and state health departments, and Emergency Operations Centers (EOC's) across the nation there are thousands of people working to prepare for a pandemic or public health emergency.  

 

I can't salute all of them, of course, but by highlighting one perhaps we can remember that a lot of preparedness work is going on in our communities, even if we aren't hearing about it every day.

 

 

The Southeastern District Health Department in Pocatello, Idaho held an innovative BlogEx Internet Pandemic Exercise this year.  Darin Letzring, the All Hazards Planner for the SDHD, helped create the exercise and moderated the website.   You can find more than a dozen blog entries on the BlogEx exercise in the AFD July Archive.

 

 

It isn't just doctors and scientists however, writers and reporters are also doing their part as well.

 

 

John M. Barry, author of the quintessential book on the 1918 pandemic, The Great Influenza: The Epic Story of the Deadliest Plague in History,  almost single handedly has reminded us of the horrors of our last great pandemic. If you haven’t read this book, you should. Period.

 

 

 

Dr. Michael Greger, author of Bird Flu: A Virus of Our Own Hatching has provided us with a compelling, and all too often disturbing look at the factory farming business, and how it contributes to the threat of a pandemic.   The entire text is available online, without charge (thank you Dr. Greger!).  

 

I promise you. Read it, and you'll never look at chicken the same way again.   Always an informative and entertaining lecturer, click here to view an abridged version of Dr. Greger's Bird Flu presentation.

 

 

Craig Delouie  the author of The Thin White Line: A History of the 2012 Avian Flu Pandemic in Canada  which I reviewed favorably here. Written like a future text-book, The Thin White Line gives a chilling fictional look at what a future pandemic might look like.  The author has now made a free version of the book available that you can read online here.

 

 

Helen Branswell, health reporter for the Canadian Press. If anyone in the field of journalism deserves the Paul Revere Award, it is Ms. Branswell. She has produced some of the finest reportage on the emergence of the H5N1 virus as exists anywhere, and she started back when few had heard of the threat. Her writing is clear, concise, and absent of the breathless prose that many lesser journalists rely upon.

 

 

Maggie Fox, Health and Science Editor for Reuters, is another standout in the world of journalism.   Her reporting on the pandemic threat (along with a myriad of other topics) has been consistently excellent.  

 

Ms. Fox has an advantage over many of her colleagues in that she understands the science, having completed fellowships at the National Institutes of Health on Genomics, at Harvard Medical School on infectious disease, and at the University of Maryland on child and family health policy.    And it shows.

 

 

Maryn Mckenna, who now writes often for CIDRAP, has become the rising star among avian flu writers over the past couple of years, but small wonder. Formerly the CDC reporter for the Atlanta-Journal Constitution, her inside access to that organization resulted in the best selling science book, Beating Back the Devil in 2004.   

 

Maryn is currently working on a book about MRSA, and her blog Superbug serves as a virtual whiteboard for her research on that topic.

 

 

Declan Butler, senior reporter for Nature, and blogger, who very early on called the attention of the world to the pandemic threat, and who has used Google Earth to great effect mapping avian flu outbreaks around the world.

 

 

Other notable names include Jason Gale of Bloomberg,  Patrick Thibodeau of ComputerWorld, Robin McDowell of the AP, and Emmy Fitri of the Jakarta Post.  There are others of course.

 

Thank you all. We need a hundred more, just like you.

 

On the Internet we have a number of flu/Public Health/Preparedness bloggers that frequently provide both news and analysis.    

 

 

Among them:

 

Crawford Kilian, author of Crofsblog, has been covering avian flu since early 2005 and is rightfully regarded as the Dean of Flu Bloggers.   His site is resource rich, his comments are invariably on target, and his tone is always professional.  In short, Crof showed the world how an avian flu blog should be done, and those with any sense have followed his example.

 

The Reveres, anonymous authors of Effect Measure, which has my nomination as the best public health blog on the Internet. Don’t be put off by their anonymity, these guys (or gals) are the real deal. They have the ability to explain the science of avian influenza (and other health threats) better than anyone else in the blogosphere. If you want to know what this humble author reads, you should know that Effect Measure is at the top of my list each day.

 

SophiaZoe, my cyber-twin and dear friend, who writes the remarkable Pandemic Chronicle.   One of the outright joys of being a blogger is that I've gotten to meet a number of people in Flublogia. 

 

SZ and I have, over the past three years, become fast friends. She never ceases to amaze me with her encyclopedic knowledge of pandemic issues, and her ability to get to the crux of the matter.  

 

 

Another blogger I've had the great fortune to meet, and work with, is DemFromCt, editor of the Flu Wiki and a blogger on the Daily Kos.  We've worked together on three projects so far; The 2007 HHS Pandemic Leadership Blog,  the 2008 Pandemic Tabletop Exercise, and are both contributors to GetPandemicReady.Org.

 

 

High on my list of people I still want to meet is Scott McPherson, although after two years of correspondence, I feel like we are old friends.  A fellow Floridian, Scott is well placed in the State's Pandemic planning and rubs elbows with State and Federal officials every day.  His insights, often sprinkled with a healthy dash of  whimsy, are always a pleasure to read.

 

 

Dr. Henry Niman, whose theories on recombination are way above my pay grade, has been a frequent spur in the flanks of an often too complacent scientific community. His continual calls for the release of the H5N1 genetic sequences, and transparency and disclosure by all parties on what we really know about this pathogen, are invaluable and appreciated.

 

 

Indigo Girl, on Allnurses.com has taken it upon herself to bring pandemic news and information to the healthcare community.  Her synopsis of avian flu news has brought a keener awareness of pandemic issues to thousands of her fellow nurses.  In doing so, she is undoubtedly saving lives downstream.

 

 

Joel at Preparedness and Response writes based on his private and professional experience in the areas of preparedness and response. He covers public health and emergency management issues.

 

 

Catherine `Jackie' Mitchell of Prepared Citizens, writes her heartfelt faith-based preparedness commentary for her hometown of Monson, and for a larger national audience as well.

 

 

And newcomer Ma Yingshen does a terrific job collecting and assembling news about emerging infectious diseases on her blog Chen Qi- A Morning Fresh Breeze.

 

 

We also said goodbye to Orange, who  after 1,245 posts, decided to bring the curtain down on The Coming Influenza Pandemic?    One of the pioneering flu bloggers, Orange's contributions will always be appreciated and will certainly be missed.

 

 

And then there are the Newshounds. 

 

Every day, dozens of hardworking volunteer flubies scour foreign language news reports, using search engines, text-finding software, and translating programs to bring us the latest tidbits of news from around the world. 

 

They do an awesome job.   If the CIA and the NSA aren't envious, they should be.

 

 

It would be impossible to mention them all, and I fear insulting those I miss. But a partial list (in no particular order) of some of the more recently active newshounds includes  Dutchy,  Ironorehopper,  Treyfish, Commonground, Niman, Florida1, DemFromCt, SusanC, Kobie, Carol@SC, Pixie, mojo, bgw in MT, Readymom, pugmom, Frenchiegirl, AlohaOr, UK-Bird, Rick, Canada Sue, Theresa42, Mosaic, Cottontop, Influentia2, Mojo, Michelle in OK, Mary In Hawaii,  dbg, flubergasted, Laidback Al, Alaska Denise, Siam, InKy, History Lover  . . .

 

To those I missed (and there are many), mea culpa.

 

Some of these newshounds can be found on multiple flu forums, while others stick with one particular home base.  Regardless, the information is freely shared between all of the flu forums, and dissected by knowledgeable and interested parties.

 

The work they do is remarkable. And I couldn't do much of what I do without them. 

 

Thank you all.

 

The owners and moderators of the flu forums deserve mention, too. 

 

Labors of love, and devourer's of both time and money, flu forums provide a place for laymen and professionals to gather to discuss the various aspects of pandemic planning, and quite often, the science behind influenza and epidemiology.   

 

The founders and moderators do a terrific job keeping things on track, and do so without compensation.  Most of the time, the costs (which can run into the hundreds of dollars each month) are borne by the owners.

 

There are a number of flu forums out there, but the most popular are Flu Wiki, Flutrackers, PFP, and PFI.    Each has their own style and personality, and in many cases, members of one forum belong to several other forums as well.  

 

The Flu Wiki, the first of the dedicated flu forums, was founded by DemFromCt, Pogge, and Melanie Mattson.  This year, we lost Melanie after a long illness.  She was a pioneer, and an activist, and is greatly missed.   

 

You can read more about her, and her legacy, here.

 

FluTrackers, founded by Sharon Sanders (but run with the aid of dozens of tireless volunteer moderators), boasts nearly 2,000 members and prides themselves on maintaining an impressive library of scientific literature on pandemic influenza and other emerging infectious diseases.

 

Also in French is Francophones des FluTrackers,  which is a section of Flutrackers, moderated by Muscade,  Éditeur et Directeur.

 

There are other non-English language flu forums as well, such as Zone Grippe Aviaire H5N1 en français which is run by Lyro out of Quebec.   This forum provides translations of many news articles, and blogs, into the French language along with commentary.  

 

 

 

And then there are the flubies, which number in the thousands. 

 

Some are active posters on the flu forums, while others take a more passive role.  Many have become activists in their communities.

 

Readymom, whom I've highlighted before in these pages, started the Readymom's Organization.  RM now runs her own forum/website Emergency Home Preparation.

 

The Readymom's organization, now led by Dr. Susan Chu  (Flu Wiki Emeritus), not only appears at public venues promoting pandemic preparedness, they have free downloadable toolkits available so than anyone can help spread the message in their community.

 

Starting in mid-2007, more than a dozen volunteers worked to put together the GetPandemicReady.Org website.   There you will find more than 3 dozen easy-to-follow preparedness guides, written by some pretty familiar names from the Flu Forums. 

 

This site is hosted by the Lewiston-Nez Perce County Board of Commissioners, and came about in large part due the hard work of Mel Johnson, Director of Emergency Management.

 

And StudentsPrepAmerica.Org was created by Justin Kamen and others at Columbia University, and is designed to get the preparedness word out to College and University Students.

 

 

Behold the power for the flu forums. 

 

 

Often forgotten, I also send out thanks to all who wear the uniform of our country, and who will be called upon to be on the front lines during a pandemic. This includes our military and national guard troops, both at home and abroad. You guys and gals do a tough, often thankless job, 365 days a year; and are deserving of both our respect and our nation's gratitude.

 

Please know, you have mine.

 

There are hundreds of thousands of doctors, nurses, technicians, EMT's, paramedics, firefighters, and law enforcement officers out there who put it on the line each and every day. I'm proud to have been able to be a part of that universe. And my thanks, and fervent best wishes go out to each of you.

 

And of course, thanks go to the readers of these forums and blogs. There are far more of you out there than you imagine. Those that post on flu forums, or comment on blog sites are just the tip of the iceberg. Ninety percent of our visitors read and absorb the information here, and say nothing. We know you are out there because our web counter software logs every visit.

 

No, I’m not going to `out' anyone. Your secret is safe with me.

 

But even this humble blog gets visits every day from dozens of corporations, government agencies, financial institutions, and even medical research facilities. Names that you would readily recognize. And that is both extremely gratifying and humbling at the same time.

 

Thank you for being a part of all of this.

 

 

It has been an amazing journey, these past three years blogging on avian flu.  I've been fortunate enough to meet dozens of people, either in person, or via email or chat, from around the world due to this blog.  

 

I've collected more than a few good friends along the way. 

 

To all of those who have written me, thank you.  And keep them coming. 

 

And lastly, a special thank you (in no particular order) to those people in the Flu Community who have gone out of their way to extend kindness, friendship, and counsel to this old medic. 

 

To SZ, and Crof, and Scott, the Revere's, Camille, Sharon, Maryn, Lisa & Nick at CIDRAP, Dr. Michael Greger, DemFromCt, chacal, Stephanie, Sally, Emmy, Maggie Fox, Jackie, Karen, Cliff, Mel, Susan, Anne, Blitzen, Snick, Corky, TomDMV, Gary The Fire Dude, Bluesky,  Redwolf, GR, hoggie, Seazar, Paul, Joel, Craig, Graeme  AnnieRn, and Bonnie  (and many more I've no doubt  left out) a special holiday thanks to you and your families.  

 

You guys, whether you know it or not, help light the path for me every day.

 

And to everyone else, a safe and happy Holiday.