NEJM Perspective: Respiratory Protection For HCWs

 

 

# 3788

 

While the debate over what constitutes suitable protection for HCWs (Health Care Workers) when dealing with influenza patients continues, the IOM recently came out with their analysis and they came down decidedly on the side of N95 respirators instead of surgical masks.

 

The complete 68 page IOM report can be downloaded by clicking the graphic below.  It is free, although you’ll be asked for your email address.

 

 

The CDC’s current recommendations are also for N95 respirators, although they are `reviewing the data’.  Many hospitals continue to use surgical masks instead of N95s, despite the CDC’s recommendation.  

 

Critics of N95s point out that they can be uncomfortable to wear for extended periods of time, and that they are in short supply.   Many HCWs, however, question whether the reluctance of some facilities to embrace N95s for influenza infection protection has had more to do with their cost than with their availability or comfort.

 

Today the NEJM has a Perspective article which reviews the IOM report data, and comes down in favor of N95’s.   I’ve provided some of the more pertinent passages below, but follow the link to read it in its entirety.

Published at www.nejm.org September 30, 2009 (10.1056/NEJMp0908437)
Novel H1N1 Influenza and Respiratory Protection for Health Care Workers

Kenneth I. Shine, M.D., Bonnie Rogers, Dr.P.H., R.N., and Lewis R. Goldfrank, M.D.

(EXCERPTS)

Health care workers have long relied heavily on surgical masks to provide protection against influenza and other infections. Yet there are no convincing scientific data that support the effectiveness of masks for respiratory protection.

 

The masks we use were not designed for such purposes, and when tested, they have proved to vary widely in filtration capability, allowing penetration of aerosol particles ranging from 4 to 90%.

 

These masks — which are open on the sides, top, and bottom — may be useful in source control when worn by a patient, but even then, there is evidence that material escapes around the mask's margins after a sneeze or forcible cough.

 

By contrast, respirators cover the nose and mouth (at a minimum) and are designed to purify the air that the wearer breathes in, either by filtering it or by providing an independent air supply.

 

It has been demonstrated that N95 respirators filter out 95 to 99% of relevant aerosol particles. Although these respirators function best when they are individually fitted, unfitted respirators do have efficacy. The available evidence indicates that the tight fit and enhanced filtration capacity of these devices offer better protection against aerosol particles than do surgical masks.

 

Until more data are available, the committee recommends that clinicians reach for the N95 respirator when confronting patients with influenza-like illnesses, particularly in enclosed spaces.

 

 

Authorities have been warning that a pandemic was likely since 2005, and  nearly 18 months ago OSHA  published a recommended stockpiling guideline for Health Care facilities, where they estimated that every nurse with direct patient contact would need roughly 480 - N95 respirators for a 12 week pandemic wave.

 

 

Despite this guidance, many facilities failed to purchase the OSHA recommended stockpile of PPEs (Personal Protective Equipment), and so N95s are reportedly in short supply at many hospitals.  

 

This shortage is being used as a justification by some hospitals that are issuing surgical masks to HCWs caring for flu patients, instead of N95 respirators.

 

And in the absence of N95s, admittedly that may be the only viable option.

 

We are indeed fortunate that we are dealing with a milder swine flu virus, and not the much deadlier bird flu virus. But that was a matter of luck, nothing more. 

 

And we are not out of the woods yet, as a more virulent virus could still emerge down the road.

 

The failure of many institutions to prepare for an event that public health officials have been warning about for nearly 4 years is hard to fathom.  

 

No doubt they had reasons that sounded reasonable to them at the time.

 

Whether those reasons will sound as reasonable to their employees – some of whom may be asked to work around flu patients this winter without the protection of N95 respirators - remains to be seen.

Why There Won’t Be A Test At The End Of This Blog

 

 

# 3787

 

 

Despite numerous news stories to the contrary, many members of the public still expect that their doctor will test them to see if they have the H1N1 virus should they develop flu-like symptoms.

For most people, it seems a no-brainer.  After all, isn’t it important to know if it’s swine flu?

The answer today is far different than it was 5 months ago.  Today, if you’ve got the flu, you’ve probably got `swine flu’.  Somewhere around 98% of the positive virus samples tested are now novel H1N1.

 

Testing is still appropriate for those hospitalized with severe symptoms, and for some people in high risk groups, but for most people testing is a waste of time, money, and scarce resources.

 

The CDC released two guidance documents last night on this issue, one for the general public and one for clinicians. 

 

We’ll take a look at some excerpts from each.

 

Influenza Diagnostic Testing During the 2009-2010 Flu Season

September 29, 2009, 6:00 PM ET

For the Public

How will I know if I have the flu this season?

You may have the flu if you have one or more of these symptoms: fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, fatigue and sometimes, diarrhea and vomiting. Most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs, and the same is true of seasonal flu. (More information is available on What To Do If You Get Sick this flu season.) Most people with flu symptoms do not need a test for 2009 H1N1 because the test results usually do not change how you are treated. 

<SNIP>

 

Will my health care provider test me for flu if I have flu-like symptoms?

Not necessarily. Your health care provider may diagnose you with flu based on your symptoms and their clinical judgment or they may choose to use an influenza diagnostic test. Depending on their clinical judgment and your symptoms, your healthcare provider will decide whether testing is needed and what type of test to perform. CDC has provided recommendations for clinicians this season to help with testing decisions. This season, most testing will be done in people who are seriously ill (hospitalized patients) and patients where testing may impact treatment decisions. In most cases, if a healthcare provider suspects you have the flu, the test results will not change their treatment decisions.

(Continue . . .) 

 

This next guidance document is directed toward clinicians.

 

Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season

September 29, 2009, 6:00 PM ET

Objective

To provide updated interim recommendations on influenza diagnostic testing for clinicians treating patients with suspected 2009 H1N1 influenza virus infection and to assist clinicians with testing decisions for the 2009-10 influenza season ¹. These recommendations may be further revised as more information becomes available. These recommendations also can be adapted according to local epidemiologic and surveillance data and other state and local considerations.  Clinical judgment is always an important part of testing and treatment decisions.

Summary Points

• Most patients with clinical illness consistent with uncomplicated influenza who reside in an area where influenza viruses are circulating do not require diagnostic influenza testing for clinical management.
• Patients who should be considered for influenza diagnostic testing include:
  • Hospitalized patients with suspected influenza
  • Patients for whom a diagnosis of influenza will inform decisions regarding clinical care, infection control, or management of close contacts.
  • Patients who died of an acute illness in which influenza was suspected.

(Continue . . .)

 

 

Included in this guidance is the following chart which shows the four common types of influenza tests, their reliability (sensitivity), and the time it takes to process. 

 

Rapid influenza tests, the type that are commonly available in doctor’s offices and clinics, do a disappointing job identifying infection with this novel H1N1 virus. 

 

Detection rates run anywhere from an abysmal 10% to as high as 70%.   We’ve discussed the problems with these RIDTs (Rapid Influenza Diagnostic Tests) before:

 

No Doesn’t Always Mean No

Apples, Oranges, And Influenza Death Tolls

Lancet: Atypical H1N1 Presentation In Children

Japan: Rapid Influenza Test Sensitivity

 

Additionally, these tests don’t tell the doctor what strain of flu you have (although a positive for Influenza `A’ right now almost certainly means novel H1N1 swine flu).   So between an inability to differentiate between flu strains, and with an accuracy rating roughly as reliable as flipping a coin, these RIDTs are of limited value with this new flu strain.

 

Which is why doctors are being urged to diagnose influenza based primarily on clinical examination of the patient, and not to rely on rapid influenza tests.

 

Although the novel H1N1 swine flu appears poised to either supplant – or perhaps co-exist along side - our other seasonal flu strains, it will probably take awhile before the public grows comfortable enough with this new flu that they no longer expect routine testing.

Until then, expect this message to be repeated by the CDC and HHS on a regular basis.

Australia Begins Flu Vaccinations

 

 

# 3786

 

A little more than a week after China announced the start of their pandemic vaccination program, Australia has become the second country to begin large scale swine flu vaccination.

 

China, however, only expects to vaccinate about 5% of their population, while Australia is hoping nearly everyone will take the jab.

 

While the winter flu season in the southern hemisphere is nearly over, fears of the virus re-emerging in the form of a second wave, or simply simmering in the population over their summer, have prompted health officials to push this post-flu-season vaccination.

 

The US expects to begin to offer the pandemic vaccine in the next two weeks, and Canada has plans to roll out a vaccine in November.

This from Reuters.

 

 

 

Australia rolls out nationwide swine flu vaccination

Wed Sep 30, 2009 9:11am BST

 

PERTH (Reuters) - Australia rolled out a nationwide vaccination drive for H1N1 influenza on Wednesday in a bid to arm itself against a possible outbreak of the disease.

 

Health Minister Nicola Roxon said 5.5 million doses of the vaccine have been delivered across the country, enough to vaccinate about 30 percent of the population, and two million doses each month will be made available until January.

 

The campaign is Australia's biggest mass vaccination and is estimated to cost over A$100 million ($87.95 million). Vaccinations will start with those most at risk in the pandemic, including health care workers, pregnant women and the chronically ill.

 

More than 4,600 Australians have been hospitalized and 172 people have died from H1N1 flu.

 

(Continue . . .)

Referral: Effect Measure On Will Modern Medicine Save Us?

 

 

# 3785

 

 

One of the arguments often heard against our ever seeing another serious pandemic has been that modern medicine – armed with antivirals and antibiotics – will save us.  

 

Of course, that ignores 90% of the world that generally has little access to those medical resources. Furthermore it assumes that in the developed world there will be room at the Inn (hospitals and ICUs) for all those  who need it. 

 

The Reveres at Effect Measure  today point out that even if these resources are available, the outcome isn’t always a happy one.

 

Swine flu: will modern medicine save us?

 

Highly recommended.

HHS Webcast Today

 

 

# 3784

 

 

The HHS will air another  Know What To Do About Flu webcast today, this time for individuals and organizations who work with seniors.

 

 

 

September 30, 2009 1:00 PM EDT

Know What to Do About the Flu Webcast: Individuals and Organizations who Work with Seniors

Join our expert panel for a discussion of what individuals and organizations working with seniors should do to help keep themselves and their employees healthy this flu season. Learn about what can be done to help inform seniors and their families about the flu. Send questions and comments for the panel to hhsstudio@hhs.gov.

 

 

Previous webcasts, which are archived and available for viewing include:

 

September 18, 2009 

Small Businesses

 

September 9, 2009 

Parents and Child Care Providers

 

August 27, 2009 

Pregnant Women and New Moms

 

August 20, 2009 

Business Guidance

 

August 4, 2009 

H1N1 Response Status Update

Jason Gale On Swine Flu Lung Damage

 

# 3783

 

 

Jason Gale, who writes regularly on pandemic flu issues for Bloomberg news, brings us news of a study from doctors in Australia and New Zealand who have been treating severely impacted Swine flu cases over their winter flu season.

 

Although the novel H1N1 virus normally remains in the upper airway and results in common flu-like-symptoms, on rare occasions it can infect deep into the lungs, and the result can be severe respiratory distress or even failure.

 

Doctors there have dubbed this phenomenon as FLAARDS (Flu A-Associated Acute Respiratory Disease Syndrome).

 

Follow the link to read the entire Bloomberg report.

 

 

Inflamed, Flooded Lungs Trigger Death by Swine Flu, Study Says

By Jason Gale

Sept. 29 (Bloomberg) -- Swine flu is most dangerous when it causes the lungs to become inflamed, flood with fluid and fail to function, doctors in Australia and New Zealand found.

 

 

While a majority of people infected with the virus have a mild illness, a small number develop life-threatening disease, intensive-care specialists Steven Webb and Ian Seppelt said. The doctors described the most common of three main complications from the pandemic strain as flu A-associated acute respiratory disease syndrome, or “flaards.”

 

“Flaards -- sometimes with associated multiple organ failure -- is the most common syndrome and has the highest attributable mortality,” Webb and Seppelt wrote in an editorial in the September issue of the medical journal Critical Care and Resuscitation.

 

(Continue . . . )

The Case Of The (Possibly) Benign Mutation

 

 

# 3782

 

 

Sometimes the influenza virus is real a mystery.

 

Scientists have been watching intently for months to detect any mutation in the H1N1 `swine’ flu virus that might add greater virulence, or perhaps antiviral resistance, to its repertoire. 

 

While there are many possible mutations that can occur, the truth is we don’t know what a lot of those would mean for the `fitness’ of the virus.  

 

One of the mutations scientists thought they understood reasonably well is the (E627K) substitution in the (PB2) protein; The swapping out of the amino acid Glutamic acid (E) at position 627 for Lysine (K).

 

Glutamic acid (E) at this position is a hallmark of avian influenza viruses, and is believed to make the virus better adapted to replicate at the higher temperatures commonly found in birds (41C). 

 

Human flu viruses normally have Lysine (K) at position 627.  That mutation supposedly makes the virus better adapted to replicate at the lower temperatures (roughly 33C) normally found in the upper human respiratory tract.

 

The H1N1 swine flu, which is a reassortment of human, swine, and avian viruses, carries this `avian’ style E627 marker.

 

Therefore, any change at that position from E to K (Glutamic Acid to Lysine) would be expected to improve human adaptability and potentially increase virulence and/or transmissibility of the virus.

 

Earlier this year we heard of an E627K mutation of the H1N1 swine flu virus detected in Shanghai (A/Shanghai/71T/2009, May 31st), which raised some eyebrows, but we’ve heard little else since then. The ProMed Mail report below doesn’t reference the Shanghai sample.

 

Now we get word of two virus samples from the Netherlands where this mutation has once again been observed.  

 

But the good news, for now, is that ferret testing has shown no obvious increases in virulence or transmissibility.  This comes as a genuine surprise to researchers, one of whom admits `he would have bet his car’ on this mutation increasing virulence.

This first report from The Canadian Press.

 

 

Dutch researchers find mutation linked to virulence in swine flu virus

(CP)

TORONTO — Dutch scientists are reporting they have found a key mutation in several swine flu viruses from the Netherlands, a mutation that in other flu viruses increases virulence.

 

But they say the mutation, on the PB2 gene, doesn't appear to cause more severe disease with the novel H1N1 virus.

 

The two people from whom the mutated viruses were isolated had standard cases of swine flu and when the mutated virus was tested in ferrets it didn't produce more severe disease.

(Continue . . .)

 

 

ProMed Mail  carried an alert on this story last night, some of which is excerpted below:

INFLUENZA PANDEMIC (H1N1) 2009 (58): THE NETHERLANDS, PB2 MUTATION

******************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Mon 28 Sep 2009
From: Marion Koopmans
<Marion.Koopmans@rivm.nl>

We would like to report 2 patients in The Netherlands, diagnosed with influenza pandemic A(H1N1) 2009 virus infection that had a mutation (E627K) in the basic polymerase 2 (PB2) protein. This mutation has previously been associated with increased efficiency of replication and possible virulence changes in other influenza A viruses.

 

The investigation identified a specific geographic region in the north of The Netherlands as the place where viruses with the same genetic background have circulated between mid July and mid August [2009]. No other cases carrying the PB2 mutation have been identified.

<SNIP>

 

PB2 627K is consistently found in human influenza A viruses, but rarely in avian-derived viruses. The E627K mutation may result in enhanced virus replication efficiency in humans, possibly by adjustment to host body temperature or cellular cofactors, and has previously been shown to be associated with fatal cases of HPAI H5N1 and H7N7 virus infection in humans.

 

Until now, A(H1N1)v viruses with Influenza pandemic (H1N1) 2009 (57): in PB2 have not been reported, and the clinical and epidemiological relevance of our finding remains unclear.

 

Preliminary experiments in ferrets using reverse genetics-derived new influenza A(H1N1)v viruses with the E267K mutation in PB2 did not indicate increased shedding, virulence or transmissibility. Further experiments as well as increased molecular surveillance to monitor the situation are ongoing.

 

 

As I said at the start of this, sometimes the influenza virus is a real mystery.   We’ve watched and waited for this particular amino acid substitution with the expectation that it would herald a more human adapted virus.  

 

Now that it has appeared, and no such behavioral changes have been observed, it suggests that there may be other factors – which we don’t understand – that must occur possibly in concert with this change to make the virus more virulent.

 

And so the mystery deepens.

The Antiviral Catch-22

 

 

# 3781

 

 

Unlike the UK, where just about everyone who gets the flu this season has been given the drug Tamiflu, the decision has been made here in the US to restrict the use of antivirals.  Tamiflu, like any drug, has the potential for adverse side effects. 

 

And there is always the worry of overuse leading to antiviral resistance.

 

Accordingly, those  who are hospitalized with severe symptoms, and those who have `risk factors’ such as pregnancy or other high risk medical conditions, are recommended to get the drug.

 

But the CDC believes that most people would not benefit from taking the antiviral.

 

As stated by Dr. Anne Schuchat in a CDC briefing on September 8th, `the vast majority of us that have an influenza-like illness don't need the antiviral medicine.’

 

And no doubt, that is true.  For 99 out of 100 flu victims, recovery is uneventful even without antivirals. 

 

But for that 1 case in 100, the timely administration of antivirals could prove life saving.  And we don’t have a really good way to indentify who those rare individuals might be.

 

Antivirals work best if given early in the course of an infection, but as we’ve seen, it is often 3 to 5 days into the infection when these patients really begin to deteriorate and the need for treatment becomes obvious.

 

By the time they show up at the hospital, antivirals are of limited use.

 

And so we end up with tragic stories, such as this one out of Fort Worth, Texas (hat tip Crof on Crofsblog).

 

 

FW girl not given Tamiflu, dies with flu

03:52 AM CDT on Tuesday, September 29, 2009

By CHRIS HAWES / WFAA-TV

FORT WORTH - Five days ago, Fort Worth eight grader Chloe Lindsey came down with a fever. She was diagnosed with the flu Friday and died Sunday.

 

The 14 year old didn't get Tamiflu at her doctor's visit because she wasn't considered high risk.

 

Chloe's mother, Tammy Osborne, said it all happened so fast.

 

She said she did everything medical professionals told her to do and can't understand how a touch of a fever turned so deadly in just a few days.

(Continue . . . )

 

 

This is a heart wrenching story (particularly viewing the video on the website), and I couldn’t help but think about my 4 teenage grandnieces as I watched it.  My heart goes out to the family.

 

We don’t know, of course, whether the early administration of antivirals would have made a difference in this case.  

 

But it might have.

 

The catch-22 for those influenza victims without pre-existing medical conditions is they don’t generally qualify for Tamiflu under the CDC’s guidelines.

 

Unfortunately, to be effective, antivirals must be started in the first 24-48 hours of the illness . . . and  most people don’t begin to show signs of actually needing the medication until much later into their illness. 

 

Catch-22

 

From a `population’ standpoint, the CDC’s recommendations make sense.  The alternative is to give the drug to 99 people out of 100 who don’t really need it.  

 

And that involves risks as well.

 

But inherent in our policy is the knowledge that some people  who might benefit from the drug are not going to get it when they really need it.

 

I wish I had a better answer here. 

 

One that would ensure that this sort of tragedy never happen, while protecting the greater population from unwanted drug side effects or worse, a resistant mutation of the virus.

 

But I don’t.

 

Which means we are likely to see many more stories like this one over this fall and winter, simply because there are no perfect solutions for dealing with a pandemic.

Referral: McKenna On Bacterial Co-Infections

 

# 3780

 

Maryn McKenna, who (when she isn’t writing books) pens the superb Superbug Blog and is a staff writer for CIDRAP news, brings us some new details about bacterial co-infections among pandemic flu fatalities.

 

Last night, in a piece for CIDRAP news, Maryn wrote of a conference call for clinicians held by the CDC yesterday.  This is a detail rich story, so follow the link to read it in its entirety.

 

CDC cites bacterial infections in some H1N1 deaths

Maryn McKenna Contributing Writer

Sep 28, 2009 (CIDRAP News) – Almost one third of a group of patients who died in the past 4 months from H1N1 influenza had bacterial infections that complicated their illnesses, the Centers for Disease Control and Prevention (CDC) said today in a conference call with healthcare providers. But the agency cautioned against applying that ratio to all cases of H1N1, saying the death records it reviewed were submitted by hospitals and medical examiners and did not represent a statistically valid sample.

 

Nevertheless, the 22 cases (among 77 deaths confirmed to be from H1N1) emphasize that bacterial co-infections are playing a role in the ongoing pandemic, something that was not clear at first, the CDC's Dr. Matthew Moore said on the call.

(Continue . . . )

 

See also:

CDC recommendation for pneumococcal vaccination for adults
http://www.cdc.gov/vaccines/recs/provisional/downloads/pneumo-Oct-2008-508.pdf

CDC recommendation for pneumococcal vaccination for children
http://www.cdc.gov/mmwr/PDF/rr/rr4909.pdf

 

In a follow up to this piece, Maryn provides details of other similar studies on her Superbug blog, in a piece called:

 

More evidence of MRSA involvement in H1N1 flu

 

Once again, Maryn provides a good deal of detail, and draws on some of what she gleaned from the recent ICAAC meeting.  

 

The CDC is urging those who are at high risk of pneumonia to avail themselves of the pneumococcal polysaccharide vaccine (PPV).  Incredibly, only about 16% of the target population in the US has taken this protective shot.

 

Although I don’t offer medical advice in this blog, I have long suggested that people consult with their primary care provider about the advisability of taking the Pneumococcal polysaccharide vaccine (PPV) – even if you aren’t sure you fall into a recommended category.

A few past blogs where I’ve discussed this option include:

 

Referral: Effect Measure On Pneumococcal Vaccines

CDC Issues Pneumococcal Vaccine Recommendations

Seven Steps You Can Take Now To Prepare For A Pandemic

It Doesn't Have To Be Pandemic Flu

With Flu Season Upon Us

 

If you’ve not talked to your doctor about the Pneumonia Vaccine, now is a very good time to do so.

British Columbia Limits Seasonal Flu Vax

 

 

# 3779

 

A hat tip to Crof over at Crofsblog who has word of a press release from the British Columbia Centre For Disease Control, which outlines their strategy for seasonal and pandemic vaccinations this fall in light of what has become known as the `The Canadian Problem’.

 
The `Canadian Problem’ is the as-yet unpublished study that is widely reported to suggest that people who received a seasonal flu shot last year were twice as likely to contract the pandemic flu strain this past spring.   

 

The CDC here in the US says they have seen no evidence in their data to support this assertion, but `would obviously like to see the data’.

 

Since we’ve not seen the Canadian study, I’ve no idea what the authors are suggesting as the cause of this phenomenon. 

 

That said, there is an immunological concept (and I’m admittedly wandering into pretty speculative territory here) known as `Original Antigenic Sin’ (a term coined in 1960 by Thomas Francis, Jr. in the article On the Doctrine of Original Antigenic Sin) that might - at least theoretically –  serve as a plausible way this could come about.

 

In Original Antigenic Sin, when the body’s immune system is exposed to and develops an immunological memory to one virus, it may be less able to mount a defense against a subsequent exposure to a second slightly different version of the virus.

 

Original Antigenic sin has been described in relation to influenza viruses, Dengue Fever, and HIV.   Whether it plays any part in `The Canadian Problem’, or whether that `problem’ even exists at all, is something we will have to wait to see.

 

Obviously this is fascinating stuff for us disease geeks (and we eagerly await more information), but for the average citizen, it comes down to a more basic question.

 

Does getting the seasonal vaccine increase your chances of getting the swine flu?    And if so, how much? 

 

Unfortunately, we don’t have the answer to that question yet. 

 

Here in the US, the CDC has so far downplayed these reports.  The WHO, and other health agencies around the world, are looking to see if they can find anything in their data to corroborate these (as yet, unpublished) findings.  

 

So far, they say they can’t.  

 

In Canada, over the past few days, several provinces – including Quebec, Alberta, Ontario, and Nova Scotia – announced they were making adjustments to their seasonal flu vaccination campaign.

 

British Columbia today has followed suit.  Partially, they say, to enable Health Care Providers more time to concentrate on delivering the H1N1 pandemic vaccine when it becomes available in November, but also clearly in response to this study.

Whether this ends up being a prudent move, or an over-reaction, is something we may not be able to figure out for weeks or months.   

 

Here is the B.C. Centre for Disease Control Press release.

 

NEWS RELEASE

For Immediate Release
2009HLS0023-000414

September 28, 2009

Ministry of Healthy Living and Sport
BC Centre for Disease Control

TARGETED VACCINE CAMPAIGN WILL PROTECT THOSE AT RISK

VICTORIA – B.C.’s seasonal flu vaccine campaign will focus first on those at highest risk for seasonal flu and be followed closely by the H1N1 flu vaccine that will be available to everyone who needs and wants it, announced Minister of Healthy Living and Sport Ida Chong with provincial health officer Dr. Perry Kendall.

 

“Delivering the vaccine campaign in this fashion allows us to best protect British Columbians most at risk from seasonal flu, while still ensuring that everyone who needs and wants the H1N1 flu vaccine will be able to receive it as soon as it’s available,” said Kendall. “By initially targeting the seasonal flu campaign to those at highest risk, it not only removes a number of logistical challenges that come with trying to run two full immunization programs at once, but it is also in the best public health interest of British Columbians.”

 

On October 13, the seasonal flu vaccine will be offered to people 65 and older, and residents in long-term care homes. A pneumococcal vaccine will also be available at the same time for high-risk individuals (seniors and those with chronic medical conditions) to prevent influenza-related pneumonia.

 

“This is a decision that has not been taken lightly,” said Chong. “It has been assisted by independent ethical review and has undergone thoughtful review and deliberation by public health officials, scientists and policy makers in B.C. and across Canada over the past several weeks.”

 

Starting in November, the H1N1 flu vaccine will be rolled out and will be available to everyone who needs and wants it. Then, in early 2010, the seasonal flu vaccine will once again be offered to everyone else under the age of 65 according to the usual guidelines.

 

“This year, the predominant strain of seasonal influenza is, in fact, the pandemic H1N1 virus,” said Dr. David Patrick, epidemiology services director at the BC Centre for Disease Control. “While those people who are 65 and older and who live in long-term care homes should still receive the seasonal flu shot, for the majority of the population, the flu virus they need to protect themselves against is this strain of H1N1.”

 

The decision to focus the flu vaccine campaign in this way was based on a number of reasons, including:

 

· The possibility of an early fall second wave of H1N1 flu.

· The timing of H1N1 vaccine availability.

· The strains of influenza that are currently circulating.

· Canadian research that has suggested a potential association between prior seasonal influenza vaccination and the risk of acquiring pandemic H1N1 disease.

For more information on the seasonal flu vaccine, including a flu clinic locator that can direct the public to get information on clinics in their area once information becomes available, visit www.immunizebc.ca.

For more information on the H1N1 flu virus, visit www.gov.bc.ca/h1n1.

 

==============================================

 Robert Roos of CIDRAP took a long and fascinating look at the concept of Original Antigenic Sin a little over a month ago, albeit in a different context, in an article called 'Original antigenic sin': A threat to H1N1 vaccine effectiveness?. 

 

He explains the concept far better than I could, and so I would refer you to his excellent article for more background.

Letters, I Get Letters

 

# 3779

 

 

Most of my readers by now know that while I preach individual and community preparedness, and I consider this pandemic to be a legitimate threat, I’m not exactly hyperventilating over the virulence of this H1N1 virus.

 

Swine flu appears (so far, anyway) to be a high morbidity, low mortality pandemic. It produces a lot of illness, but relatively few deaths.  A scenario we’ve discussed here for several months now.

 

That could change, of course.   But for now, 99% of those who are infected recover without incident.

 

Which means we seem poised to experience a CAT 1 pandemic, at least here in the Developed World.

 

Countries without access to antivirals, vaccines, and other modern medical resources may see something worse  (see A Tale Of Two Pandemics).

 

Not that a CAT 1 pandemic is anything to trifle with. 

 

It can, and no doubt will, exact some heavy costs over the next few months.   Absenteeism could run very high, and we may see some serious economic effects from this pandemic.

 

The impact, particularly on the Health Care Delivery system, is likely to be significant.  And I worry about my friends who are working on the front lines, for the pandemic they must deal with is likely to be different that the one most of the world experiences.

 

And of course, if you, or someone you care about, is one of the unlucky 1% who see serious complications from this virus, you will think of this pandemic as having been anything but `mild’.

 

As you might imagine, I get occasional emails and letters – some from readers, and some from friends and relatives – asking me specific questions about how to deal with pandemic issues.  

 

The best I can do is tell people how I would deal with a situation.   If they find that approach reasonable, they are free to follow suit.

 

Anyway, a few from my in-basket I thought you might find of interest.

 

A couple of weeks ago, talking to a nurse on the phone she mentioned she was going to be flying cross-country in a week.  She wondered if she should wear a surgical mask on the plane?

 

I told her I was flying to Minneapolis that same week to attend the CIDRAP conference, and I didn’t plan on wearing one.   I’d probably stuff a surgical mask in my pocket in case I was seated next to a particularly active cougher or sneezer, but doubted I would use it.

 

As it turned out, I left the mask in my carryon luggage, but never felt the need to wear one.  Even though I was seated next to a woman who reeked of cherry cough drops, and who tried to cough surreptitiously into her blanket for the 3 hour flight.

 

While I still obsessively wash (or sanitize) my hands, and try to avoid coughers and sneezers, I’m more or less resigned to the fact that if I’m susceptible, there’s little chance of avoiding exposure.  

 

This is the flu, and over the next few months it will likely become ubiquitous.  If I’m called upon to provide direct care to someone I suspect of having the flu, I would use a mask.

 

 

My Dad is 85, a cancer survivor, and has a heart condition.  He lives now with my sister who is (mumble-mumble) years older than I.  He was worried about the risks of having his great-grandchildren (who are teenagers) visiting during this fall and winter flu season.

 

As an aside, I have a friend who spent a fortune `child-proofing’  her house, but she complains they still get in . . .

 

But I digress. . . .

 

I told him there was no such thing as zero risk (hey, when you’re 85 and have bad coronary arteries, it’s risky buying green bananas or starting to watch a TV mini-series) 

 

If the kids are obviously sick, they should stay away. 

 

But otherwise, treat every opportunity to visit with them as a gift. There’s little point in hanging around at the age of 85 if you shut yourself up out of fear of the virus.

 

 

I was recently asked via an email whether I still advocated stockpiling food, medicines, and other supplies for 30 – 60, or even 90 days?  

 

On April 30th of this year, scarcely a week after this virus made the national spotlight, I wrote that it was probably too late to suggest that kind of preparation (See The Stockpiling Dilemma). 

 

I replied that I wholeheartedly believe that every family should strive towards better preparedness.  

 

That means having a personal disaster plan, a good first aid kit, and at least 2-weeks food and water, along with extra prescription medications on hand in case of any crisis.  But for the pandemic before us, I see no pressing need for 3 months of supplies.  

 

Quite honestly, I’ve let my 3-4 month stockpile dwindle over the past 5 months down to probably less than 60 days.  And I’m more than comfortable with that.

 

Perhaps the most interesting question came this morning, when I got an email from someone who is buying a house, and just found out her new neighbor has a pot-bellied pig as a pet. 

 

She wanted to know if that posed any special swine flu danger?

 

I told her, as long as she didn’t sneeze on the pig, it should be fine.

 

People, I said, were more likely to give the flu to the pig, than the other way around. If the pig acts sick, keep your distance for  awhile.

 

And if YOU are sick, try not to infect the pig.

 

 

But otherwise . . . unless theres' a BAR-B-Q in the little guy's immediate future . . I told her to feel free to make friends with him.

 

There you have it, a few from the mailbag that perhaps can give my readers some feel for how I’m viewing this pandemic.

 

At least today.

A Note From A Mom

 

# 3778

 

 

With the high level of angst out there about the pandemic flu shot, I thought it would be helpful to print (with the author’s permission) an email that was sent to me by a Mom whose child is part of the clinical trials. 

 

I know this same note appeared on Crofsblog a couple of days ago, but on the oft chance that one of my readers missed it, I reprint it here.

 

For anyone with concerns about the swine flu vaccination, I'd like to report that earlier this month we enrolled our 2 1/2 year old daughter in the swine flu vaccine trial at our local children's research hospital.  She had her second dose last week and has had no side effects other than apparent slight soreness on her thigh for one day after the last injection. If you have any questions about her experiences during the trial, I'd be happy to answer them via the comments section.

 

 

We are so grateful she was able to participate and receive this early protection from what is not a "mild" flu (isn't it interesting that the handful of journalists who've suffered through this virus first hand are now changing their tune about its severity?).

The Coincidence Factor

 

# 3777

 

I don’t usually tell `war stories’ in this blog  . . .  but today I’m going to make a brief exception because it illustrates a point that needs to be made.

 

Some years ago (okay, decades) my EMS partner and I were called to the scene of a suspected stroke.   We found an elderly gentleman sitting in an overstuffed chair in his living room, with at least a dozen distraught family members and neighbors standing vigil.

 

He was, according to the family, suddenly struck with one-sided paralysis and an inability to speak (aphasia).

 

I did what I always did when I approached a new patient.   I knelt down beside him, placed my hand on his bare arm (a great way to reassure a patient and to pick up `skin signs’ at the same time) and said, ”I’m a paramedic, and my partner and I are here to help you”.

 

Almost instantaneously, the gentleman’s paralysis and aphasia resolved.  Very quickly he was able to squeeze my hands, stand, and speak normally.

 

It was, by popular acclaim in the room, nothing less than a Miracle!

 

My partner and I tried (unsuccessfully) to explain that no miracle was involved, that the gentleman had suffered a T.I.A.  - a Transient Ischemic Attack – a temporary condition that mimics (and can be a precursor to) a stroke.

 

I’d preformed no miracle.  It was simply a coincidence.   A case of perfect timing on my part.

 

But no one was buying that explanation.

 

 

They’d seen it with their own eyes.  I `laid my hands’ on the gentleman, told him I `was here to help him’, and he was cured.

 

Case closed.

 

As my partner and I tried to convince the gentleman that he still needed to go to the hospital (why bother?  He was cured!), word of my miraculous powers quickly spread through the neighborhood.

 

Suddenly we were barraged by neighbors with medical problems wanting me to `put my hands on them’, to cure everything from deafness to hammertoes.   Pregnant women wanted me to touch their bellies.    For a time, I feared I’d be trampled.

 

We had a tough time extricating ourselves from the scene that night, and for weeks thereafter we got calls from that neighborhood requesting an ambulance, but only if that `nice young man with `the hands’ would come. 

 

 

If you are wondering what in blue blazes this has to do with an influenza pandemic, consider that millions of people are going to begin to receive pandemic vaccines next month.  

 

Many of those recipients are going to be `high risk’ individuals, with comorbid conditions. A certain number of them are going to have a medical event; a heart attack, a stroke, a miscarriage, a seizure, an asthma attack . . . something, in the days and weeks following their vaccination.  

 

Overwhelmingly, the odds are that the vaccine will play no part in their illness, but many people will link the two anyway.   They won’t see it for the coincidence it is.

Get a vaccine on Monday, and have a  miscarriage on Tuesday?  

 

It had to be the vaccine, right?

In the US, 2500 women miscarry each day.   Nearly 1 million women each year.    And that is without a pandemic vaccination program.    If we could vaccinate all of the pregnant women in the country today, tomorrow 2500 would still miscarry. 

 

And most would blame the vaccine.

 

Of course, there is no such thing as a completely benign drug.  And that includes flu vaccines.  

 

So doctors and scientists will be on the lookout for any signs that the pandemic vaccine is having adverse effects. But as they do, they must keep in mind the following statistics.

 

The much feared GBS (Guillain Barre Syndrome) afflicts more than 5,500 people each year.   If half the country takes the vaccine, then we could reasonably expect about 700 cases of GBS to develop in vaccine recipients within 90 days of their vaccination.

 

And that would have nothing to do with the vaccine.

 

The possibility exists, however, that this vaccine could produce adverse side effects.  And so it is important to monitor the number of cases of GBS, and miscarriages, and strokes among vaccine recipients so we could detect any changes in the pattern.

 

In July, I wrote a post called Flu Math where I compared the mortality rate of the much maligned 1976 swine flu vaccine with this H1N1 pandemic virus.  Even assuming a very low CFR (Case Fatality Ratio) for this virus, the odds overwhelmingly favor taking the vaccine.

 

But if you are uncomfortable with the idea of taking the vaccine, and would rather take your chances with the virus, I do understand. 

 

After all, despite knowing the odds, I still buy the occasional lottery ticket (Hope springs eternal).

 

I’m heartened to see that many of the mainstream press outlets are talking about these background rates of disease, and how we can’t automatically assume that adverse medical events are linked to getting the vaccine.  Hopefully those stories will continue to run as the vaccine is rolled out.

 

But I fully expect that some of the more `tabloid’ aspects of the media are going to try to link the vaccine to adverse medical events in order to draw viewers or sell papers.   

 

This is the scenario I wrote about in Public Health’s Biggest Pandemic Challenge, and what I worry about most with this vaccination program; that people will shun the vaccine because of undeserved bad publicity.

 

And should this vaccine should be shown to increase the incidence of  __________ (fill in the blank), that would still have to be put up against the costs of the virus.  

 

And right now, the swine flu virus is hospitalizing thousands of people each month here in the US, and killing hundreds.  Those numbers are only expected to climb.

 

Which makes my personal risk-reward analysis for taking the vaccine decidedly in favor of the jab.

Hong Kong Finds Success With Higher Tamiflu Doses

 

# 3776

 

 

The `standard’ adult course of Oseltamivir (Tamiflu) for seasonal flu has long been 2 - 75mg capsules per day, for 5 days.  

 

Or a total of 10 pills.  

 

And despite reports from the field in countries treating the H5N1 virus that 150mg/day wasn’t terribly effective (50+% mortality rate, even with treatment),  the definition of a `treatment course’ hasn’t changed.

 

Doctors, of course, have had the latitude to make adjustments to these regimens – and so many bird flu patients in Vietnam, China, Indonesia, and Egypt have received more than the standard 10 pill course. 

 

In March of 2007, it was announced that doctors in Hong Kong would begin clinical trials, looking to see if higher doses of antivirals improved patient survivability.   See Hong Kong: Doctors To Test Higher Tamiflu Doses. 

 

Shortly thereafter the WHO released the following guidance which allowed for two-fold higher dosage, and longer duration on a `case by case basis’:

 

Summary of the second WHO consultation on clinical aspects of human infection with avian influenza A(H5N1) virus, 19-21 March, 2007, Antalya, Turkey

 

Accordingly, many pandemic planners (particularly in the UK) began talking about the need for more Tamiflu in their stockpile.  In November of 2007, I undertook a rather long discussion of the matter in How Much Tamiflu Is Enough?

 

 

Fast forward two years, and the pandemic we’ve got isn’t the pandemic we planned for.  

 

The  H1N1 swine flu virus, thankfully, doesn’t have the high CFR (Case Fatality Ratio) of it’s avian cousin.  But for a small subset of patients, the viral pneumonia it can produce easily rivals bird flu in severity.

 

In Hong Kong, where the H5N1 Tamiflu clinical trial was supposed to take place, one hospital has been routinely doubling the dosage of Tamiflu for their most severely ill pandemic flu patients.

 

And so far, at least . . . not one of them has died.

 

Doctors at the Prince of Wales Hospital in Hong Kong are encouraged enough by these results to recommend doubling the dose of Tamiflu for all patients who are severely impacted by the pandemic flu.

 

This from the Hong Kong Standard.

 

City flu strategy may set roadmap for global fight

Mary Ann Benitez
Monday, September 28, 2009

The treatment of severely ill swine flu (H1N1) patients at Prince of Wales Hospital - which has a zero death rate so far - may be held up as a model for the world.

 

The World Health Organization will consider new treatment guidelines at a meeting of experts in Washington next month, and the Hong Kong model is among those being discussed.

 

<SNIP>

 

It has treated at least 60 severely ill patients, out of the city's 106 severe cases, without loss of life, according to David Hui Sui-cheong, a specialist in respiratory medicine at Chinese University.

 

Hui said severely ill patients should receive double the dose of Tamiflu as viral pneumonia is what kills patients with pandemic H1N1.

 

Antibiotics are given to patients in intensive care units to treat underlying bacterial infections brought about by long use of ventilators, he added.

 

(Continue . . .)

A Hospital Is No Place For A Sick Person

 

 

# 3775

 

 

 

One of the more surprising things to come out of last week’s CIDRAP summit in Minneapolis was the group polling that indicated that Hospitals were among the least likely to make it easy for employees to stay home if they were sick.

 

Of course, I remember from my own days as a paramedic, that you had better be on death’s door before you could even consider calling in sick.   EMT’s and paramedics were a scarce resource, and since everyone was working at least a 56-hour-week . . .  trying to find someone to fill a shift was a major hassle.

 

So we worked with colds, with the flu, with aching backs, and Lord knows what else  . . . because the system required it.  And there were real (unwritten) punitive downsides to calling in sick. 

 

Of course, this was nearly 30 years ago.   One hopes that things have changed a bit in 3 decades.

 

But from what I heard at the CIDRAP Summit, and from what I hear nearly every week in emails and conversations with HCW’s (Health Care Workers), HR (Human Resources) departments in hospitals are very slow to make any changes to their policies, even in the face of a pandemic.

 

Of course, Hospitals will say they want sick employees to stay home . . . but their HR policies often run counter to that claim.

 

Sick leave for HCWs often comes out of an accrued PTO (Paid Time Off) account which combines vacation, holiday, and sick time off.  Workers accrue hours based on shifts worked, and their seniority.

 

Employees who haven’t sufficient hours `banked’ (or part-time workers who aren’t usually enrolled in PTO plans), must take unpaid leave if they fall ill.  

 

Those that do have banked time, must `burn’ vacation days even though they may have contracted the swine flu `in the line of duty’.

 

Either way, it is a decided disincentive to stay home if you are ill.

 

Live polling of the attendees at the CIDRAP conference indicated that industries other than Health Care, such as manufacturing, were more likely to give employees paid time off for the flu and for taking care of sick family members.  

 

Working sick is a bad idea in any workplace.

 

It exposes co-workers to the virus – who then can take it home to their families. It can also cause waves of absenteeism that can cripple a workplace.

 

But in the health care field, working sick can do much more damage. 

 

Infected HCWs can pass the virus on to their patients, who are often compromised and frail.   Sick HCWs are also impaired and more likely to make errors in judgment, which can endanger patients, and expose their facilities to liability. 

 

I’ve had HCWs tell me that when they try to call in sick they are sometimes urged to work `half a shift’, until a replacement can be found.   A reckless, but apparently common practice.

 

Many hospitals have `streamlined’ their operations to the point that they don’t have any `depth on the bench’.  There is also considerable peer pressure to work, even if you are sick, because if you don’t show up, someone else will have to do your job.

 

If any industry should be leading by example here, it should be the health care industry.

 

But the evidence suggests otherwise.

 

For more perspective – this time from a nurse with 30 years experience (Terri Polick) – I’d call your attention to this blog which appeared on the Nursingjobs.org website.   

 

Follow the link to read it in its entirety.  You’ll note, this was written BEFORE the pandemic virus emerged.

 

Presenteeism: Why Nurses Don’t Call Out Sick

 

February 27th, 2009  |  The Blog

It’s cold and flu season and many of my non-nursing friends are shocked when I tell them that hospitals have unwritten rules about nurses calling into work when they are sick. Sure, nurse recruiters tell new hirers that they can call in sick, but in reality, nothing could be farther from the truth. I’ve actually heard a nursing supervisor refuse to accept a nurse’s callout because there was no one that could take her place on the unit. There are consequences for calling in sick. Nurses that choose to take care of themselves when they are ill face the wrath of their employer when they return to work. Most nurses choose to work when they are sick. This scenario plays out everyday in hospitals and it’s called presenteeism.

(Continue . . .)

 

And yesterday, Crof over at Crofsblog posted an article – also on Presenteeism – which indicates that 1/3rd of American workers feel pressured to work when sick.

The curse of "presenteeism"

Via the Vancouver Sun, a good opinion piece by Craig McInnes on the unsanitary aspects of a good work ethic: H1N1: Those keeners may be the death of us. Excerpt:

A survey of American workers by the U.S. based National Foundation for Infectious Diseases a couple of years ago found that about a third of employees felt pressured to go to work despite being sick.

 

None of this bodes well for containing the spread of the H1N1 flu, which is now well-established in British Columbia. It may be that slackers and hypochondriacs are the heroes in the battle against this global pandemic. 

 

 

Whether it is due to punitive or restrictive corporate policies, financial necessity, peer pressure, or an overactive work ethic . . .  Health Care Workers are going to find themselves torn between doing the right thing and staying home when sick, and and caving into the myriad pressures and going in to work.

 

While there is no law or regulation to force them, hospitals have a moral duty . . .to their employees, to their patients, and to the community in which they operate . . . to make it easier for all employees (part time or full time) to take sick leave during this pandemic.

 

And if that isn’t enough justification, hospitals need to consider the liability angle as well.    Sick employees are more likely to make errors . . . and medical errors can be very costly.

 

While a liberal paid sick leave policy may cost some money in the short run, doing anything less is likely to end up being penny wise and pound foolish.

Referral: That Was The Year That Was

 

# 3774

 

 

In what is admittedly a self serving act, I’m cross posting today’s essay from my OTHER BLOG – Master of My Public Domain – in the hope that some of my readers might find something of interest in this labor of love of mine.

 

Tomorrow is my 1 year blogaversary of MOMPD, and during the past 12 months I’ve produced more than 90 essays on old time radio, TV, and movies available online and for free.

 

If you have a nostalgic bone in your body I think you’ll find something here you’ll like.  -  Mike Coston

 

Saturday, September 26, 2009

That Was The Year That Was

 

Sunday, September 27th is the one-year anniversary of this blog.  Over the past 12 months I’ve produced more than 90 essays, with links to hundreds of radio broadcasts, TV shows, and movies that are available for free viewing or downloading from the Internet.

 

The first show I wrote about was Your Hit Parade, in a piece called  'Twas Rock & Roll That Killed Your Hit Parade.  In short order, I was contacted by Andrew Fielding, whose mother had appeared on Your Hit Parade often during the early 1950’s.  

 

He sent me his book, which I reviewed here, and we’ve stayed in contact via email since then.  His blog, The Lucky Strike Papers, is featured in my sidebar.

 

Just two days later, we learned of the passing of Paul Newman, which prompted me to write a blog entitled Paul Newman's Early TV Appearances,  with links to his first TV appearance on  Tales of Tomorrow which aired on August 8th, 1952.  

 

Next came 4 episodes of Rocky King, Detective from the Dumont network, then an in depth look at the surprising radio and TV career of Jack Webb, in You Really Don't Know Jack.  

 

October brought us an homage to Dr. Frank Baxter, an icon to those of us who went to school during the 1960s and remember the Bell Laboratories science films of that age.  A Tribute to Mendel Berlinger (aka Milton Berle), and a look at some of our best scary movies in The Horror Of It All!, along with several other essays.

 

November started out with all things Horatio Hornblower in I Knew Him, Horatio, followed by the BBC Classic miniseries Quatermass And The Pit, and then a series of Christmas show entries, including Cinnamon Bear - A 71 Year-Old Christmas Tradition.

 

But it wasn’t all holiday fare, as evidenced by Memories Of Rocky Jones, Space Ranger and my tribute to The Bickersons in Not Exactly Ozzie And Harriet.  I encouraged my readers to Spend `An Evening With Groucho Marx', then closed out November with 4 takes on a famous short story The Most Dangerous Game, called Four Variations On A Theme.

 

December opened with a 2-part essay on Victor Borge The Great Dane Pt 1 and The Great Dane Pt II, followed by a half dozen Christmas stocking stuffer posts, with everything from Bob Hope to Dragnet Christmas specials.

 

2009 opened with John Newland Going `One Step Beyond', which was followed by The Colgate Comedy Hour With Abbott & Costello. and then The Two Richard Diamonds (radio and TV). Next came Things Go Better With Eddie Fisher and then a fond look back at Jackie Gleason in The Great One.

 

Before the month was out, I presented More Tales Of Tomorrow, featuring some very recognizable TV and movie stars long before they became household names.

 

In February we recalled the life of Ralph Edwards in This Was His Life, and laughed once more at CAR 54, Where are you?  in Gunter and Francis Together Again. Lee Liberace was featured in Mr. Showmanship, followed by 4 essays on Sherlock Holmes.

 

Holmes Sweet Holmes Pt. 1

Sherlock Holmes On The Big Screen

Three Decades of Holmes On The Radio

Sherlock Holmes On The Small Screen

 

March brought a look at old TV commercials, in And Now A Word From Our Sponsor, Martin Kane, Private Eye, and a look at Lucille Ball’s early career in Before We Loved Lucy.

 

I also presented the first of several collections of blooper reels from Warner Brothers in Warner Brothers Breakdowns of the 1930’s.  Followed by a fond look back at Sky King in  From Out Of The Clear Blue Of The Western Sky Comes . . ., and topped off with a contortionist act you have to see to believe in Solid Potato Salad.

 

April brought, among other things, the first realistic medical show for TV A Boone For TV Medical Shows, Borrah Minevitch And His Harmonica Rascals, and Joan Davis The OTHER Wacky Housewife Of The 1950’s.  Another red head, by the name of Skelton, closed out the month in Seeing Red.

 

May brought us Lloyd Bridges Adventures Above and Beneath The Sea, Swing music, old radio show openings in Themes Like Old Times and classic comic books of the 1950s in Warning: A Graphic Post.

 

In June we were able to Meet Boston Blackie, remember All About Eve Arden, and learn music appreciation from The Musical Marx Brothers. Mr & Mrs. North proved that Finding A New Murder Every Week was good for ratings, and I presented the star studded 1957 special Hardly An Edsel Of A Show.  Last, but hardly least, an homage to Judy in Shout Hallelujah.

 

July opened with What It Was, Was A Young Andy Griffith, followed by Matt Dodson . . . err, Make That Tom Corbett, Space Cadet!.  We said goodbye to Gale Storm (1922-2009), watched some more classic commercials in And Now, Another Word From Our Sponsor . . ., and watched Soundies . . . Music Videos Of The Past.

 

August started out with some Classic Film Noir, and then some rare Big Band Remotes.  We explored one of the earliest, and most outrageous sc-fi/singing cowboy serials ever made in The Phantom Empire Strikes Back, and then took to the scenic highways of the 1950s in The Roads To Romance travelogues.

 

Before the month was out, we’d remembered why There Is Nothing Wrong With Your Television Set . ., and took the pulse of mid-60s with Hollywood Palace 1965.

 

This month (September) we enjoyed some Bob Cummings Attractions, and spent some quality time with My Man (Arthur) Godfrey and A Little More Godfrey.

 

I skipped some, of course.  To give my new readers a reason to browse back through the archives. 

While I don’t know what I’ll write about next (I never do), I do know there remains much unexplored territory in the world of online radio, TV, and movies.   

 

Much of my time is devoted to my other blog – Avian Flu Diary – but I fully expect to produce 4 to 6 essays a month in the coming year.

 

My hope is you will enjoy them as much as I will.