A Journey Through The World of Pandemic Influenza

A Pandemic Seminar in Mobile Alabama, US

Alabama's agency for Influenza Pandemic Emergency Preparedness held a seminar in Mobile aimed at nurses, social workers, and emergency first responders describing what a 1918 style pandemic (our last severe pandemic) could mean for the US. That translates to roughly 100 million people falling ill and a potential of 1.9 million dead, with each state suffering their statistical percentage.

The Press-Register report of the seminar is one of the few that I have read that states the situation law enforcement may well find themselves in during a severe pandemic.

[snip]

Lt. Joseph McClellan of the Alabama Department of Homeland Security said that law enforcement agencies and other first responders have to prepare to lose about half their work force because they will either be sick or caring for dying relatives.

It's unclear if crime will increase, but it certainly won't decline, he said.

"Bad people will take advantage of good people during bad times," McClellan said.

Security will need to be provided for mass burial sites, hospitals and pharmacies as fear and chaos could take hold of the community, McClellan said. Officers will have to reprioritize their calls; burglaries and robberies may not be on the top of the list.

While looking over various agencies' plans, McClellan said he's found that too many call for support from Alabama State Troopers.

"There aren't enough state troopers to fill those spots," he said. Those plans need to be changed, he said.

 

In late 2006 I posted my assessment of Law Enforcement during a severe pandemic here and again here. Since law enforcement is also near and dear to me I pay extra attention when the issues of policing and pandemic meet.

Unfortunately, in the year and a half since I wrote those entries the only thing that has really changed when it comes to law enforcement's planned response to a severe pandemic is that now they are planning to plan instead of being blissfully ignorant. That means, to put it bluntly, that now they are informed but still lacking in any meaningful preparations, although they plan to plan.

There are a few exceptions of course, but the vast majority still feel that they will handle a pandemic as they handle every other "incident"… they will do what needs to be done.

Someone needs to tell the rest that doing what needs to be done presupposes personnel to do the "doing". And as it stands currently that means doing it without adequate personal protection against infection, no vaccine, no prophylactic antivirals, no proper and modern medical treatment should they become ill or injured. And last, the very real likelihood of having no available and timely "backup" from fellow officers should they find themselves in an "Officer Needs Assistance" situation.

 

As the mother of a patrol officer under 30 years old I take these issues personally. It's hard to get more personal than a threat to one's own child. To help him meet the threat of what he may face as a cop during a pandemic I have taken it upon myself to make sure he has the means of protecting himself from infection as well as anyone can and still perform their public functions. But I know there is nothing I can do to protect him from potential injuries sustained in the performance of those duties. Injuries, perhaps life-threatening, that will likely go medically untreated, or at best, inadequately treated.

I have come to question whether I will support his decision to remain on patrol or if the "mother" in me will over ride my sense of civic duty and encourage him to be one of the many who will refuse to put themselves in such a tenuous and precarious position. When I am being honest with myself there is no question: I value my son's life far, far more than I value the property or life of some anonymous stranger.

If strangers want to be protected those strangers need to demand that their local law enforcement agencies adequately prepare for a severe pandemic. Otherwise, well, those strangers may find they have to protect themselves.

It's as simple as that.

 

SZ

Pandemic Accounting

My "day job" is in the accounting department of a vacation rental company, wholly owned by a publicly traded holding company, as such accounting standards tend to be rigorous so I have some concept of "corporate accounting"—to say nothing of some level of interest.

Today's news item of interest (my thanks to: DeepImpact2005 @ FluWiki) hit two areas of interest: Influenza Pandemic and Bean Counting.

From MedPageToday.com:

Flu Pandemic Would Cost Hospitals Billions

By Michael Smith , North American Correspondent, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.

BALTIMORE, Dec. 4 -- A flu pandemic like the one in 1918 could cost U.S. hospitals $3.9 billion, but a human-to-human outbreak of the H5N1 avian influenza strain could dwarf that estimate.

This opening line is of major importance, at least in my estimation. I ask that you indulge me as I give a little background on why the above sentence is noteworthy and paradigm challenging.

Planning assumptions for a severe pandemic rarely account for anything worse than 1918. In fact, today is day two of a web dialogue on the US vaccine prioritization preliminary guidance, and the "PanFlu aware" who are participating are continually running up against the facilitators inability (or refusal) to step outside of the possibility that the next PanFlu could be worse, or even significantly worse, than the 1918 pandemic.

This steadfastness is in the face of WHO findings, multiple scientific papers, notable experts, and just plain common sense given available facts.

The sentence also makes the distinction of a human transmissible avian influenza. That distinction is not well understood, even after all the coverage of H5N1 and pandemic influenza. Influenza A comes in two varieties: human and avian. People only get avian influenza rarely because of (partly or mainly) its "binding affinity", the cells it will bind to and enter for viral replication. Although scientists do not yet know the entire puzzle of what makes an avian influenza adapted to humans, the binding affinity is a big piece of the "why".

However, it is an avian influenza virus adapted to human infection and transmission that is the most deadly to humans of the influenza viruses. The genetic makeup is still entirely of avian origin but the virus undergoes changes at the nucleotide or the amino acid level that give it human infection, replication, and transmission capabilities. As I noted above, we still don't know exactly what those changes are or even on which gene or genes they have to occur to confer this ability, but the puzzle is slowly being unraveled. Hopefully, we will find out in time as it is that bit of knowledge that gives us the greatest potential of having meaningful advanced warning.

The article continues:

The lost revenue to hospitals from a 1918-style pandemic would come from deferred elective cases and uncompensated care for flu victims, found Eric Toner, M.D., and colleagues at the Center for Biosecurity of the University of Pittsburgh, in Baltimore.

The average community hospital would lose $353,985 by deferring cases over an eight-week pandemic period, Dr. Toner and colleagues reported in the quarterly Journal of Health Care Finance.

At the same time, the effects of the pandemic would mean uncompensated costs of $430,607 per hospital to treat the influx of flu patients, the researchers said.

Across all U.S. hospitals, that adds up to $3.9 billion -- a sum that could create severe financial strains in the health care system, the researchers said.

"Some hospitals may not have sufficient cash on hand to cover these losses," they said.

For a macro-level analysis I recommend HealthyAmericans White Paper: Pandemic Flu and the Potential for Economic Recession: a state-by-state analysis (pdf here). In it you will find their assessment that an increase in healthcare spending will go a long way in offsetting down turns in the other major sectors of a state's economy. I remember my reaction when the paper hit the internet—unbelief is a bit of an understatement.

(article continues)

Government planning assumptions also suggest that if a pandemic were on the 1918 scale, hospitals would find it difficult to treat all the patients who required care.

For example, Dr. Toner and colleagues said, the average community hospital has 20 ventilators available and -- by deferring cases -- could have 81 free beds.

But at the height of a 1918-style pandemic, 42 patients would need ventilators and 290 would need beds, they said.

All this is based on extrapolations of planning assumptions from the Department of Health and Human Services, which were predicated on the 24% mortality rate from infections in the 1918 flu.

If the pathogen involved is a humanized version of the H5N1 avian flu strain, "the severity and duration of a pandemic could be greater than [the government] assumes," the researchers said.

The health and human services department is assuming inpatient mortality would be about 24% in a 1918-type pandemic, they said, but when the H5N1 virus has infected humans it has killed more than half of its victims.

As of Dec. 4, the World Health Organization says there have been 336 confirmed cases of H5N1 influenza in humans, of which 207 have been fatal.

"A 1918-like pandemic is far from the worst case possible," Dr. Toner said in an accompanying audio interview on the journal's website. (Click here to go to the website to hear the entire audio)

"A pandemic with [the H5N1] virus could certainly be worse than that, worse than 1918," he said.

Again, it is important to note the distinction Dr. Toner is making. A human adapted H5N1 avian influenza is a "different beast" than the 1918 pandemic strain, which, via genetic reconstruction, was determined to have been wholly avian on a genetic level as well. We don't understand why H5N1 has such a frightful mortality rate, but just because we don't understand it doesn't make it not so.

Among other things, the numbers of sick would swamp available capacity. At the height of such a pandemic, an estimated 60 million people could be sick, 30 million could need intensive care, and six million could need ventilators.

Currently, Dr. Toner said, there are 105,000 ventilators in the entire U.S. and about 87,000 intensive care beds. "The numbers are truly frightening and far exceed our ability to care for those numbers of patients," he said.

 

Even though this article addresses the financial burdens a pandemic will place upon most hospitals the supporting underpinnings are some of the best I have seen outside of dense scientific papers. Admitting it's crass and insensitive to lean on financial concerns to support PanFlu concerns in general when I refer to what will be human lives and miseries, it's as the saying goes—money talks.

The question is—is anyone listening?

 

SZ

Being Civilized

I will state up front that what follows is part opinion and part public musing.

As I buzz around the Cyber Flu Community and the PanFlu information sites (official and otherwise) I run across mention after mention of the threat of the "civil unrest" that is believed to be likely, at least in some places, during a moderate-to-severe PanFlu, should we experience one. What, exactly, is meant by the term civil unrest?

Generally, civil unrest is the term used to describe an incident whereby a group, or gathering, of people who are one or more of the following:

1. Visibly displaying aggressive or an angry demeanor that would readily be interpreted as threatening to civil order or public safety.
2. Engaging in behavior that is in some way illegal (ranging from illegal demonstration to private property destruction, or looting, or some combination of both)
3. Either threatening, or engaging in physical violence
4. The group is operating on some level of mob psychology

    

It is generally accepted by both officials, and those who follow the PanFlu issue, that there are likely to be riots over scarce medical care, medicines, and vaccines as people may feel unfairly denied something that they need. Other riots are envisioned if there is a shortage of food or water, or both.

 

These occurrences are being built into all levels and departments of governmental COOP's (Continuity of Operations Plans). While they won't be pretty, or especially comfortable to deal with, they are assumed to be readily manageable because of their localization. That will, unfortunately, have to wait for the history to be written before we know for sure.

 

But what about society as a whole; will it hold together if there is a shortage of food, water, medicine, medical care, utilities, in other words, physical comfort and wellbeing? I like to think so, but hey, I've already admitted previously that I tend to be naïve and idealistic. Yes, I believe that the vast majority of people are good and decent, and that they far outnumber the ones who are not. After all, we live in a civilized society, we, the collective we, because my assumption is that if you are reading these words you, too, live in a civil, orderly, environment.

 

Last evening I read an interesting article from The New Yorker "Swingers: Bonobos are celebrated as peace-loving, matriarchal, and sexually liberated. Are they?" by Ian Parker. The article brought out various and sundry beliefs that the public hold about bonobos that are either in error, supposition, or fantasy. Toward the end of the long article is a bit about a very docile captive bonobo male:

Hohmann mentioned a recent experiment that he had done in the Frankfurt zoo. A colony of bonobos was put on a reduced-calorie diet, for the purpose of measuring hormones in their urine at different moments in their fast. It was not a behavioral experiment, but it was hard not to notice the actions of one meek male. "This is a male that in the past has been badly mutilated by the females," Hohmann said. "They bit off fingers and toes, and he really had a hard life." This male had always been shut out at feeding time. Now, as his diet continued, he discovered aggression. "For the first time, he pushed away some low-ranking females," Hohmann said. He successfully fought for food. He became bold and demanding. A single hungry animal is not a scientific sample, but the episode showed that this male's subservience was, if not exactly a personal choice, one of at least two behavioral options.

 

As the article's author is quick to point out, it doesn't prove anything about, or likely behavior in a broader population, but I believe it might be a disturbing peak into what underpins our civility: a fed stomach.

 

Food for thought as I remind you that experts and civil leaders, at every level, assume supply chain interruptions at the same time they offer no clear guidelines for stocking an emergency supply of foodstuffs. There are recommendations from three days to "at least two weeks". The CDC's recommendations to their own people are truly nebulous:

If You Are Asked:

Should I stockpile food, water, medications? How long should a stockpile be designed to last? What are the Government's recommendations for personal and family stockpiles?

There can be no single approach to family and personal stockpiling that is perfect for everyone. Each family and individual must analyze their unique situation and needs and design a stockpile that works for them.

Below. Admirial John 0. Agwunobi, Assistant Secretary for Health, Department of Health and Human Services, provides some important overarching preparedness principles not specific to a pandemic that should help strengthen your family and individual pandemic preparedness plan with regards to stockpiling:

1. A stockpile should be able to support its owner through a pandemic, a hurricane, a blizzard, an earthquake ... or any other circumstance that might require them to be self sufficient for a period of time until outside support can be reestablished.

2. For a family or individual to be prepared, they must have planned and practiced the ability to be self sufficient for the period of time it might take to get outside assistance in an emergency

3. One should be aware that the resources of a stockpile may need to be used at home, in a shelter or on the road during an evacuation

4. Given that the main purpose of a stockpile is really to allow the owner the time needed to reconnect to support from the outside world, it does not need to be aimed at assuring self sufficiency for prolonged periods of time. Even in the most extreme emergency circumstances the need for prolonged periods of self- sufficiency is very unlikely. (More information on preparing a stockpile)

My thanks to big critter who posted this on FluWiki; the Diary where s/he originally posted it, along with comments, is located here.

 

A hungry population is likely to be an ill-mannered, restless, and potentially violent, society; that veneer of civilization that we sometimes hear about may be gnawed away should we have a severe pandemic.

Speaking of a fed stomach… I have a dinner to cook!

 

SZ

Natural Disasters

 

Recently we have had massive floods in China and Britain, and earthquakes of 6.6 and 6.8 on the Richter scale in Japan. Disasters on this scale are not frequent and the fact that the world is watching three of this magnitude with the massive numbers of people effected, as well as 100's of thousands displaced from their homes, and facing ongoing danger to life and health is unusual.

 

If the world should suffer a pandemic, regardless of the severity, although the more severe, consequences increase exponentially, nature will not magically cease to toss out the periodic large-scale disaster. Perhaps a statement of the self evident, or perhaps I am too focused on threats and disasters, but major hurricanes/typhoon, earthquakes, floods, blizzards, mudslides, avalanches, and wild fires will continue to occur where they are prone to occur at their normal frequency. The life-critical difference is that while in "normal" times the response may seem, and often is, inadequate, during a pandemic there is likely to be no response, or so delayed as to qualify as none.

Should you be intrigued enough to continue reading please keep in mind the last sentence of the above paragraph as you do so.

 

CHINA

 

Chinese floods displace billions of rats, mice; Raise fears of disease

USAToday 12 July 2007

(Excerpt)

Nearly 500,000 people have been evacuated from flood zones along the Huai River in central China, where Reuters says displaced residents and relief workers are fighting an influx of 2 billion rats displaced by the rising waters and a shortage of natural predators.

The wire service says the rats have destroyed more than 6,000 square miles of cropland.

Xinhua says about 2.3 million rats -- weighing some 90 tons -- have been killed in the last two weeks.

"Residents had to beat them to death with clubs and shovels - a single blow killing as many as eight at a time. The message is: urgent measures must be introduced to combat this menace," the Chinese news service reports.

 

BRITAIN

Evacuation warnings as UK floods rise

FT.com             

By Christopher Adams, Political Correspondent

Published: July 23 2007 20:40 | Last updated: July 24 2007 00:05

Thousands more people were told to prepare to leave their homes last night as flood-waters across huge tracts of central and southern England rose to their highest in 60 years.

In the worst flooding to affect the UK since the devastating 1947 floods, there were fears that the Thames and the Severn rivers, already more than five metres above normal summer levels, could burst their banks.

Hundreds of thousands of people living in 42 areas at risk of flooding, eight under severe flood warnings, were urged to prepare "do-it-yourself" defences.

In Oxfordshire, people were being moved from their homes and many more residents began piling sandbags in front of their doors and taping up letter boxes.

Drinks suppliers reported "massive" demand for bottled water, with supermarkets selling out fast in the worst affected areas of Gloucestershire and Worcestershire.

Supplies of tap water, already cut to 70,000 homes, were due to be cut to up to 350,000 in Gloucester, Cheltenham and Tewkesbury by yesterday evening after a treatment works was flooded. J Sainsbury, the supermarket group, said it would donate 1m litres of bottled water to residents in the area.

Forty-five thousand people were without electricity and another 200,000 were at risk of losing power.

There were efforts to protect an electricity substation at Walham and last night the Environment Agency said flood levels in the Severn at Gloucester had peaked 2in below the height that could flood the substation and the city centre. Tewkesbury remained cut off, though water levels there were said to be dropping.

"We have not seen flooding of this magnitude before," said the Environment Agency.

Hilary Benn, environment secretary, told the House of Commons that the emergency, which began on Friday when more than 160mm of rain fell in just 24 hours, was "far from over and further flooding is very likely".

Another story is coming to light specific to the British flooding that doesn't bode well for a pandemic even without the exasperation of an additional disaster:

Looting, panic buying - and a water shortage

The Times (UK)

July 23, 2007

Valerie Elliott

Food and drinking water shortages, panic buying and the threat of looting have followed the worst flooding to hit England in 60 years.

[snip]

In the area worst affected by the floodwater from the Severn and the Avon over the weekend, some homes were left without running water and supermarkets reported panic buying of bottled water and food, which is expected to create serious shortages for several days.

[snip]

Staple food items, including fresh vegetables and salad, are also in short supply because supermarket lorries were unable to make deliveries. Fresh produce grown in the waterlogged Vale of Evesham has also been unable to reach the shops. Kevin Hawkins, the director-general of the British Retail Consortium, gave warning last night that there would be localised shortages but that supplies would be resumed quickly in the next two days.

[snip]

Even those who escaped the floods are suffering. More than 200,000 people have now been left without drinking water. Severn Trent Water said that homes in the north of Gloucestershire would be left without supplies for the next two days after a big pumping plant near Tewkesbury was overwhelmed by the floods.

Carrie Douch, 26, a mother of two children from Gloucester, said that she had driven more than 15 miles to buy water after the closure of the water treatment plant. "We have been to three supermarkets and water had sold out in all of them," she said. "The queues outside the supermarkets are horrendous. Everyone is desperate to get their hands on some water. We have heard stories of grown men pushing kids out of the way to get to bottles of the stuff. It is disgusting."

 

JAPAN

 

Japan quake victims take shelter

Reuters

By George Nishiyama Mon Jul 16, 6:57 PM ET

(Excerpt)

KASHIWAZAKI, Japan (Reuters) - More than 10,000 people sheltered in evacuation centers on Tuesday in Japan's northwest after a strong earthquake flattened hundreds of houses, killing at least nine people and injuring more than 900.

As aftershocks continued, rain began to fall, and forecasts for two days of wet weather raised fears of mudslides that could add to the devastation.

Houses collapsed and water, gas and electricity supplies were cut by the 6.8 magnitude quake in Niigata prefecture on Monday, which also caused a small radiation leak and fire at the world's biggest nuclear plant.

Nine elderly people were killed by the tremor, which hit at 10:13 a.m. (0113 GMT) on Monday, police said.

"I am worried about the aftershocks," said 80-year-old Toshiko Kojima, who said she had spent a mostly sleepless night in a crowded elementary school gymnasium in Kashiwazaki.

The quake halted gas service to about 35,000 homes and disrupted the water supply to all of Kashiwazaki, a city with a population of around 95,000 that was hardest hit by the quake.

About 25,000 homes in Niigata prefecture were without electricity, local officials and media said.

The country was rattled late on Monday evening by a deep tremor under the Sea of Japan estimated at magnitude 6.6 to 6.8 that caused buildings in Tokyo to sway, but there were no immediate reports of further damage.

 

I extend my hope that all remain safe, if not exactly comfortable, as they deal with these disasters, and I remind everyone that while we sit back and contemplate their scope and future implications, there are real individual people and families behind the numbers.

 

SZ

The Rituals of Our Lives

This weekend found me preparing for, anticipating, and attending the Christian Sacrament of Christening for my granddaughter.

The Presbyterian Church where it was preformed was consecrated in the late 1700's, serving the rural plantation and farming gentry of the community that resided on the island. It is large for what was then, and still mostly is, a rural church, elegantly austere, proudly conservative and traditional. It is also furnished with the most uncomfortable pews I have ever had reason to sit in for an hour and a half.

As I sat there, contemplating the sanctity of the occasion, I could not help but remember the previous three times that found me in attendance; the funeral of the young lady who was to be the Matron of Honor at my son's wedding, my son's wedding, and the funeral of my son's first born, lost to us before drawing his first breath. Occasions of great joy or deep sadness, each marked with a profoundly meaningful sacrament.

Whilst I am not a congregant I know many of the members, so I feel somewhat like a distant cousin, but still a member of this close-knit family. I know the importance of their faith and the expression of it in their lives.

Looking around at all the familiar faces my thoughts naturally wandered to pandemic issues and how they, specifically, would fare. People that have intertwined with my life for all these many years now, people that I care about; people that have helped me celebrate and mourn, people that participated in important spiritual sacraments and rituals marking life changing events.

 

During a moderate to severe pandemic our gatherings for worship and religious sacraments will be either voluntarily or compulsorily closed. During the very time that we will need to draw upon the strength that our rituals impart they will be unavailable.

Physical preparation for a pandemic is of paramount importance, as our very lives, and the lives of those we love and treasure may depend on how well we are physically prepared. The religious communities have been grossly, dare I say sinfully, negligent in getting the potential threat and preparedness message out.

One is left assuming they do not espouse the physical preparations because they have not "bought into" the reality of the potential threat. Conferences of Religious Leaders have been held where the threat of a possible severe pandemic has been specifically addressed, ignorance is not the reason.

If the religious leaders have not bought into the PanFlu threat how can they prepare to meet the spiritual needs of their memberships? Simple answer: They can't.

 

I have marked my running agenda to contact the minister of my son and daughter-in-law's church, the church that plays such a central role in their lives, the church that celebrates and performs the important rituals so meaningful to so many. I will take my message of PanFlu preparations, physical and spiritual to him, a man who takes shepherding his flock with seriousness and singularly focused dedication.

 

As I write this I am reminded of Jesus' own words: Who hath ears to hear, let him hear.

 

SZ

First Responders

I am putting out a general call to all my First Responder readers.

As I often mention, my son is a patrol officer for a small city. His department is not taking the threat of a possible severe pandemic with any seriousness, and I am deeply concerned.

I would like to hear from you out there about plans that your departments are working on or how they are approaching the problems. Is there anything you could suggest to me to help get the message across? What are your departments doing to educate and protect personnel?

I can be reached at my listed email on the "About me" page or you are free to drop a comment on the blog itself. The comments are open to anonymous commentators.

I look forward to hearing from you!

SZ

More on Statins and Pandemic Influenza

 

Reuters ran a story today about a new study on the apparent benefits of statin usage in providing a measurable protection against death from pneumonia and seasonal influenza. For an earlier post on Statin use during an Influenza Pandemic see here.

 

(Reuters) -- People who use statin drugs are less likely to die of influenza and chronic bronchitis, according to a study that shows yet another unexpected benefit of the cholesterol-lowering medications. Their study of more than 76,000 people showed that those who had taken statins for at least 90 days had a much lower risk of dying from chronic obstructive pulmonary disease or COPD, the technical name for emphysema and chronic bronchitis.

 

    [snip]

 

"This study found a dramatically reduced risk of death from COPD among statin users and a significantly reduced risk of death from influenza/pneumonia," the researchers wrote in their report, published in the journal Chest. "These findings suggest that moderate-dose statin use reduces the risk of influenza/pneumonia death and strongly suggest that statins reduce the risk of COPD death."

 

In 2006, researchers in Canada reported that statins act against sepsis, a dangerous blood infection, and a 2005 study found the death rate was 64 percent lower in pneumonia patients who had been taking statins.

 

As I stated in the first post on this concept: No one knows if the benefits found with seasonal influenza and statin usage would have any translatable benefit to an Avian Influenza Pandemic. But given the potential benefit weighed against the potential risks it seems a worth wild avenue of exploration.

Also in the previous post, and as stated above, it isn't something that you can begin taking the day you think you may have been infected. At minimum, it is assumed that taking it for thirty days would be needed to confer benefit, and this paper looked at ninety days as the measure. Either way, it will require preplanning and advance supplying. You should bring in your supply prior to a pandemic because it is believed that there will be no medication resupply during a severe pandemic.

 

See my previous entry to read about the natural alternative to prescription statins, Red Yeast Rice.

 

SZ

UK DoH Mass Casualty Incident Planning Framework

The Sunday Telegraph (UK) ran a piece on the Department of Health's planning framework for operations during a Mass Casualty Incident (MCI).  An MCI is an incident where a large number of sick or injured occur due to a chemical, biological, radiological or nuclear incident.  Pandemic Influenza would fall under this designation.

Security guards could be posted at hospitals to stop casualties gaining entry and contaminating other patients in the event of a "chemical" terrorist attack, government plans show.

 

Guidance published last week instructs every hospital to "retain control of access to its facilities" following a chemical, biological, radiological or nuclear incident.

 

The advice is part of the Department of Health's planning framework for dealing with "mass casualty incidents" - whether from terrorist attack or infectious diseases, such as a flu pandemic.

 

This planning framework is probably reasonably workable during a localized event but not during severe PanFlu (Pandemic Influenza).

Understanding that there are often differences in meaning and usage of words between English and American "English", I sit here wondering what the operative definition is of "security guard" as used in this piece.  Does the term mean anyone functioning in that role, such as military or law enforcement personnel, or does it mean, literally, a privately employed security guard? 

If it is the privately employed type I'm afraid their "framework" still needs "work".   It will be a dangerous and difficult task to hold back a desperate and determined crowd, even a small one, which is determined to gain entry.

It is well understood that the health care system, in every country, will be rapidly over run in the event of a moderate to severe pandemic.  Many more people will be in need of treatment than will be able to be handled.  Hospital beds are a finite resource, as are the supportive equipment, staff, and medical supplies.  When capacity is reached the others will have to be turned away.  Those denied treatment, either for themselves or a loved one, will not be happy.

 

The most recent official prediction of the number of people who could die in a flu pandemic is 750,000; and the framework admits that the main problem would be finding "dignified and suitable" temporary storage for the dead within hospitals.

 

Although certainly a part of the PanFlu picture, …dignified and suitable temporary storage for the dead within hospitals…, is neither the main problem, nor should it be a hospital problem.  This was also a bit of a surprise because the UK has made no secret of their intent to utilize mass graves if a sever pandemic were to happen and bodies overwhelm their mortuary capacity.

 

While the NHS would attempt to "provide the best care possible", normal medical protocols might have to be suspended, the document warns.

    …   

However, he warned that the current hospital system in the UK - with no designated "major trauma centres" to take charge in an emergency - would result in "chaos" in the event of a full-scale crisis.

Chaos.  At least they know, and understand, that much. 

What is never publicly addressed in any of these plans is the fact that should our health care systems become over run the "triage" plans will be immediately rendered nothing more than so many hollow words.

It will not be deciding who is a "better" candidate for treatment, a 27 year old mother of two, a 7 year old little girl, or a 77 year grandmother, it will be deciding which few of the 100's of 27 year old mothers, 100's of 7 year old little girls, and 100's of 77 year old grandmothers, along with 1,000's of others is the "better" or more "deserving" treatment candidate.  In an average size small city of 100,000 residents it is reasonable to plan for 10% of the population being ill at the same time.   That's 10,000 potential sick and dying vying for that finite health care resource at roughly the same time.

Yes, they are wise to consider security needs as person after person is told that their loved one will receive no care, even such as it will be reduced to during a severe pandemic.  And, I certainly hope they plan on using personnel better trained and equipped than those who fall under the American concept of "security guard".

 

SZ

 

 

 

 

The Military and PanFlu: Part I

I have a deep and abiding love for our men and women who serve our country in uniform.  Most of my minority was spent as a Navy Brat and I am married to a man who did his requisite stint during the Vietnam Era, also in the Navy.  Of course, each branch of the military thinks they are the best, the special, the chosen, but the Marines… well… they are Special. 

Never have I met a current, or former Marine (some say there is no such thing as a former Marine), that I didn't instantly peg him as being such.  Sorry ladies, I have never met a woman who served in the Marines. 

I often dwell on the Military's role during a severe pandemic, in my mind, on the forums, and in this blog.  The men and women in uniform will be the biggest chunk of the Federal Government's response to the societal and humanitarian issues that will likely arise.  The concept is a sound one, after all, no other organization, in the world, is better able or better equipped to address those issues.

The problem, the huge, insurmountable, ignored problem, is that there is just not enough military to go around.

In total, the men and women under uniform, or readily made so, comprise no more than 1% of the American population.  That's in total. 

I have read references over this past year to the government's commitments to the idea of providing assistance to other nations during a severe pandemic.  When I read them I have always experienced this split personality, one  part wanted to laugh, hysterically, and the other wanted to scream in despair… and then slap someone up-side the head (as we say here in the South) for blatant stupidity on a grand scale.

There is little doubt that much of our critical infrastructure will be strained, under-provisioned, and under staffed, perhaps to the point of collapse. 

Should our power generation and water systems fail US citizens will be looking to the military to make it better.  Should our food deliveries significantly slow, or stop, US citizens will be looking to the military to make it better.  Should social order break down US citizens will be looking to the military to make it better.  On and on and on, in every sector of critical need of a modern society we will be looking to our military men and women to make it better.

We will be looking to one percent to save the other ninety-nine percent of us.  I will readdress the fallacy of even that one percent in another post of this planned series, but for now, it suits for illustration purposes anyway.

 

The inspiration for this post and those that will follow in the series was this piece from The Stars and Stripes...

III MEF ready to respond if avian flu pandemic hits 
By David Allen, Stars and Stripes
Pacific edition, Monday, April 9, 2007

CAMP COURTNEY, Okinawa — If the avian flu becomes a real pandemic threat to humans, especially in the Western Pacific, the III Marine Expeditionary Force will be ready.

During a recent humanitarian relief deployment to the Philippines, MEF corpsmen tested technology a Portsmouth, N.H., firm developed for almost instant tracking of vital information that in the past would take days or even weeks to analyze.

And a team of Marines and sailors has developed a detailed pandemic influenza response plan for Okinawa.

Global Relief Technologies was awarded a $3.5 million contract last fall to provide about 120 PDAs — hand-held computer devices — to the Marine Corps, which at any time has personnel scattered on deployments throughout Southeast Asia. The region is considered ground zero for the bird flu that could one day mutate and become the next great human pandemic.

The equipment, along with accompanying computers and satellite hookups, was delivered to the 3rd Medical Battalion before they deployed last month for a humanitarian mission to southeast Luzon, the Philippines island where some 15,000 people lived in camps after being displaced following a series of natural disasters in December.

"This initiative is driven by the need to collect and record data for tracking the avian flu — and any other humanitarian crisis — quickly and accurately," said Navy Capt. David Lane, Force Surgeon for the III MEF. "It worked exceedingly well."

Continues at link….

 

Bless the Marines.

Bless the Marines, and slap their leaders upside the head.  Just what are they thinking? 

 

These are men and women who are presumed to have the highest risk of death from H5N1 solely because of their age bracket.  These are men and women who, if left in their OCONUS duty assignments, will be left in crumbling countries with little or no infrastructure remaining, with little or no government left standing,  with no advanced medical treatment facilities, and little or no resupply, and quite possibly sick and dying.

They will be on foreign soil, attempting to Band Aide a hopeless situation, meanwhile their fellow citizens will have their own hopeless situation(s) that will be in desperate need of those very Band Aides.

Bless the Marines.  They don't understand the phrase "hopeless situation".  And for those responsible for this action plan… consider yourselves slapped up-side the head by a Southern Mother.

 

SZ

Fla_Medic's Lesson... to us all.

My dear friend, Cyber Twin, Compatriot, and All-Around-Wonderful Guy, Fla_Medic took ill suddenly.  I have cross-posted his blog entry from Avian Flu Diary because what he recounts is a very important lesson.  Not only for everyday, but most especially for PanFlu.

Many Flubies, myself included, are planning to make up PanFlu medical "kits" that we will use should we become infected with no one around to minister to us.  The severity of FM's illness from an "average" and "mundane" virus exposes the weakness and, perhaps, utter foolishness of self-treatment, for PanFlu.

It was especially sobering for me because I know how knowledgeable and capable FM is.  The fact that he was rendered "senseless" enough to neglect his critical hydration needs is a message in and of itself.

I think I will have to make a "cyber date" with FM after he fully recovers to go over a more specific plan of attack for our "flu kits".  Suddenly, my plans don't appear to be too sound... at all.

Lessons Learned

# 639

Thirty-six hours ago I was hit, and hit hard, by what I suspect was a norovirus.   In the space of an hour I went from feeling fine, to having a severe headache, fever, nausea, vomiting, dizziness,  and diarrhea.  

Being a sensible type, I figured if I laid down for a couple of hours, I'd feel better.  So around 6 pm Thursday night I took to my bed.   I didn't bother putting any medicines, or a water bottle by my bed, after all, the kitchen was only 30 feet away.

The next 24 hours are a feverish blur.  For the first 12 hours, I was afraid I was going to die, for the following twelve, I feared I wouldn't.

I managed to make more than a dozen semi-conscious runs to the bathroom, but the kitchen, 30 feet away, was too far to manage.   I knew I should be drinking fluids, and desperately wished I could reach my phenergan and loperamide to control the nausea and diarrhea, but it was simply beyond my means to get to them.

I'm pleased to report that after 24 hours of delirium, I managed to finally get to my meds, and to start taking fluids.  And twelve hours later, I'm in better shape.  Not well, by any sense of the definition, but getting better.

There is a lesson here, for me, and everyone one else. 

If you live alone, or with someone who isn't likely to be a good caregiver, put a `flu box' under your bed, an arm's reach away.   I desperately wished I had some basic meds and some sports drinks at hand. I could have saved myself considerable misery over the past 36 hours had I done that.

As a paramedic, I should have known better. I should have been better prepared.   But honestly, I never considered that a simple virus would knock me flat like this one did. 

The good news is, I've learned my lesson. I'll be better prepared the next time.

posted by FLA_MEDIC @ 4:26 AM