Avian Flu Diary

Tuesday, October 30, 2012

The Morning After

Minimum Preps : Emergency Weather Radio, First Aid Kit, Battery Lantern, Water storage

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The sun is just now coming up across the Mid-Atlantic states - roughly 12 hours after post-tropical storm Sandy slammed into New Jersey and New York. Early damage reports suggest this storm has lived up to it’s epic billing, but it will take a day or more before we really know the true extent of the destruction.

For 7 million residents across several states, this morning breaks cold, dark, and damp. Power is out in many places, and may remain out for days, leaving millions without heat, light, communications, or the ability to cook.

Temperatures are chilly, but running above freezing at night. At least for now.

New York City’s infrastructure . . . particularly their mass transit systems, appear to have been significantly impacted. There are reports of subway tunnels flooded with salt water, which may produce corrosion problems even after they are pumped out.

In a town where most people ride, instead of drive, this will have a major impact on how quickly that city returns to work.

There are reports this morning of levee breaks in New Jersey, prompting fresh rescue operations. Hurricane force gusts whipped a major fire in Queens, which at last report had engulfed dozens of homes.

If it’s been a bad night for residents, keep in mind it’s been even a worse night for emergency responders and emergency management personnel. Even though they have their own homes and families to worry about, they are out there taking care of others.

Some twitter feeds to follow today, to keep track of the damage, and the emergency response:

FEMA Director Craig Fugate   @CraigAtFema

FEMA                                    @FEMA

NYC Mayor's Office                @NYCMayorsOffice

New Jersey Gov Christie       ‏@GovChristie

NY Gov Andrew Cuomo        @NYGovCuomo

American Red Cross               @RedCross

Monday, October 29, 2012

CMAJ On Mandatory Flu Shot For HCWs

Photo Credit – CDC PHIL

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In an editorial today, the CMAJ (Canadian Medical Association Journal) endorsed requiring HCWs (Health Care Workers) to get a seasonal flu shot, thus joining a growing list of medical associations around the world calling for similar policies.

First, the press release followed by a link to the editorial, then I’ll return with more.

Canadian Medical Association Journal

Mandatory flu vaccine for health care workers to protect patients

All health care workers in health care institutions should be vaccinated with the annual influenza vaccine to protect patients, argues an editorial in CMAJ (Canadian Medical Association Journal).

Each season, 20% of health care workers get influenza, and 28% of young healthy adults who get it have asymptomatic or subclinical infections," writes Dr. Ken Flegel, Senior Associate Editor, CMAJ. "Some of them may shed virus up to a day before symptoms appear. It is time that all people who work in a health care institution be vaccinated."

In Canada, there are approximately 20 000 hospital admissions related to influenza and an estimated 4000 to 8000 deaths attributed to the illness. However, 55%% of physicians do not get vaccinated against the flu and are putting patients at risk of illness and death.

Dr. Flegel argues that flu vaccination for health workers must be compulsory, although there could be exemptions for medical or religious reasons. A vaccination rate above 90% is required to prevent outbreaks in hospitals. Mandatory programs for health care workers in many US institutions have resulted in participation rates of about 95%.

"Our schools have shown us the way. During measles outbreaks, access to schools has been successfully denied to nonvaccinated children and staff. The time has come for health care institutions to demand that all health care workers be vaccinated. Our patients' lives depend on this change," Dr. Flegel concludes.

You can read the entire editorial at this link:

EDITORIAL

Health care workers must protect patients from influenza by taking the annual vaccine

October 29, 2012

We know that health care workers import and transmit seasonal influenza to patients. We know that many patients get seriously ill from it and that some die. We know that the annual influenza vaccine can interrupt most of this imposed disease burden. It is time that we act on our knowledge and require all health care workers to be vaccinated.

Full article

Despite vocal resistance from some HCWs and their unions, calls for mandatory flu vaccination for health care workers have been coming from many professional organizations for several years.

A few earlier blogs on these include:

APIC Calls For Mandatory Flu Vaccination For HCWs

AAP: Recommends Mandatory Flu Vaccinations For HCWs

SHEA: Mandatory Vaccination Of Health Care Workers

IDSA Urges Mandatory Flu Vaccinations For Healthcare Workers

In 2011, the following editorial opinion appeared in The Lancet.

The Lancet, Volume 378, Issue 9788, Pages 310 - 311, 23 July 2011

doi:10.1016/S0140-6736(11)61156-2

Time to mandate influenza vaccination in health-care workers

This perspective was penned by Arthur Caplan, Ph.D., who is director of the Center for Bioethics at the University of Pennsylvania, and addresses the ethics of mandating yearly influenza vaccination for Health Care Workers (HCWs).

Caplan argues that the evidence overwhelmingly shows that vaccinating HCWs helps to protect patients from infection (and possible death), and that the influenza vaccine is both safe and effective.

Citing language common to all oaths sworn by health care professionals (Doctors, Nurses, Techs, etc.), he points out the universal concept that the interests of the patient must come first, and that all HCWs must honor the core medical principal of, “First, do no harm.”

Both tenets, he argued, are violated when HCWs fail to accept a yearly flu vaccination.

While strongly advocating HCW influenza vaccination, the CDC has stopped short of mandating them. I blogged on this back on June 23rd, 2010 in CDC: Proposed Influenza Infection Control Guidance.

And earlier this month we saw Rhode Island Adopts New Flu Vaccination Requirements For HCPs.

Although many infection control experts see this as a long overdue step in patient and employee protection, compulsory vaccination remains a hugely divisive issue, with many HCWs believing that it is an infringement of their rights to decide what will be injected into their bodies.

I’ve covered some of the HCW’s objections to forced flu shots in the past, including:

HCWs: Refusing To Bare Arms

HCWs: Developing a Different Kind Of Resistance

While their concerns over the vaccine’s safety may be overblown, one of their arguments that does carry some weight is the relative effectiveness of the flu vaccine.

It simply isn’t as good as with other vaccines.

Most years (see CIDRAP: The Need For `Game Changing’ Flu Vaccines), protection from the flu shot runs under 60% for healthy adults, and probably even less for those over 65 or with weakened immune systems.

Having a better flu vaccine would remove at least one of the objections that many HCWs have voiced.

Popular with HCWs or not, hospitals are increasingly looking at this as both a liability and an economic issue. Unless the courts intervene, the momentum increasingly appears to be moving towards mandating yearly flu shots for many Health Care Workers down the road.

Uganda MOH: Update On Marburg Outbreak

Credit Wikipedia

# 6675

The Ugandan Minister of Health, Dr. Christine Ondoa, has issued the following update on the Marburg virus outbreak which has been ongoing in that nation since October 19th.

The major points are that there are now 8 deaths confirmed, and that cases have now been confirmed in three districts; Kabale , Ibanda, and Mbarara.

This from the Ugandan Media Centre.

PRESS STATEMENT ON THE UPDATE OF MARBURG OUTBREAK

October 29th 2012

Today on behalf of the Ministry of Health, I take this opportunity to welcome you all to this press briefing organized to update you on the outbreak of Marburg in the country. You will recall that we declared an outbreak of this highly infectious disease on October 19th and since then the Ministry of Health and its partners have undertaken a number of interventions to control the spread of the disease.

I wish to inform you that cases are now reported in the neighbouring districts of Ibanda and Mbarara. However, I want to assure you that the Ministry of Health and its partners are on the ground in the mentioned districts to contain the spread and manage the identified cases.

To date, the death toll of both the probable and confirmed cases stands at eight, with the latest being a case that died at the isolation facility at Rushoroza Health Centre III on October 27th (Saturday). The case that was referred from Ibanda Hospital – Ibanda to Mbarara Regional Referral Hospital died on October 24th.

I wish to clarify that since the onset of the outbreak, we have collected a total of 45 samples of which nine were confirmed positive; five in Kabale, two in Kampala and two from Ibanda.

Working closely with the US Center for Disease Control and Prevention (CDC), we have set up a field diagnostic laboratory at Kabale Regional Referral Hospital. All samples from the affected neighbouring districts will hence be taken to this laboratory for quick diagnostics. This will shorten the time when we get results to three hours from the original 24 hours due to distance. Further serological testing will be undertaken at the Uganda Virus Research Institute (UVRI).

Due to the presence of cases in other districts, we have established temporary isolation facilities to accommodate the suspected and confirmed cases. In Ibanda, a temporary isolation ward has been created at Ibanda Hospital, while plans are underway to set up a proper isolation facility by tomorrow.

At Mbarara Regional Referral Hospital, a separate temporary has been designated for the suspect Marburg cases. A triage has also been set up at the causality ward.

We have assembled a team of experts to work in the newly established isolation facilities and they are expected in these districts today. We also plan to undertake infection control procedures in these facilities as safety measures for the workers and the admitted patients.

Today, the total number of cases admitted is 12. Eight are currently admitted at Rushoroza Health Center III in Kabale. Two confirmed cases, a couple (husband and wife) still remain admitted at Mulago National Referral Hospital. Another two suspect cases are currently admitted at Mayanja Memorial Hospital in Mbarara.

There are seven suspect cases (student nurses) quarantined at Ibanda. These cases attended to the confirmed case that later died at Mbarara Regional Referral Hospital on October 24th. Other health workers who attended to the patient are closely being monitored.

We have line-listed a total of 436 contacts for close observation in four districts of Kabale, Kam-pala, Ibanda, Mbarara, Fort Portal and Rukungiri. Those being monitored got into contact with either the dead or confirmed cases. The team continues to monitor them on a daily basis for possible signs and symptoms of this highly infectious disease until they have completed 21 days without showing any signs and symptoms.

We have completed an orientation of the Kabale district taskforce on Marburg case presentation and prevention, barrier nursing and infection control. Plans are underway to conduct the orien-tation at Ibanda and at Mbarara Regional Referral Hospital.
We have trained a total of 42 volunteers from the Uganda Red Cross Society and deployed them to conduct house to house community sensitization and active case tracing.

We plan to set up burial committees in Ibanda district to manage burials of people suspected to have died of the disease. The committee will be oriented on burial procedures and infection prevention and control. This is one of the control measures to curb the spread of the highly con-tiguous disease.

The Ministry of Health would also wish to clarify on media reports that one of its officers, Dr. Sheila Ndyanabangi, the head of the Mental Health Unit Division, had contracted Marburg and had been isolated. Dr. Ndyanabangi has not been isolated but has been advised to exercise social distancing. She is one of the contacts who are being monitored. She has not developed any signs or symptoms of the disease and therefore cannot be isolated from the community. She is due to complete the 21 days of observation.

I once again urge the public to take the following measures to avert the spread of the disease.

Report immediately any suspected patient to a nearby health unit

Avoid direct contact with body fluids of a person suspected to be suffering from Marburg by using protective materials like gloves and masks

Persons who have died of Marburg must be handled with strong protective wear and buried immediately

Avoid eating dead animals

Avoid unnecessary public gathering especially in the affected district

Burial of suspicious community deaths should be done under close supervision of well trained burial teams

Report all suspicious deaths to a nearby health facility

Once again the Ministry of Health calls upon the public to stay calm as all possible measures are being undertaken to control the situation.

For a history of the Marburg virus, you may wish to revisit Marburg Virus Reported In Western Uganda.

Red Cross Apps

# 6675

With nearly 60 million people in the path of Hurricane Sandy, and estimates that as many as 10 million may be without electricity over the next several days, their ability to communicate with friends and loved ones may be temporarily compromised.

To aid those in the midst of a disaster, the Red Cross has maintained a SAFE & WELL web-based program since 2006 that lets people log in and post their name, address, phone number and a brief message that worried family members can check for.

To search for someone, you need their name and either address or phone number. Multiple (date stamped) messages may be retrieved.

The Red Cross has recently updated their Safe & Well program, and it now lets users update their Facebook and Twitter statuses as well.

The Red Cross also has a web based FIND SHELTER app that lets you input a location and gives you the locations of open emergency shelters in the vicinity.

You’ll also find a wide selection of mobile Apps available for iPhone/iPad and Android on their Red Cross Mobile Apps page.

Wildfire App

First Aid App

Hurricane App

Shelter Finder App

Earthquake App

Now would be a good time to download these apps, and to let your friends and family know - that should they be unable to reach you by conventional means - they should look for a message from you on the Red Cross Safe and Well site.

Sandy Strengthens Overnight

# 6674

As predicted by the National Hurricane Center in Miami, Sandy’s barometric pressure has dropped to an astonishing 946 millibars and its winds have increased to 85MPH, as it moves north at 15 mph.

Although a hurricane at present, Sandy is expected to transition into a post-tropical storm later today as it merges with a trough from the west and cold Arctic air.

This transition will not diminish the storm’s impact, which is expected to be experienced over a wide area.

This from the 5am Advisory on Hurricane Sandy.

BULLETIN
HURRICANE SANDY ADVISORY NUMBER 28
NWS NATIONAL HURRICANE CENTER MIAMI FL AL182012 500 AM EDT MON OCT 29 2012

...SANDY STRENGTHENS...EXPECTED TO BRING LIFE-THREATENING STORM SURGE...COASTAL HURRICANE WINDS AND HEAVY APPALACHIAN SNOWS...

SUMMARY OF 500 AM EDT...0900 UTC...INFORMATION
----------------------------------------------
LOCATION...35.9N 70.5W
ABOUT 285 MI...460 KM E OF CAPE HATTERAS NORTH CAROLINA
ABOUT 385 MI...615 KM SSE OF NEW YORK CITY
MAXIMUM SUSTAINED WINDS...85 MPH...140 KM/H
PRESENT MOVEMENT...N OR 360 DEGREES AT 15 MPH...24 KM/H
MINIMUM CENTRAL PRESSURE...946 MB...27.94 INCHES

Local radio & TV stations are streaming coverage over the Internet, including:

Watch Live: Hurricane Sandy Coverage – NBC NYC

Live storm coverage from Eyewitness News – ABC NYC

WINS 1010 News Radio

Sunday, October 28, 2012

The Very Model Of A Natural Disaster

Credit NHC 11am Sunday Track Map

# 6673

While it is impossible to know just how bad Hurricane-Hybrid Sandy will be as it approaches and crosses the eastern seaboard over the next 48 hours – or who, exactly, will be most affected – models continue to paint a sobering picture.

Tidal surge models from the National Hurricane Center suggest that large areas of the coastline could see storm tides 5-10 feet above normal.

The following map is for a 5 ft surge:

Some models are suggesting that portions of New York Harbor could see tides exceeding 10 feet above normal, and the 11am advisory warns:

STORM SURGE...THE COMBINATION OF AN EXTREMELY DANGEROUS STORM SURGE AND THE TIDE WILL CAUSE NORMALLY DRY AREAS NEAR THE COAST TO BE FLOODED BY RISING WATERS. THE WATER COULD REACH THE FOLLOWING DEPTHS ABOVE GROUND IF THE PEAK SURGE OCCURS AT THE TIME OF HIGH TIDE...

NC NORTH OF SURF CITY INCLUDING PAMLICO/ALBEMARLE SOUNDS...4 TO 6 FT

SE VA AND DELMARVA INCLUDING LOWER CHESAPEAKE BAY...2 TO 4 FT

UPPER AND MIDDLE CHESAPEAKE BAY...1 TO 3 FT

LONG ISLAND SOUND...RARITAN BAY...AND NEW YORK HARBOR...6 TO 11 FT

ELSEWHERE FROM OCEAN CITY MD TO THE CT/RI BORDER...4 TO 8 FT

CT/RI BORDER TO THE SOUTH SHORE OF CAPE COD INCLUDING BUZZARDS
BAY AND NARRAGANSETT BAY...3 TO 6 FT

Based on the forecast of surge tides, heavy rains, and high winds the City of New York will suspend mass transit routes starting at 7pm tonight.

Gov: MTA will suspend all subway, bus and rail service as Hurricane Sandy advances

Last subway and rail trains will be at 7; last bus at 9pm

By Shane Dixon Kavanaugh / NEW YORK DAILY NEWS

The last time the New York Subway system was shut down due to flooding was for Hurricane Irene in 2011. The NYC MTA carries more than 8 million passengers on a typical weekday, and shutting down the entire system will take 8 to 10 hours (cite WSJ).

From Johns Hopkins University, we get this `model’ of possible power outages due to Sandy, based on current track forecasts.

MEDIA ADVISORY: Hurricane Sandy – 10 million could lose power

As many as 10 million in the mid-Atlantic will lose power in the coming week, according to a computer model developed by an engineer at The Johns Hopkins University.

Please note: A multicolored map of power outage predictions is available. Email acl@jhu.edu

A map of power outages as predicted by Guikema’s model based on the official National Hurricane Center track and intensity forecast from 18UTC (3 p.m. EDT) on Saturday, Oct. 27.

An engineer at The Johns Hopkins University predicts that 10 million people from northern Virginia through New Jersey and into southeastern Pennsylvania will be without power in the wake of Hurricane Sandy. Seth Guikema (pronounced Guy-keh-ma) and his team have developed a computer model built on outage data from 11 hurricanes to estimate the fraction of customers who will lose power, based on expected gust wind speed, expected duration of strong winds greater than 20 meters per second, and population density. They ran their model using the official National Hurricane Center track and intensity forecast from 18UTC (3 p.m. EDT) on Saturday, and emphasize that the number of power outages could change as the storm progresses and forecasts become more definitive. It is possible that 10 million people is a conservative estimate, Guikema said.

Guikema’s model may help power companies allocate resources by predicting how many people will be without power and where the most outages will take place, and it provides information that emergency managers can use to better prepare for storms. Guikema, an assistant professor in the Department of Geography and Environmental Engineering at the Johns Hopkins Whiting School of Engineering, says the goal is to restore power faster and save customers money. Guikema will be running the model throughout the weekend and into next week as Hurricane Sandy makes landfall.

The Governor of New Jersey warned yesterday that power could be out for some residents for `seven to ten days’. And for many people, that means no ability to cook, or to heat their homes.

Municipal water supplies, or water quality, could be affected as well. Hence the need to be prepared to go several days - at least - without city services or utilities.

And while most people automatically worry about storm surge or high winds from hurricanes, between 1970 and 1999, the most lives have been claimed due to inland flooding.

The NHC has released this five-day precipitation forecast, which should provide some idea of the extent of flooding that may occur.

While it is possible that Sandy won’t be as destructive as has been billed, storms like Camille, Andrew, and Katrina have shown us the folly of underestimating nature’s fury.