CIDRAP News Summarizes The Minnesota Pandemic Ethics Discussion

 

# 2734

 

 

 

Yesterday, at 11am, the Minnesota Pandemic Ethics Project website opened to the public, presenting two draft plans (PDF files) on how that state can deal with expected shortages of personnel, hospital beds, and medical supplies during a pandemic.

 

 

 

 

 

For the Good of Us All: Ethically Rationing Health Resources in Minnesota in a Severe Influenza Pandemic: Preliminary Report January 30, 2009

• This report contains rationing frameworks that are unique to each of these resources: antiviral medications, N95 respirators, surgical masks, pandemic vaccines and mechanical ventilators. Most frameworks include one set of guidelines for prioritizing different groups in the general public and another set for prioritizing key workers. The report also has background information about pandemic influenza, the project team’s process, assumptions made for this project and next steps.  comments. 

Implementing Ethical Frameworks for Rationing Scarce Health Resources in Minnesota during Severe Influenza Pandemic: Preliminary Report January 30, 2009

• This report offers recommendations that address issues about the practical application of ethical frameworks for rationing in an influenza pandemic. While such ethical frameworks for rationing play a critically important role in pandemic planning and response, important questions nonetheless remain about how their moral guidance can be practically implemented in the enormously complex context of actual pandemic planning and response. These recommendations concern broad practical issues that span the ethical frameworks. 

 

 

 

The first PDF file, including appendixes and references, runs 84 pages.   The second PDF file runs 95 pages.  As you might imagine, I haven't even begun to examine these documents in detail. 

 

Luckily, Lisa Schnirring  of CIDRAP (Centers For Infectious Disease Research & Policy) News gives us an excellent first look at these documents, and where the discussion is expected to go from here.

 

You'll want to spend some time looking over these documents, but first, follow the link to read the entire article.

 

 

 

Minnesota groups issue reports on allocating pandemic resources

Lisa Schnirring  Staff Writer

 

Jan 30, 2009 (CIDRAP News) – Minnesota health groups today unveiled two preliminary guidance reports designed to help the state make and implement difficult decisions about allocating scare resources such as antivirals, respirators, ventilators, and vaccines during a severe influenza pandemic.

 

In accepting the groups' reports today at a press conference, Sanne Magnan, MD, PhD, commissioner of the Minnesota Department of Health (MDH), said the avian influenza virus was a hot topic in 2007 when the MDH hired the Minnesota Center for Health Care Ethics (MCHCE) and the University of Minnesota Center for Bioethics (UMCB) to study the issue and start writing guidance documents. Though bird flu news has waned in the public's consciousness, "the strain that triggered the concern is still making people ill in Asia and Africa," she said.

 

Magnan said the reports predict that in a pandemic as bad as the one in 1918, more than 30,000 Minnesotans will die. "And there will not be enough of anything we need to treat the ill," she added.

 

The preliminary reports clearly articulate the nonmedical criteria that will help public officials fairly distribute scarce pandemic resources, Magnan said, adding, "This does provide a roadmap for negotiating the difficult landscape, but doesn't tell us how to drive the car."

 

A vital next step is to gather public feedback to ensure that the final reports reflect the shared values of Minnesotans, she said, adding that transparency and trust may help community members understand the decisions health officials may someday have to make. Today MCHCE and UMCB launched a Web portal to gather public feedback on the draft documents.

 

Magnan told reporters that over the coming months the groups will also host town hall meetings in two Minnesota cities and convene six focus groups to review the recommendations.

 

(Continue . . . )

 

 

Jan 30 MDH press release

Jan 30 preliminary report on ethically rationing Minnesota health resources in a severe influenza pandemic

Jan 30 preliminary report on implementing the ethical framework for rationing scarce health resources in Minnesota during a severe pandemic

Public comment portal for pandemic ethics and implementation reports

Oct 31, 2006, CIDRAP News story "Pandemic vaccine rationing proposal favors the young"

Hong Kong Testing Dead Birds For Bird Flu

 

# 2733

 

 

 

 

Hong Kong finds, on average, a couple of dozen dead or dying wild birds in their 1,100 sq km territory each year that test positive for the H5N1 virus.    

 

Most are assumed to have made their way to Hong Kong from mainland China.

 

Today, Hong Kong has announced that the carcasses of two ducks and a goose have been found on a beach near Sha Lo Wan football pitch.  These badly decomposed birds are suspected, based on preliminary testing, to have died from the H5N1 virus.  

 

Further testing is expected.

 

Eighteen people who came in contact with these bird carcasses are under observation.   Of those, 17 remain asymptomatic, and one has a fever and a respiratory infection, but was symptomatic BEFORE exposure to the dead birds. 

 

He has been hospitalized as a precaution.

 

 

Two reports from the Info.gov.hk  site.

 

 

 

 

 

 

Carcasses of a goose and two ducks tested positive for H5 virus

**********************************************************

     Preliminary testing of a dead goose and two dead ducks found in Sha Lo Wan, Lantau has indicated a suspected case of H5 avian influenza, a spokesman for the Agriculture, Fisheries and Conservation Department (AFCD) said today (January 31), adding that further confirmatory tests were being conducted.

     The carcasses of a goose and a duck were found and collected on January 29 at a beach near Sha Lo Wan football pitch. They were highly decomposed when being found.  Today AFCD staff collected another dead duck at the same location.

     The spokesman said there were no poultry farms within three kilometres of where the carcasses were found.  This morning AFCD staff conducted inspection of the beach and the nearby villages of Sha Lo Wan Tsuen and Sha Lo Wan San Tsuen. There was no evidence of any backyard poultry being kept there.

     AFCD is very concerned about the incident and will continue to monitor the situation. Inspections of the beach and its vicinity will be stepped up. The department is looking into different possibilities of why the goose and duck carcasses were found at the beach, including whether they had been washed ashore or dumped.

   <SNIP>

 

     The spokesman said the threat of avian influenza remained. The relevant departments will remain vigilant and continue to strictly implement preventive and control measures against avian influenza.

Ends/Saturday, January 31, 2009
Issued at HKT 21:26

 

 

 

 

Eighteen persons with contact of dead birds put under medical surveillance
******************************************************

     Following the finding of dead birds in Sha Lo Wan, Lantau, the Centre for Health Protection (CHP) of the Department of Health is liaising with the Agriculture, Fisheries and Conservation Department in tracing people who had potential contact with the dead birds suspected of being infected with H5 avian influenza.

     CHP contacted six members of the public who reported the incident and 12 staff involved in the operation of collecting dead birds.

     Seventeen of them are asymptomatic and have been put under medical surveillance, a CHP spokesman said today (January 31).

     The 26-year-old driver who had participated in collecting the dead birds on January 29 developed fever and symptoms of upper respiratory infection since January 27. He denied having contacted with the birds during the operation.

     Given the fact that the driver developed symptoms two days before the operation, the spokesman noted that the chance of him being infected with avian flu was low.

     “However, as a precautionary measure and in order to follow up his condition more closely, the driver has been admitted to the Princess Margaret Hospital for observation and further investigation,” he added.

     The spokesman reminded members of the public to remain vigilant against avian influenza infection and to observe the following measures:

* Avoid direct contact with poultry and birds or their droppings; if contacts have been made, they should wash hands thoroughly with soap and water;

* Poultry and eggs should be thoroughly cooked before eating;
* Wash hands frequently;
* Cover nose and mouth while sneezing or coughing, hold the spit with tissue and put it into covered dustbins;
* Avoid crowded places and contact with sick people with fever;
* Wear a mask when you have respiratory symptoms or need to take care of patients with fever; and
* When you have fever and influenza-like illnesses during a trip or when coming back to Hong Kong, you should consult doctors promptly and reveal your travel history.

     For further information on avian influenza, please visit the CHP website: http://www.chp.gov.hk.

Ends/Saturday, January 31, 2009
Issued at HKT 22:59
NNNN

Bird Flu Outbreak Confirmed In Cooch Behar Poultry

 

 

# 2732

 

 

 

Last Sunday, headlines in The Statesman were screaming about a `panic' in the Cooch Behar district of West Bengal over the sudden deaths of thousands of fowl.   

 

These poultry deaths had been ongoing for at least 5 days, according to that report.

 

 

Sunday, January 25, 2009

Bird flu panic in Cooch Behar

 

Bird flu panic in Cooch Behar
COOCH BEHAR, Jan. 25: The villagers of Uttar Dangkoba under Pachagarh gram panchayat in Mathabhanga sub-division are grappling with a bird flu panic in the wake of birds’ deaths in thousands over the last five days. The Pachagarh gram panchayat pradhan, Mr Kajal Roy, has drawn the attention of the higher authorities to the suspected renewed advent of the Avian Flu in the district.

 

Asked to comment, the deputy director of the animal resource development department in Cooch Behar, Dr Tapan Kumar Roy, today, said that they had already collected blood samples from the affected Uttar Dangkoba area for examination.

 

Cooch Behar, West Bengal

 

Six days later,  laboratory tests have confirmed the presence of the H5N1 virus, and culling is expected to begin on Monday - nearly 2-weeks after the first poultry deaths occurred.  

 

 

 

 

Bird flu in WB's Cooch Behar district

 

Cooch Behar (WB), Jan 31 West Bengal&aposs Cooch Behar district was today declared bird flu-affected with authorities directed to cull 45,000 birds, official sources said.

 

Blood samples sent from Nagar Bhangni and Uttar Dangkoba villages, where a large number of chickens suddenly died tested positive for the H5N1 virus at laboratories in Kolkata and Bhopal, District Magistrate Rajesh Kumar Sinha said.

 

Sinha said culling would begin from Monday at Nagar Bhangni village under Dinhata-II block and Uttar Dangkoba village under Pachagarh gram panchayat in Mathabhanga sub-division.

 

Thirty culling teams comprising five members each would destroy 45,000 chickens, he said.

 

The border has been sealed and trading and transport of chicken from the affected areas prohibited.

 

The BSF on the Indo-Bangladesh border have been alerted to prevent birds from being smuggled out, he said.

China Reports Another Human H5N1 Infection

 

# 2731

 

 

 

 

Hunan Province

 

 

After nearly a week without any new reports of human infections out of China, today we learn about a 21 year-old - again from Hunan Province - that has tested positive for the virus.

 

Officially there have been two cases from Hunan Province in January, a 16 year-old who died, and a 2 year-old named Peng that recovered. 

 

Unofficially, the 2 year-old's mother died of symptoms consistent with bird flu, but was never tested, and therefore is not counted.

This from Xinhua News.

 

 

 

 

 

 

Human infection of bird flu reported in central China

www.chinaview.cn 2009-01-31 20:05:39

 

    BEIJING, Jan. 31 (Xinhua) -- A 21-year-old female farmer was confirmed infected with bird flu in central China's Hunan Province, said the provincial health bureau on Saturday.

 

    The farmer, surnamed Shu, fell ill on Jan. 23 in Xupu County of the province and was hospitalized at the county's People's Hospital on Jan. 26, said a statement from the bureau.

 

    Shu was transferred to a hospital in Changsha, capital of the province, on Thursday. So far she has been in a stable condition and become better.

 

    According to the test result on Friday from the Chinese Center for Disease Control and Prevention, the farmer tested positive for the H5N1 strain of avian influenza.

H5 Outbreak In Canada Appears Limited To One Farm

 

# 2730

 

 

Some good news, according to the Canadian Press.  

 

The (presumably) LPAI H5 infection discovered on one Fraser Valley turkey farm about a week ago has not been detected on neighboring farms.

 

 

Tests show avian flu virus remains contained to lone Fraser Valley farm

 

 

VANCOUVER, B.C. — Avian flu found on one Fraser Valley turkey farm has not spread to any other farms in the quarantine area.

 

The Canadian Food Inspection Agency says so far all commercial flocks have tested negative in the three-kilometre quarantine zone set up to stop a virus from spreading.

 

Authorities had to destroy 60,000 turkeys earlier this week at a farm in Abbotsford, B.C., and the birds carcasses are being composed with in the barns to prevent further spread of the virus.

 

The H5 virus was discovered in some of the birds in one barn on the farm.

 

Further tests that would indicate how virulent the virus strain is still have not been completed.

 

The agency says additional quarantines may be set up as the investigation continues.

 

In 2004 a highly contagious strain of the avian flu swept through Fraser Valley poultry flocks forcing the destruction of millions of birds.

Vietnam: Bird Flu Suspect Hospitalized

 

# 2729

 

 

 

 

Vinh Long province

 

 

Lying in the center of the Mekong Delta, Vĩnh Long province is the home to more than 1 million people, and over the years, has also been the site of a number of bird flu outbreaks.

 

Today Reuters is reporting on a suspect H5N1 infection out of that province; that of a 31 year old man who is hospitalized with pneumonia.

 

Samples have been sent to the Pasteur Institute in Ho Chi Minh City for testing.  We should hear about his status, one way or another,  over the next few days.

 

 

 

 

 

Sickened Vietnamese man suspected to have bird flu

Sat Jan 31, 2009 3:54am GMT

 

HANOI, Jan 31 (Reuters) - A 32-year-old Vietnamese man has been hospitalised in the country's southern Mekong Delta with pneumonia and doctors suspect he may have caught bird flu, a state-run newspaper said on Saturday.

Samples from the man in Vinh Long province suffering from fever, cough and pain chest were now being tested for the H5N1 virus at the Pasteur Institute in Ho Chi Minh City, the Thanh Nien (Young People) daily said.

It did not say on how he fell sick.

The Health Ministry has warned bird flu could spread during and after this week's Lunar New Year festival when chicken is consumed in vast quantities. In addition, winter creates an ideal environment for the avian influenza virus to thrive.

 

(Continue . . )

 

 

 

On January 7th we learned of another case out of Vietnam, an 8 year-old girl from Thanh Hoa province named Bui Thi Thao.   She eventually recovered, and was allowed to go home on January 15th.

 

Contrary to this report, since her illness began in December, she is counted in the 2008 totals.   

 

Her older sister wasn't as lucky.  She died of similar symptoms in December, but was never tested, and so is not counted as a possible bird flu victim.

The CDC's Peanut Butter Recall Blog

 

 

# 2728

 

 

No, this isn't about bird flu.  But it is important, nonetheless.

 

As of January 25th, 2009  more than 500 cases of Salmonella poisoning have been reported to the CDC, coming from 43 states.  As many as 8 deaths may be related to this outbreak.

 

This Salmonella contamination has been traced to a Peanut Corporation of America (PCA) facility in Blakely, Ga.  Potentially contaminated peanut butter has been sold to many other food manufacturers, resulting in a recall of more than 400 food products.

 

Salmonella poisoning, called Salmonellosis, is described by the CDC as follows:

 

What is salmonellosis?

 

Salmonellosis is an infection with bacteria called Salmonella. Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection.

The illness usually lasts 4 to 7 days, and most persons recover without treatment. However, in some persons, the diarrhea may be so severe that the patient needs to be hospitalized.

In these patients, the Salmonella infection may spread from the intestines to the blood stream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics. The elderly, infants, and those with impaired immune systems are more likely to have a severe illness.

 

Some people who have followed the HHS's and FEMA's advice to stockpile a couple of weeks worth of food may have peanut butter products in their stash, and need to check carefully to make sure they aren't part of the recall list.

 

 

The CDC and HHS along the the FDA have set up a special blog to keep the public informed of the latest recall information regarding this outbreak.

 

Social media, like blogs, videos, podcasts, and twitter micro-blogging are being used increasingly by government agencies to get the word out on a variety of important topics.

 

Case in point, I learned about this website from my Twitter feed. 

 

A hat tip to @AndrewPWilson  on Twitter, one of the team members working on social media at the HHS for this update. 

 

 

Links

FDA Peanut Butter Recall Update

Searchable Product Recall List

CDC Salmonella Outbreak Update

HHS Homepage

FDA Homepage

CDCHomepage

 

Today, there is a message from the Acting Director of the CDC, Dr. Richard E. Besser regarding the ongoing investigation.

 

 

Yesterday, there were two blog entries: Ingredient Driven Outbreaks: The Inside is Bigger than the Outside   and:

 

 

Peanut Butter Product Recalls Expanded

Based on CDC and FDA's ongoing investigation of the Salmonella outbreak, consumers are advised:

• Do not eat peanut butter products that have been recalled.
• Peanut Corporation of America expands recall of all peanuts and peanut products produced since January 2007. Includes dry and oil roasted peanuts and granulated peanuts.
• To date, no association has been found with major national brand name jars of peanut butter sold in grocery stores.
• Do not feed recalled pet products to your pet or other animals. Throw away the product and immediately wash your hands and pet utensils. Learn more about handling pets that may have eaten contaminated products.
• If you are concerned about a product, call the consumer hotline phone number on the product packaging.
• Check out additional consumer advice, the latest information from CDC and updates from FDA.
• Call 1-800-CDC-INFO (1-800-232-4636) for up-to-date information. Representatives are available 24/7 to answer your questions in English and Spanish.

Minnesota Unveils Draft Pandemic Ethical Guidelines, Looking For Public Comment

 

 

# 2727

 

 

The rationing of scarce medical resources is one of the biggest ethical dilemmas that doctors, hospitals, and emergency planners will have to deal with during a pandemic.

 

Who gets admitted to the hospital, and who gets sent home?   Who gets a ventilator, and who doesn't?  Who is prioritized for vaccines?   And with a limited stockpile of antivirals, there may even have to be decisions made regarding who gets Tamiflu or Relenza.

 

 

Minnesota has been on the forefront of this discussion, and I've covered their efforts several times over the past year, including the posting of a Video: Ethically Rationing Scarce Resources In A Pandemic.  

 

The draft guidance is presented on this new website, and public comment is being solicited between today and March 16th, 2009.

 

 

 

 

 

 

Preliminary Recommendations

Frequently Asked Questions

Consent Information

Submit Comments as an Individual

Submit Comments as an Organization

 

 

Share Your Thoughts

Public comments accepted from January 30, 2009 - March 16, 2009

How should health-related resources be rationed in Minnesota during a severe influenza pandemic?

You are invited to offer your advice on this important question. Your voice is important, and we want to hear from as many people as possible—whether or not you live or work in Minnesota or are familiar with pandemic planning.

Thank you in advance for considering and commenting on the draft recommendations about how Minnesota might fairly ration health resources to protect the population’s health in a severe pandemic.

 

• Step 1: Decide what recommendations you are interested in reading about.
• Step 2: Write your comments to either or both reports in your word processing program.
• Step 3: Cut and paste your comments into the text box that appears when you click on the link to submit comments either as an individual or on behalf of an organization.

 

What is the Minnesota Pandemic Ethics Project?

The project’s goal is to propose ethical frameworks and procedures for rationing scarce health resources in Minnesota during a severe influenza pandemic. The frameworks recommend how to decide in what order different groups of Minnesotans should be prioritized to receive resources. There are also recommendations about how to implement the ethical guidance provided by the frameworks. The preliminary recommendations have been developed by a broad-based panel and work groups of more than 100 Minnesotans. An important part of this project is to gather public input so that the final recommendations include broader perspectives.

 

<snip>

 

Project Leaders and Funder

The project is funded by the Minnesota Department of Health and is led by the Minnesota Center for Health Care Ethics and University of Minnesota Center for Bioethics.

Minnesota Pandemic Ethics Public Engagement Study Team:

Minnesota Center for Health Care Ethics

J. Eline Garrett, JD
Karen Gervais, PhD
Angela Witt Prehn, PhD
Dorothy E. Vawter, PhD

University of Minnesota Center for Bioethics

Debra A. DeBruin, PhD
Joan Liaschenko, RN, PhD, FAAN

CDC Resources On The Internet

 

 

# 2726

 

 

Government agencies like the CDC (Centers For Disease Control) produce a wealth of good, timely, and helpful information designed for public consumption that surprisingly few Americans bother to take advantage of. 

 

I suspect most people either don't know about these resources, or find them and simply forget to check back.   That's why I try to highlight them from time to time.

 

First, a timely reminder about winter weather hazards and safety.  Follow the link to read the entire webpage.

 

 

Stay Safe and Healthy in Winter Weather

 

Although winter doesn't come as a surprise, many of us are not prepared for its arrival. If you are ready for the hazards of winter, you will be more likely to stay safe and healthy when temperatures start to fall.

 

• Listen to or download a podcast:
  • Preventing Hypothermia and Frostbite ( 0:50 mins) (2007)
  • Recognizing Frostbite ( 0:50 mins) (2007)
  • Recognizing Hypothermia ( 0:50 mins) (2007)
  • Avoiding Carbon Monoxide Poisoning during a Power Outage ( 0:54 mins) (2007)
  • Proper Use of Candles during a Power Outage ( 0:49 mins) (2008)
• Winter Weather
• Winter Weather: Take Steps
• Winter Weather: Stay Safe and Healthy

 

 

 

Last month I highlighted the CDC Podcasts for December.

 

This month, a new set of videos are available, along with the second issue of The Risk Communicator, a new online resource for risk communications.

 

First, the new podcasts, which this month includes information on Peanut butter and salmonella, Streptococcus pneumoniae, National Black HIV/AIDS Awareness Day, Emergency Preparedness Concerns for Older Adults, Field Triage protocols, and Stress Management for Emergency responders.

(note: the podcast line up at this link is current as of today, but will change over time)

 

Podcasts at CDC

 

Older podcasts are archived, and available for viewing here.

 

 

The CDC's second issue of The Risk Communicator is now online.  Issue 1 came out in August 2008.   I've just recently discovered this publication, and look forward to reading this new issue.

 

Issue 1

(Click on image to view issue)

 

 

 

 

Issue 2

(click on image to view issue)

Indonesia Updated Case Summary

 

 

# 2726

 

 

From the Bird Flu Information Corner - a weblog collaboration between Kobe University, Japan and Institute of Tropical Disease, Airlangga University, Indonesia - we get this updated summary chart of Human H5N1 Bird Flu infections in Indonesia since 2005.

 

 

Indonesia case summary update (Komnas Flu burung, 2009)

January 30, 2009

Avian influenza human infection cases up to 2009 update issued by Indonesia Ministry of Health.

Kindly contributed by Dr C. A. Nidom of Avian Influenza Laboratory, Institute of Tropical Disease Surabaya Indonesia.

 

(Click to Enlarge)

 

 

The Bird Flu Information Corner is one of the first resources I check each day, as their reporting is both authoritative and it comes from actual boots on the ground in Indonesia. 

 

I know I'm not alone in thanking them for the work they are doing.

Uttar Pradesh On Bird Flu Alert

 

 

# 2725

 

 

 

 

The Indian state of Uttar Pradesh, acting  in response to the recent discovery of bird flu in neighboring Nepal, has declared a `bird flu alert' in some districts along the border. 

 

Essentially banning the transport or sale of poultry out of Nepal, setting up response teams, and requiring farmers to report sick or dead chickens immediately.

 

While the bird flu virus has only been confirmed in eastern Nepal, two days ago we got this report from Nepal News. 

 

 

 

Sindhuli villagers terror-stricken after flocks of chicken die of unknown disease

 

nepalnews.com ag Jan 28 09

Even as the government has been trying to dispel rumours about the spread of bird-flu virus in the country, a report from Sindhuli says more than 1,000 chickens have died of unknown disease in a remote village of the district.

 

The state-owned National News Agency quoted a local poultry farmer as saying that the chicken died from the disease that has spread for the past few days.

 

Sindhuli is located in central Nepal.

 

Given that the outbreak in eastern Nepal started two weeks ago, and that Uttar Predesh's border is adjacent to western and central Nepal, it seems likely that the report out of Sindhuli may have influenced the decision to issue today's alert.

 

This report from the New Kerala.

 

 

Alert in Uttar Pradesh after bird flu in Nepal

 

Lucknow, Jan 30 : An alert has been sounded in various districts of Uttar Pradesh after bird flu was been detected in Jhapa district of Nepal, an official said Friday.

 

Several districts including Shrawasti, Bahraich, Maharajganj, Basti and Pilibhit on the India-Nepal border have been put on alert following detection of the virus in the eastern district of Nepal, deputy director of animal husbandry Khursheed Alam told IANS.

 

"We have also banned the import of chickens and poultry products from Nepal," he added.

 

He said special monitoring committees and rapid response teams have been set up in the districts.

 

“Poultry farm owners have also been instructed to keep a strict vigil on chicken and provide report to veterinary officials on a regular basis,” he said.

 

The animal husbandry department has also been directed to contact the officers associated with the task of preventing bird flu in Assam, Bihar and West Bengal and ensure that the traders exporting birds from these states to Uttar Pradesh produce certificates testifying that the birds have not been brought from any area affected by bird flu.

--- IANS

Pandemic Video Roundup

 

# 2724

 

 

Every 6 to 12 months I put together a listing of pandemic and emergency preparedness videos available to view or download from the Internet.  As you might imagine, sometimes some of these videos move to new locations, or are removed from the Internet - so if something interests you, you ought to view it as soon as you can.

 

The list is getting longer, particularly since the HHS has produced a series of 9 (roughly) hour-long pandemic related videos over the past year, and since FEMA now has a channel on Youtube.

 

You can, of course, simply go to Youtube or Google Video, type in a search phrase like `Pandemic' or `Bird Flu', or even `H5N1'  . . . and you'll get a lot of hits.    Many of the videos I will mention will probably show up.

 

But you'll also get an assortment of other videos.   Some will be decent, or at least interesting.  Others will try to sell you something (supplements, bogus bird flu `cures', videos, books, etc.), and some promote agendas, like the anti-vaccine movement or conspiracy theories.  

 

As always, no matter what anyone is selling . . .whether it be a product or ideas . . . Caveat Emptor.

 

The videos I list below present pandemic flu and preparedness issues in ways that I find reasonable and responsible.  That's a personal determination on my part, and quite arbitrary. 

 

Your mileage may vary.

Even if a video makes my list, that doesn't mean that I endorse everything said in it.  That said, here are some of the best pandemic videos I've found on the net.

 

From the HHS, and Pandemicflu.gov.

 

Antiviral Drug Use and Employer Stockpiling (December 17, 2008) – 53 minutes

Secretary Leavitt’s Discussion on Pandemic Planning and Preparedness (October 29, 2008) – 72 minutes

Individual Preparedness (September 25, 2008) - 57 minutes

Home Health Care Agencies Planning (July 8, 2008) - 57 minutes

 

Workplace Preparation (June 4 2008) - 46 minutes

New Federal guidance for State Pandemic Planning Assessments (April 30, 2008) - 65 minutes

New Federal guidance for State Pandemic Planning Assessments (April 2, 2008) - 76 minutes

New Federal guidance for State Pandemic Planning Assessments (March 13, 2008) 68 minutes

 

From FEMA

 

 

 

From READY.GOV

 

Older Americans Video
(5 minutes) - Flash Format - 20Mb

Ready Pets Video
(5 minutes) - Flash Format - 16Mb

 

Americans with Disabilites
(5 minutes) - Flash Format - 18Mb

Ready America's Instructional Video
(3 minutes) - Flash Format - 12Mb

 

 

And From Around the Net.

 

 

 

BUSINESS NOT AS USUAL - Prepared by Public Health Seattle and King County (leaders in pandemic awareness and preparation in the US), this 20 minute video is a free download from the Internet or is available as a  free DVD.  If you watch just one video . . . make it this one.

 

 

The American Red Cross has a video on pandemic flu you can view HERE.

 

 

A CONVERSATION WITH JOHN M. BARRY - Historian and author John M. Barry, whose seminal work The Great Influenza: The Epic Story of the Deadliest Plague in History has probably done more to enlighten us on the events of the 1918 Spanish Flu than other book in history, visited MIT (Massachusetts Institute of Technology) last month and participated in a conversation about his book.

 

 

Michael Greger, M.D.

Bird Flu: A Virus Of Our Own Hatching - The lecture based on his critically acclaimed book on bird flu, by Michael Greger. MD.  An entertaining speaker who deals well with a disturbing subject; factory farming practices that have exacerbated the growth of zoonotic diseases worldwide. 

 

His book is freely available online here, and is highly recommended.

 

 

Utah Public Service Announcement -  Only 30 seconds, but it packs a wallop, this TV spot has been running on local channels in that state for several months. 

 

 

Larimer County's The Plan -   How prepared are you to weather a disaster?   Larimer county, Colorado has a particularly proactive health department.   This 15 minute video gives a good intro into planning to deal with a pandemic.  Check out the other videos on this page.  Broadband and dialup speeds are supported.

 

 

Countdown To Crisis- Hosted by First Responder Products, this film takes a hard look at Arizona's pandemic planning, and their annual Coyote Crisis drill.  I first plied my skills as a paramedic in Scottsdale Arizona, so I'm heartened to see how seriously they are taking this threat.

 

 

Is the Bird Flu Threat Still Real? - A roundtable discussion presented by the Council on Foreign Relations with Bruce Gellin, Michael Osterholm, and Laurie Garrett.

 

 

And last, but not least, the BBC's Horizon documentary/ docudrama presentation from the summer of 2007 called  PANDEMIC.   

 

This 90 minute video is available again (no telling for how long) divided into 3 30-minute segments on the video sharing site  GUBA.    This presentation includes segments with such notable scientists as Dr. John Oxford and Greg Poland. 

 

 

 

Pandemic. (Part 1 of 3)

 

 

Pandemic. (Part 2 of 3)

 

 

Pandemic. (Part 3 of 3)

 

As If We Needed Another Reminder To Prepare

 

 

# 2723

 

 

 

 

 

While this blog deals with pandemic influenza, and emerging infectious diseases, the primary focus is all about preparedness. 

 

As individuals, as neighborhoods, and as communities.

 

Right now more than 1 million Americans are icebound, and without electricity (and in some cases heat) in the heartland after a major winter storm.   

 

Some areas may not see their power restored for 2 weeks or more.

 

The Red Cross is reporting (RedCross) more than 3,000 people are being housed in emergency shelters in Kentucky, Arkansas, and Missouri.

 

There are fears that some people may literally freeze to death, or succumb to carbon monoxide poisoning from make-shift heating arrangements, in their homes.

 

This report from the AP.    Then some discussion.

 

 

 

 

Thousands may face frigid, lightless nights ahead

 
Jan 29, 6:55 AM (ET)
By BRUCE SCHREINER

(AP) Rick Lucas of the Dayton, Ky., Department of Public Works prepares to move a resident's car after a...
 

 

LOUISVILLE, Ky. (AP) - More than a million people stranded in darkness Thursday in the wake of an icy winter storm could face a lengthy wait for electricity to course through their frosty homes, even as federal help was promised to two states hit hardest by the blast.

 

Late Wednesday, President Barack Obama signed requests from Kentucky Gov. Steve Beshear and Arkansas Gov. Mike Beebe for federal emergency declarations. Crews - even the National Guard in Kentucky - worked around the clock to resurrect power lines downed by thick ice in both states. Officials in states from Oklahoma to West Virginia fought to do the same.

 

Utility officials estimated more than 1.31 million homes and businesses across a wide swath of states were powerless early Thursday, and warned it could be mid-February before some customers had power. The storm has been blamed for at least 23 deaths so far.

 

Many flocked to shelters, while others huddled next to wood-burning fires and portable heaters to fend off the frigid night air. Some who stayed put relied on gas stoves to cook food. Meanwhile, emergency officials feared the crisis could escalate as temperatures plunged.

 

(Continue . . . )

 

 

As a native Floridian, I'm used to being prepared for Hurricanes.  When I lived in Missouri (which I did for about 10 years), we dealt with ice and snow, tornadoes in the Spring . . . and the potential of an earthquake from the New Madrid fault.  

 

Fortunately, we had no significant earth movements, but I was once icebound on our property for 3 weeks, unable to get out our 1/4th mile drive.  We had wood heat, 5 cords of wood stockpiled, generators, fuel, and ample supplies. 

 

So, to us, it wasn't an emergency.

But to others, less prepared, it became a life-or-death event.

 

Preparedness, whether it be for an ice storm, a hurricane, a tornado (tornado season is not far away), an earthquake . . . or even a pandemic - is everyone's responsibility.

 

The Red Cross, Salvation Army, and FEMA can provide aid, but not always as quickly as they would like.    People need to be able to deal with disasters for at least the first 72 hours on their own.

 

 

The Federal government wants you, your family, and your business to be prepared.   They know that that bad things happen all the time, and that being prepared is the best insurance policy of all.

 

 

They urge you to GET A KIT, MAKE A PLAN, and to BE INFORMED.

 

The government wouldn't be spending the kind of resources they do each year touting preparedness if they didn't think it was worth doing.

 

Every family, and every business, needs a COOP - or Continuity Of Operations Plan.  Governments do it, Fortune 500 businesses do it, and so should you.

 

There are many degrees of preparedness, of course.   At the very least, every family should have 3 days worth of food and water on hand, along with flashlights, a first aid kit, and a battery operated radio.   

 

But that is just the start of what needs to become a culture of preparedness in our country, and around the world.

 

Once you have the basic 72 hour kit in place, it is time to start working on a 2-week kit.   And once you've reached 2-weeks, it is time to look beyond that.

 

Given the uncertainties that the future holds, it only makes sense to make 2009 the year that you, your family, and your business becomes better prepared to face an emergency.

 

A few good places to get started are:

 

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

For Pandemic Preparedness Information: HHS Individual Planning Page

For more in-depth emergency preparedness information I can think of no better resource than  GetPandemicReady.Org.   

 

Admittedly, as a minor contributor to that site, I'm a little biased.

 

But whether you are preparing for a hurricane, an earthquake, a pandemic, or a terrorist attack - the important thing is not to delay.  

 

Ready or not, the next disaster will likely come with very little warning.

More Details On Latest Indonesian Bird Flu Case

 

 

# 2722

 

 

 

When someone presents with a high fever, respiratory symptoms,  or pneumonia in Indonesia, or China, or anywhere else in the world where the H5N1 virus exists, one of the first questions most doctors ask is about recent exposure to poultry.

 

Since H5N1 is primarily a disease of birds, that makes sense.  

 

And early on, almost all of the known human bird flu infections could be traced directly to some sort of contact with fowl.

 

Increasingly, however, we are seeing occasional cases where there are no known contacts with poultry, leaving us with an  unanswered question. 

 

Where did the victim contract the virus?

 

Another animal vector, like a dog or a cat, or even possibly an asymptomatic human?   Or perhaps the virus was in the environment; bird droppings brought in on someone's shoes, or in house plant fertilizer, in store-bought produce, or . . . 

 

Well, you get the picture.   There are a lot of possibilities.

 

The latest case out of Indonesia, that of a 21 year-old housemaid, is another example of an unknown vector for the virus.    

 

This from the Jakarta Post.

 

 

 

Thursday, January 29, 2009 7:34 PM

 

Dead housemaid tests positive for bird flu

 

Indra Harsaputra ,  THE JAKARTA POST ,  SURABAYA   |  Thu, 01/29/2009 1:46 PM  |  The Archipelago

 

A housemaid who died from a lung infection at Dr. Soetomo General Hospital in Surabaya over the weekend was infected with Avian flu, the hospital revealed Wednesday.

 

Chairman of the Press Forum at state-run hospital Urip Murtedjo said Sunday that a blood sample taken before the victim's death and sent to the Health Ministry had tested positive for Avian Flu.

 

The victim, identified only as S, and who is believed to have worked as a housemaid for a family in the city, was transferred from to the hosptical from a private hospital last Friday after suspicions were raised that she was suffering from the fatal disease.

 

"Initially, we did not know but remained suspicious of the patient's symptoms. After her death, the hospital's medical team sent a sample of her blood to the Health Ministry and the laboratory test result *confirmed* she was infected with the H5N1 virus," he told The Jakarta Post.

 

Urip said the hospital's medical team had doubted she was infected with the disease after learning the patient was not exposed to poultry at her work place or in her home village in Lumajang.

 

"This case has received a serious level of attention from the medical team because it is a new phenomenon," Urip said.

 

Chairul Anwar Nidom, a bird flu specialist at Airlangga University in Surabaya, said it would be foolish to rule out the possibility of an endemic in the city, citing recent outbreaks in Jakarta, West Java, North Sumatra and Banten.

 

He said his team would continue to research the path the virus was taking across the archipelago to determine which areas were vulnerable.

UK: DOH Awards New Antiviral Contracts

 

# 2721

 

 

 

 

In November of 2007, the UK's  SAG (Science Advisory Group) recommended that Britain increase their Antiviral Stockpile from their current levels, deemed adequate to treat 25% of the nation, to enough to treat 75% of the population. 

 

Basically, trebling the supply. 

 

Previous blogs on this issue include  UK To Double Pandemic Flu Drug Stockpile , Prudence and the Pill, and How Much Tamiflu Is Enough? )

 

 

After considerable debate, a decision was reached to double the supply, which would give the UK 30 million 10-pill doses.

 

Not quite what the SAG pushed for, but a major increase nonetheless.

 

Today, the UK DOH has announced that they have awarded contracts to Roche and GlaxoSmithKline, and that the new stockpiles should be in place by April 2009.

 

This will put the UK in the forefront as being one of the best stockpiled nations in the world in regards to antivirals for their population.

 

While there are concerns that antivirals may lose some of their effectiveness during a pandemic, they remain one of the few treatment options available for pandemic influenza.

 

The BBC is reporting that this new purchase will consist of 10.6 million doses of Relenza in addition to another 7.6 million doses of Tamiflu. 

 

This will hopefully give doctors more options if antiviral resistance to one drug should occur.

 

Meanwhile, the United States is closing in on their goal of a combined State and Federal stockpile sufficient to treat 25% of the nation. 

 

 

 

The HHS has urged the private sector here in the United States to join in, in order to expand coverage to include outbreak prophylaxis for high risk employees.

 

• Guidance on Antiviral Drug Use during an Influenza Pandemic

• Considerations for Antiviral Drug Stockpiling by Employers in Preparation for an Influenza Pandemic

 

 

 

This from the UK DOH website.

 

 

 

 

 

Thursday 29 January 2009 12:36
Department of Health (National)

Pandemic flu drug stockpiles are set to double

 

The UK today awarded contracts to double emergency supplies of flu drugs to treat everyone who is predicted to fall ill in a pandemic, making the UK one of the most prepared countries in the world.

 

The agreements with Roche and GlaxoSmithKline will double antiviral stockpiles, which are expected to be in place by April 2009. The contracts will deliver an additional 7.6 million treatment courses of Tamiflu (Roche) and 10.6 million treatment courses of Relenza (GlaxoSmithKline). Once the extra capacity is in place, there will be 33.5 million treatment courses of antivirals.

 

Without antiviral treatment, estimates suggest that up to 750,000 people could die in the UK during a pandemic. Antivirals will play a key role in the clinical response, reducing the severity of the illness and reducing the chance that complications such as pneumonia will set in.

 

There are currently enough drugs for a quarter of the population, but the latest cross-government pandemic plan aims to cope with the worse case scenario of an infection rate that could hit up to half the UK population. Contracts awarded today by the Department of Health will ensure that we can meet that aim.

 

Public Health Minister Dawn Primarolo said:

 

"The UK is already widely recognised as one of the best prepared countries in the world. The increased flu-drug stockpile means that we should be able to treat everyone who falls ill in a pandemic.

 

"Antivirals are an important part of our robust countermeasure strategy and will ensure we respond effectively in the event of a flu pandemic."

 

World Health Organization Assistant Director-General for Health Security and Environment Dr David Heymann said:

 

"The UK remains among the best prepared countries in the world.

 

"Purchasing enough antivirals to treat the worst case attack rate scenario, and two different antivirals in case resistance develops, is a first class example of the UK's advanced planning."

PandemicFlu.Gov on Twitter

 

 

# 2720

 

 

Over the past couple of weeks I've written about Twitter (see Agencies All Atwitter ) , and how government agencies are moving into this (relatively) new communications medium. 

 

FEMA recently held a press conference using Twitter, and today, the HHS provided a twitter feed  (#planfirst) to go along with today's PlanFirst Webcast.

 

Several flubies, including StandingFirmCM, and Flutrackers also participated, re-tweeting BirdFluGov updates to their followers.

 

In this way, many more people saw the #planfirst tweets than just those following BirdFluGov.   

 

Kudos to all those involved!

 

 

You can follow today's (and future) twitter feed on the PlanFirst broadcast by visiting http://search.twitter.com/search?q=%23planfirst

 

 

And if you missed the HHS Planfirst broadcast today, it will be archived and available for viewing within a couple of weeks on the HHS site.

 

 

Here is the news release on pandemicflu.gov.

 

 

 

PandemicFlu.gov is on Twitter

 

Follow us at http://twitter.com/BirdFluGov.

More Information about Twitter and How We Plan to Use It

 

What is Twitter?
Twitter is a free social messaging utility that helps users communicate in real-time. Each message is 140 characters or less in length, and is called a “tweet.” Tweets can be sent and received using computers and mobile devices. Twitter lets you control how many messages you receive by allowing you to choose the users you want to “follow.” Other people can “follow” you to receive your updates. Twitter in Plain English is an excellent, short (2:25 min.) video that provides more on the basics of Twitter.

 

How does PandemicFlu.gov plan to use Twitter?
Our presence on Twitter is an experiment in progress. We plan to provide updates when information is posted to the PandemicFlu.gov Web site and when there are credible reports about Bird Flu in the mainstream media. There are many other potential uses of the medium and we encourage anyone with ideas to make a suggestion by sending us a tweet.

 

Will we follow you back?
We recognize that new tools like Twitter derive much of their value from the two-way conversations that they enable. However, participating in these new forums adds additional responsibilities without the benefit of additional resources. To help us manage our workload while experimenting with these new tools, our current approach is to only follow users who have sent meaningful and pertinent replies directly to our Twitter account.

 

What about Hashtags?
Hashtags (#) help organize tweets on Twitter into user-defined groupings around one general topic, making threaded conversation easy to follow. Individuals from the PanFlu community have suggested that we use the #prep and #panflu hashtags on our Twitter account. For the time being, our intention is to use #planfirst in conjunction with our PlanFirst Webcast series. To see how this would work, try searching for #planfirst on Twitter .

Russia Increases Disease Surveillance On China Border

 

 

 

# 2719

 

 

 

 

Sino-Russian border in Red.

 

 

Russian and China share a 4000 km border, and as one might imagine, Russian officials are watching the resurgence of bird flu cases in China with interest. 

 

Russia has dealt with bird flu outbreaks in poultry, and has detected antibodies to the virus in wild birds, particularly in Siberia.   They have not, however, reported any human cases to date.

 

 

Gennady Onishchenko, Russia's chief Sanitary (public health) doctor, has issued orders for establishing  -  quarantine stations at crossings on the Chinese border with disinfectants, individual protective clothing and equipment to identify people with increased body temperature arriving from China and other countries of bird flu concern.

 

Obviously, they would like to keep their record of no human cases intact.

 

 

This report from RIA Novosti.

 

 

 

Russia tightens disease control amid bird flu deaths in China

15:25
|
28/ 01/ 2009

 

 

MOSCOW, January 28 (RIA Novosti) - Russia's chief sanitary official has instructed regional authorities to tighten disease control measures amid a rise in the number of bird flu cases in China, his press service said on Wednesday.

 

According to the World Health Organization, eight cases of human bird flu infection have been registered worldwide in 2009 - two in Egypt and six in China. Five people in China have died. However, the WHO said they did not believe China was facing a bird flu epidemic as all the cases were scattered around the country and appear to be random.

 

"He [Russia's chief sanitary doctor Gennady Onishchenko] instructed to provide quarantine stations at crossings on the Chinese border with disinfectants, individual protective clothing and equipment to identify people with increased body temperature arriving from China and other countries of bird flu concern," the press service said.

 

Onishchenko also urged improved measures of bird flu vaccinations for people working at poultry farms.

 

Disease control will also be tightened at markets selling live poultry and pet birds, as well as at airports receiving flights from China and other bird flu-affected countries.

 

A total of 399 cases of human infection with the deadly H5N1 strain of bird flu have been registered worldwide since 2003, in 252 of them have been fatal. No confirmed cases of human bird flu infection have been reported in Russia.

Update On Indonesian Suspect Case

 

 

# 2718

 

 

 

 

A big hat tip to Dutchy who relayed this update from Bird Flu Information Corner regarding the suspect case out of Indonesia I reported on earlier this morning.

 

Despite a difference in the reported age of the victim, this appears to be the same person referenced in the AFP report.   

 

It will be interesting to see how the Indonesian Health Ministry chooses to respond to this independent declaration of a positive test result.

 

 

 

 

Bird flu suspect from Surabaya tested positive H5N1

January 28, 2009

 

An information for reliable source, Dr Chairul Anwar Nidom, Head of Avian Influenza Laboratory, a collaborative research of Institute of Tropical Disease Airlangga University, Indonesia, and International Center of Medical Research and Tretament, Kobe University Japan. This information is related to recent post at Afludiary.

 

St (18), female,  was working as a house maid at Darmo Permai (Western Surabaya) has died due to bird flu infection. On 16 January, victim developed respiratory disorder and admitted to private maternity service. On 22 January, victim admitted to Muji Rahayu hospital because of worsening condition. After diagnosed to having lung failure, she was directed to Dr. Sutomo hospital Surabaya on 23 January. Samples were sent to Jakarta laboratory on 24 January, and she passed away at the same day.

 

Laboratory examination result has been issued on 28 January 2009 evening and samples were tested postitive H5N1 infection by PCR.

 

Victim has visiting history to her hometown, Lumajang, last October (2008).

 

===AvianInfluenzaIndonesia===

 

 

 

Dr. C.A. Nidom, and his team at the Avian Influenza Laboratory, are working on the front lines in Indonesia on the bird flu problem.  

 

I've reported on Dr. Nidom's work often in this blog, including here, here, and here.

 

Today I discovered this page, giving information about the Avian Influenza Laboratory.  Their website appears to be under construction, but it is nice to get a glimpse of the people working at the lab.

 

 

 

 

 

Avian Influenza Laboratory, Institute of Tropical Disease Indonesia

 

Our acitivities in bird flu research for Indonesia

• About AI Lab

About AI Lab

Avian Influenza Laboratory, Institute of Tropical Disease, Airlangga University, Surabaya is working in the bird flu research field collaborating with Kobe University, Japan .

AI Laboratory, ITD Surabaya Team Members

Activities

The laboratory, which led by Dr Chairul Anwar Nidom, currently active in bird flu virus surveillance within Java island.