A Journey Through The World of Pandemic Influenza

Australian GP’s and a severe pandemic

 

Today a story is circulating around the cyber flu community about another sector that will likely suffer a dangerous level of "job abandonment".

 

From News.com.au [excerpted]:

GPs refuse to treat bird flu patients

By Tory Shephard August 05, 2008 12:01am

BIRD flu will hit Australia but some GPs will refuse to treat patients - preferring to keep themselves and their families safe, research shows.

Others say they are unprepared to deal with the "horror" situation and hope it never happens, although experts say it is a matter of "when", not "if" disaster strikes.

Research in the latest Medical Journal of Australia shows only one of the 10 South Australian GPs surveyed felt prepared for a pandemic.

The report's authors said the doctors "felt their responsibility to themselves to stay healthy and to protect their families outweighed their responsibility to continue working".

Australian Medical Association state president Dr Peter Ford said most doctors had received no formal training in dealing with a flu pandemic.

 

I have touched on this issue several times (as have others around Flublogia).

Pandemic Dominoes: HCW's stand at the Apex

For the Greater Good

For the Greater Good II

 

I have also previously quoted this from the AMA:

AMA policy document "Physician Obligation in Disaster Preparedness and Response" adopted in June 2004:

National, regional, and local responses to epidemics, terrorist attacks, and other disasters require extensive involvement of physicians. Because of their commitment to care for the sick and injured, individual physicians have an obligation to provide urgent medical care during disasters. This ethical obligation holds even in the face of greater than usual risks to their own safety, health or life. The physician workforce, however, is not an unlimited resource; therefore, when participating in disaster responses, physicians should balance immediate benefits to individual patients with ability to care for patients in the future. (AMA 2004)

 

The above bolded sentence cannot be any plainer.

 

The article Australian article further states:

The report's authors said the doctors "felt their responsibility to themselves to stay healthy and to protect their families outweighed their responsibility to continue working".

 

Everyone who provides a critical service to, and interacts with, the wider community, doctors, nurses, firefighters, EMT's, police, to name the most obvious, will have to make the choice about whether or not to work should we suffer a severe pandemic. Those that make the choice to work will no doubt make that choice each day the danger exists.

 

It will be a tough decision for most, but certainly not all.

 

It is important to realize that doctors and nurses did not "sign on" to risk their lives wantonly when they chose their professions. I would hazard the bet that most chose their professions out of a deep respect for health and life, even their own, most especially their own, if they are worth their parchment.

 

To expect someone, anyone, to step into harm's way we assume an obligation to make them as safe as we can while they do so. We do this with our first responders via training, equipment, and their fellows who valiantly stand at their sides (or backs) while danger presents.

 

During a severe pandemic (should we have one) who will equip our medical workers to stand in the face of infection? Who will "stand beside them"?

 

Until we can answer those questions, and provide the means and materials to those answers, we have no right to expect anyone to aid strangers at the risk of their own lives. Keep that in mind as you read the following, also from the Australian article:

 

Australian Medical Association state president Dr Peter Ford said most doctors had received no formal training in dealing with a flu pandemic.

[…]

Vaccine expert Professor Nikolai Petrovsky, Flinders Medical Centre's director of endocrinology, is working on vaccines to protect against bird flu. A lack of funding and of political will means the whole health system is unprepared for a pandemic that is already "overdue", he said.

"The reality is that we will be hit by an influenza pandemic at some point. But we don't know if it will be this year or in 50 years' time so governments are loathe to spend the money and the effort when they don't know," he said.

 

Those last two paragraphs could be applied to any number of countries, not just Australia. And, equally as damning, to most states, counties, municipalities, and districts (or a country's equivalents).

 

I wish I had an easy answer to offer up, unfortunately, I don't. There are no easy answers, and there certainly aren't many inexpensive ones either. We must have the wisdom and foresight to prepare those we will hope to see in our moments of greatest need by providing them the means to be there safely.

 

Even if it costs money.

*********

 

I've said it once or twice before, and I always suffer an internal cringe when I do:

 

As the mother of a police officer I have moments of very selfish "not my son" when I think about the possibility of his being hurt in the line of duty and not receiving medical care. When I am being brutally honest with myself – and with you – I admit that his life is far more valuable to me than yours.

 

My son "signed on" accepting the "normal" risks his profession carries, something his father and I are both appreciative of since we both wore the uniform ourselves. We, as his parents, understand that what can be done to guard and protect him is being done, or will be done, should the worst happen, and yes, we understand – and accept – that a positive outcome is not always guaranteed. However, things change when not everything that "could be done", is not.

******

 

Before we blissfully assume others have a self-sacrificing "obligation" to risk themselves we need to ask what we are "obligated" to do in return. If you're honest with yourself, as honest as I have been with you, you will know that we, the collective "we", have done pathetically little, nor have "we", the electorate, demanded anything from those in positions to effect what needs done.

 

"We" just blissfully assume all will be well and fine because someone else has an "obligation".

 

Please think about what I've said here.

 

Please consider adding your "voice" to the chorus against dangerous assumptions; ask that we adequately protect those we want to be there during our times of need.

 

Please.

 

SZ

 

Law Enforcement and PanFlu

According the US Department of Justice [2004] there are more than 800,000 full time sworn law enforcement officers in the US [link]. 2004 being the latest statistics I could find.

Summary findings In 2004 there were more than 800,000 full-time sworn law enforcement officers in the United States

 

Type of agency	Number of agencies	Number of full-time sworn officers
Total		836,787
All State and local	17,876	731,903
Local police	12,766	446,974
Sheriff	3,067	175,018
Primary State	49	58,190
Special jurisdiction	1,481	49,398
Constable/Marshal	513	2,323
Federal*		104,884
Note: Special jurisdiction category includes both State-level and local-level agencies. Consolidated police-sheriffs are included under local police category. Agency counts exclude those operating on a part-time basis. *Non-military federal officers authorized to carry firearms and make arrests.

What these statistics don't show is that roughly half of the total are employed by departments of less than 100 officers, or that only about half of the state and local sworn officers are in positions where they respond to calls for service [LEMAS2000].

Also from LEMAS2000, the latest published survey:

• On average, larger municipal police departments employed 22 full-time sworn personnel per 10,000 residents.
• County police departments and sheriffs' offices employed an average of 11 and 10 officers per 10,000 residents, respectively.
• State law enforcement agencies employed an average of 2 officers per 10,000 residents.

A breakdown of personnel is found on page 16 should curiosity inspire a slightly more informative breakdown. When considering police officers one must account for the twenty-four hour nature of law enforcement as well as days off.

When I speak about our LEOs (Law Enforcement Officers) during a time of severe pandemic influenza I assume operations at an emergency response footing, i.e., 12 hours on – 12 hours off, no days off, shift staffing. But even with that it's easy to see there are not a lot of spare LEOs on average to go around.

Furthermore, as a general rule most departments have sworn officers unfit to perform "street duty", whether due to advancing age, declining health, or service related injury. Under normal operations they fill the slots that don't require physical aptitude but still need to be filled. During an emergency being a "sworn officer" does not equal "being deployable on the streets" since potential physical demands will be even higher than they are normally.

Additionally, one only need do an internet search for "police staffing shortages" to get a glimpse of the depth and breadth of the problem of recruitment and retention departments all across the US are facing (examples: here and here, contrarian: here).

You may be asking yourself Why would all of this relative minutia be of interest to someone other than a "numbers kinda gal"? Simply: When we need or want a police response, we need or want one.

During an influenza pandemic planning assumptions focus on 30 – 50% staffing shortages across all sectors and segments of society due to illness, family illness, or fear of infection. There is no reason to assume the statistic will be much different for our police. Conversely, there is reason to believe it may be worse, my more thorough analysis of the underlying issues can be found here.

 

A severe pandemic defined by the US Centers for Disease Control (CDC) as 30% of the population falling ill and 2% or more of those having fatal outcomes. Should the world experience a severe influenza pandemic our Law Enforcement agencies will be tasked with not only their traditional roles, but new ones as well, driven by the health emergency.

 

The prospect of responding during a time of civil crisis with a chronically understaffed force, suffering the same (or worse) attrition as the general workforce, is one I find disturbing. Our police have a fiduciary responsibility to the community they serve, but that community has a reciprocal responsibility to give them the means to accomplish theirs.

Lest you view me as an overwrought alarmist here is a snip from The role of Law Enforcement in Public Health Emergencies (2006) [pdf link], a joint effort of The U.S. Department of Justice, Office of Justice Programs' Bureau of Justice Assistance (BJA) and the Police Executive Research Forum (PERF):

In a large-scale incident, such as a pandemic, law enforcement resources will quickly become overwhelmed, and law enforcement officials will have to balance their resources and efforts between these new responsibilities and everyday service demands. All of this may have to be accomplished with a greatly diminished workforce, as officers and their families may become infected and ill, and some personnel may determine that the risk of continuing to report to work is just too great to themselves or their families. A department's ability to respond effectively to any emergency—public health or otherwise—greatly depends on its preparedness, and this is directly linked to the law enforcement agency's planning and its partnerships. [Emphasis added]

One of those "partners" is the public, and the public should demand that even during a pandemic all means to ensure an effective police response are in place since only the pre-pandemic phase affords the opportunity to properly prepare – during is too late, way too late. Because, after all, when we need or want a police response we need or want that response, and excuses for inability to provide one are not only hollow but also carry potentially human life price tags.

Of course as the mother of a patrol officer for a small city, I have a very selfish reason to advocate for PanFlu prep by our law enforcement agencies: my only child's ability to perform his fiduciary responsibility without it costing him life or limb unnecessarily. That means he must be adequately supplied with Personal Protective Equipment (PPE), such as disposable infectious disease barriers (masks, rubber gloves) and copious amounts of alcohol based sanitation gels to last the length of the pandemic. It also means that his department must not assume more roles than they can perform, and have adequate staff to perform those that they will perform.

I would love to be able to report that his department meets those criteria, unfortunately I cannot. Sadly, I don't anticipate ever being able to report their attaining those three items. So I would suggest that if/when a severe pandemic strikes you not call your local police… you wouldn't want to hear their excuses and the phone might just go unanswered anyway.

 

SZ

Medical treatment for First Responders during pandemic

Last month an AP story titled Who should MDs let die in a pandemic? Report offers answers hit the wires and Flublogia; here is the discussion as it unfolded on P4P.

The concept of medical triage is not new to those who have been following the issue of PanFlu (Pandemic Influenza) and on several occasions I have raised the issue of Law Enforcement Triage, and this story touched both, in a big way. Unfortunately, it hit at a very inopportune time for me to address it in depth, and only now does my time allow the attention it deserves from the very narrow perspective of our law enforcement and fire fighters.

Who should MDs let die in a pandemic? Report offers answers
LINDSEY TANNER, AP Medical Writer
May 4, 2008 9:23 PM

CHICAGO (AP) - Doctors know some patients needing lifesaving care won't get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.

Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals ''so that everybody will be thinking in the same way'' when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.

The idea is to try to make sure that scarce resources - including ventilators, medicine and doctors and nurses - are used in a uniform, objective way, task force members said.

Their recommendations appear in a report appearing Monday in the May edition of Chest, the medical journal of the American College of Chest Physicians.

''If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing,''the report states.

To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

-People older than 85.

-Those with severe trauma, which could include critical injuries from car crashes and shootings.

-Severely burned patients older than 60.

-Those with severe mental impairment, which could include advanced Alzheimer's disease.

-Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

Dr. Kevin Yeskey, director of the preparedness and emergency operations office at the Department of Health and Human Services, was on the task force. He said the report would be among many the agency reviews as part of preparedness efforts.
[snip]

James Bentley, a senior vice president at American Hospital Association, said the report will give guidance to hospitals in shaping their own preparedness plans even if they don't follow all the suggestions.

He said the proposals resemble a battlefield approach in which limited health care resources are reserved for those most likely to survive.

Bentley said it's not the first time this type of approach has been recommended for a catastrophic pandemic, but that ''this is the most detailed one I have seen from a professional group.''

While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary, Bentley said.

Devereaux said compiling the list ''was emotionally difficult for everyone.''

That's partly because members believe it's just a matter of time before such a health care disaster hits, she said.

''You never know,'' Devereaux said. ''SARS took a lot of folks by surprise. We didn't even know it existed.''

 

I titled my last post "Rules" since it dealt with the rules countries are in general agreement on when dealing with each other. I made mention that some "rules" are loosely defined and some are immanent, so universally understood that they do not need to be codified, although in service to a civil society they are.

Aristotle held that sometimes what was just by nature, "natural justice", was not necessarily just by law, i.e., dependant on society's rules. We are all aware that there have been many laws throughout human history that could hardly be considered "just"; valid legally, but a violation of natural law.

 

There is an understood "contract", "unspoken rule", a "natural law" if you will, when a police officer or fire fighter is injured or wounded in the line of duty everything that can be done will be done until all hope is exhausted. That is as it should be for those who risk limb and life to protect us.

The reason these guidelines are relevant is because, as everyone who understands the implications of a severe pandemic knows, medical supplies, mechanicals, and personnel will be in short supply, if not absent altogether. The reason they are so shocking is because those who would otherwise receive medical care would likely survive, if only until their next medical crisis in the case of the chronically ill. Stated plainly: It is assumed that treatment carries a high probability of success.

 

Setting aside the question of the likelihood of having any advanced medical care available during a severe pandemic, where, exactly, will our severely injured/wounded police and fire fighters fall in this triage scheme?

It is widely assumed that during a pandemic personnel levels will be affected, heavily dependent on the pathogen's virulence and pathogenicity. Official assumptions place absentee levels at 25% or more. The staffing levels for our first responders is apportioned according to current, non-crisis needs, just as the staffing levels for any well run and fiscally responsible business. Those that do show up for a shift will be performing their jobs without the safety margins built in with a full squad/squadron.

One assumption leads to another: With reduced manning levels the incidents of injuries requiring medical care are likely to rise in lock-step. Under normal operations the likelihood of suffering something life threatening is quite small hour-to-hour on average, given training, equipment, and—adequate personnel to mount a tactically sound response (police or fire), but that is under normal operating conditions.

 

Our social contracts are being re-written against a future threat. How long will our police and fire fighters remain blissfully ignorant of these issues? I've read any number of outraged rebuttals from the elderly and social advocates, but you in uniform serving and protecting us remain silent.

It is important to understand that guidelines are to be applied uniformly, strictly speaking that leaves no room for considerations of how you found yourself requiring treatment.

Where are your voices? Will you wait until you are severely injured and denied treatment to speak? If so, I have my doubts that anyone will be in a position to hear your outraged arguments—or those of your fellows and family.

 

SZ

 

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

Royal Mounted Canadian Police

Some days just seem to have a motif; today is one such day. Today it's running from the computer, screaming as I gouge my eyes from their sockets. My day job was one of those days that reduce me to wondering if I really do like to eat regularly and have a roof over my head.

As I was chomping on my lunch buzzing through FluWikie's News Diary for today I came across a post that got my blood pumping with (good) excitement. A snip from a larger piece was prefaced by "Royal Canadian Mounted Police Get It":

In addition to operational readiness, one of the key messages that emergency planners are sending to employees is to be personally prepared.

Large-scale emergencies pose unique psychological, social and physical challenges even for experienced first responders. Because many employees live in the same communities in which they serve, there is a good chance they will be personally affected when disaster strikes. This could result in not reporting for work or being distracted out of concern for their families or their own personal safety.

"Workforce resilience is the underpinning of everything that we do," says Neily. "If our people are not personally prepared to be at work with the comfort that their loved ones are being taken care of, then we are going to have a challenge."

 

I was totally deflated when I got home and read the entire piece.

The first paragraph from the RCMP Gazette cover story:

Preparing for a pandemic

National plan starts with individual readiness

By Katherine Aldred

The estimates speak for themselves. According to the Public Health Agency of Canada (PHAC), over the course of an influenza pandemic, up to 70 per cent of the population will become infected and between 15 and 35 per cent will become clinically ill and miss work. If antivirals are not available, 1 per cent of the ill will be hospitalized and 0.4 per cent will die.

 

Reading that paragraph I just wanted to scream and toss my laptop across the room—and then gouge out my eyes. Yes, I truly was that upset.

This was the official information two years ago. Two years ago—before we had scientific findings, computer models, and reassessments of both.

OK, sure, the next pandemic could be this mild. My problem is the presentation of these figures as a foregone conclusion—that it won't and can't be worse.

[snip]

"We don't know when a pandemic will occur, what the cause will be, how severe it will be or who will be hardest hit," says Dr. Arlene King, director general for Pandemic Preparedness at  PHAC. "We do know one thing: when any emergency hits, it's too late to be doing the planning. The structures, processes and tools have to be in place."

Police agencies involved in responding to a pandemic must be prepared not only to deal with the complex requirements of a public health emergency but to carry on their normal day-to-day operations with a greatly diminished workforce. The challenge is getting ready.

They say the right (scripted) words.

[snip]

According to Neily, the RCMP could be called in to provide a number of different functions during a pandemic such as enforcing public health orders like quarantines and travel restrictions, limiting access to areas deemed out of bounds, transporting and protecting medical equipment or medications, protecting certain types of facilities and, in a worst-case scenario, controlling crowds.

And like any operational response, police must be prepared for the conditions — in this case, a contagious disease.

[snip]

"From a health point of view, our preparedness plan outmatches anything out there," says Legault. "One of the greatest challenges will be trying to assist with public order and containment measures to prevent the spread of the virus while a vaccine is being developed. We may also be enforcing social distancing measures and there are always people who do not want to follow that."

 

Although they are saying the right things about preparing for a pandemic, they are quite probably preparing for the wrong pandemic. The mild pandemic they are preparing for is one as happened in 1957, what the US CDC (the Centers for Disease Control) has quantified as a category 2 pandemic.

A category 2 on the pandemic severity scale will only occur if the influenza strain (whether H5N1 or not) is not a wholly avian strain of influenza, instead it would require that the avian strain swaps genes with a human influenza virus. Sure, it could happen, but why plan for it to happen that way when there is no guarantee that it will?

 

Planning for a mild pandemic and being socked with a severe one will cost lives, many lives, many RCMP lives. Planning for a severe pandemic and only having to deal with a mild one costs nothing but a bit more money and a few more brain cells.

 

Perhaps they will get a clue before it is too late to act upon it.

 

SZ

 

 

Civil Foul: Not Adequately Informed, Trained, Equipped

 

Some days it is utter torture to have a "day job", and today was one such day. When the news hit the wires that a police department in North Wales was being sued by one of their own over how an outbreak of Avian Influenza was handled by the police and the resultant disease I sat up and took immediate note.

In some respects police work is akin to a "family business". Having been one, being married to a retired officer, the daughter and sister of others, and finally, the mother of a patrol officer, I am naturally interested in most things law enforcement. But when law enforcement also crosses into Avian Influenza/PanFlu I am more than idly curious.

Bird flu officer to sue North Wales Police

Nov 2 2007 by Roland Hughes, Daily Post

A POLICE officer who stood guard outside a farm at the centre of the bird flu outbreak fell ill and are now suing North Wales Police.

There is confusion on my part as to whether there are one or two officers involved. The early stories on the internet indicated two, and the wording of this sentence, as well as a few others, still show what might be "echoes" of that earlier release.

The officer is claiming compensation for inadequate training and a failure to provide them with protective clothing.

A constant issue within law enforcement departments is training. Any well run department has ongoing training for its personnel. Ongoing training can, and should, cover firearms (of course), self-defense, civil and vicarious liability issues, legal issues and changes in criminal law, and in America at least, "sensitivity" training. These are the minimum issues addressed on a rotating training schedule throughout the year by departments that concern themselves with the welfare of their officers and the communities they serve.

Professional departments concern themselves with the wellbeing of their officers. In modern law enforcement it costs a lot of money to properly train a police officer, and when an officer finds him or herself on a department that doesn't take the necessary steps to safeguard their life and health, with proper training and proper equipment, those officers tend to quickly go someplace where they do and that big chunk of training budget expended is lost to that department. Yes, police departments are like any private business; the bottom line counts and funds are not limitless.

But an equally driving motivation is vicarious liability. One of my husband's division assignments was that of Commander of Training, so I am reasonably informed on at least the broad brush stroke issues that I speak. And while any police officer is in constant danger of civil lawsuits, as the Commander of Training being named in a civil action for some "lack" on his part was always an encumbrance to the security and safety of our very home.

Two members of the officers' family also fell ill – and are understood to be included in the landmark legal action lodged against the force.

Wales' first-ever case of bird flu was confirmed on a smallholding near Llanfihangel Glyn Myfyr, Corwen, in late May this year. The outbreak was confirmed as H7N2, a less pathogenic strain of the virus than the deadly H5N1, which struck at a Suffolk turkey farm and is circulating in Asia.

Police immediately set up a 1km cordon around the farm to restrict movement, with officers preventing access and looking after the owners, Barbara Cowling and Tony Williams.

But while officers wore their usual police uniforms, public health staff attended in full protective gear.

Both Ms Cowling and Mr Williams showed flu-like symptoms, but tested negative for the illness.

However, the officer showed similar symptoms soon after visiting the farm, with two family members, including a child, following suit.

Doctors are understood to have indicated the policeman did show symptoms of non-human flu, although public health officials yesterday said not all tests had been completed.

The officer felt he were not given adequate training in how to act in the event of a bird flu outbreak.

I am torn between being excited about the issue of information, training, and protection of and from Avian Influenza being brought to bear on departments worldwide and my sense that I should be outraged over a civil suit for what is, in essence, a case of "the flu". Is some other wife sitting at home worried about losing her home in a civil action over "the flu"?

The Larger Threat demands that police departments inform and provide protection for their officers when faced with the dangers of Avian Influenza, and that is especially true when H5N1 is involved, although this particular incident involved H7N2.

Compared to the cost of some standard equipment issued or made available to police officers, the cost of PPE (Personal Protective Equipment: masks, gloves, bio-suits) are downright cheap. The fact that officers were deployed to the scene of a known biohazard without the proper protection is comparable to sending a police officer out without bullets, Barney Fife aside.

Asked about the legal action, a North Wales Police spokeswoman said: "We can confirm that representation has been made to our legal department.

"The matter is still currently under investigation and therefore it would be inappropriate to comment further."

The North Wales Police Federation, which would support the officers' cases, chose not to comment on the case when contacted by the Daily Post.

Public health chiefs said a total of 17 people showed flu-like symptoms in the wake of the outbreak, and a similar case at another farm near Pwllheli days later.

Chris Lines, of the National Public Health Service for Wales, said it was still not known exactly how many people fell ill, and whether those illnesses were down to the bird flu outbreak.

He said: "We are awaiting the results of serology tests. Essentially, some months after someone has fallen ill, it is a test we can do which shows antibodies you have in your blood.

"If you did indeed suffer the illness, then you will have developed the antibodies. But the tests will take some months to do."

Mr Lines would not confirm whether police officers were among those who had been tested.

 

I will watch this case with great interest, both out of general curiosity and because of very personal reasons. I may be an ex-cop but I am the mother of cop, and mother trumps just about everything.

 

SZ

Basics: Pandemic Severity

I often use the phrase "moderate to severe PanFlu", when I do so I generally use my own criteria for what will constitute severe.

Generally I qualify any CFR at 5% or less as a moderate pandemic, where the CDC has settled on the criteria below 2%.

And just for clarity's sake I hold the opinion that a CFR above 15% would be catastrophic to everyone and everything.

I should probably adjust my phrasing but I won't, I am used to the mental constructs that have informed my thinking up to this point.

Early this year the CDC (Centers for Disease Control and Prevention) developed and published a way to judge pandemics, in the pre-pandemic planning stage, by severity, assigning categories reminiscent of hurricane strength classifications.

The model assumes that 30% of the overall population will get the pandemic strain of the virus, although different age groups and population centers may experience significant differences in the percentages, both overall and in the specific age groups.

Age groups can be thought of as preschoolers, elementary school children, students in upper grades, working adults, older adults, and finally, the elderly.

Official assumptions seem to be that the age group that will experience the highest level of illness is the younger children, picked up in daycare centers and school.

The percentage of the population expected to become ill is termed the Case Attack Rate, sometimes stated as the acronym CAR.

The numbers of those ill who are expected (statistically) to die are the Case Fatality Ratio (CFR).

From Wikipedia:

The pandemic severity index levels are:

• Category 1, CFR of less than 0.1% (example: seasonal flu)
• Category 2, CFR 0.1% to 0.5% (examples: Asian Flu and Hong Kong Flu)
• Category 3, CFR 0.5% to 1%
• Category 4, CFR 1% to 2%
• Category 5, CFR 2% or higher (example: Spanish flu

Recommendations for a response to a flu pandemic were based on the history of the last three major flu pandemics, mathematical models, seasonal flu transmission, and input from experts and citizen focus groups.

It should be noted that the Category 5 on the CDC's pandemic scale has a fatality ratio of 2% or greater. Currently the CFR is just a bit over 60%, both cumulative since 2003, and also if one only includes the cases thus far in 2007. The yearly CFR can, and has, varied from the cumulative CFR, sometimes markedly.

1.8 million deaths in the United States are estimated for a Category 5 pandemic with a CAR of 30% and CFR of 2%. An increase of 1% in the CFR would result in 2.7 million deaths, or an increase of 10% in the CAR would result in 2.4 million deaths.

Each 1/10^th of the total US population translates to 30,000 people. Living, breathing, loving, laughing, men, women, and children, not abstract numbers. Something I fear often gets consigned to oblivion as we toss out numbers, levels, categories, and statistics in our presentimental predictions.

There are other variables that drive the severity or mildness of an influenza pandemic, but I will save them for another day.

Finally, while an influenza pandemic based on the officially sanctioned criteria for severe, 30% CAR and 2% CFR would be bad, it could be a great deal worse. At this time no one knows what the next pandemic will be in terms of pathogen, lethality, or numbers likely to be stricken. The range is wide, from barely above "normal" all the way to atrociously catastrophic. We watch, we analyze, we guess; we plan for the worst and hope to have it prove to have been done in vain.

SZ

Emergency Mutual Aid Communications

As some of you will know, I am an ex-cop that comes from a police family, and my son is carrying on the "family business". The reason I do much of what I do in the Cyber Flu Community is in an effort to educate myself on issues that may be of benefit to the Police/fire/EMT folk that will be "out there" during a moderate to severe PanFlu, and that, for good or ill, includes my one and only progeny.

When my husband and I wore the uniform we worked for a small city in a medium sized county. Within the county there are seven cities, each with their own police and fire departments, and of course the county sheriff's department, county fire department, and county wide EMS service. All told, there were seventeen Emergency First Responder agencies that worked side-by-side and often on the very same calls for assistance but we couldn't communicate with each other over our radios or walkie-talkies.

There was a "Mutual Aid" channel that we all had access to, but that always proved less than mutually aiding because many of the entities didn't speak the same "language", we used different codes. It was not only inefficient, and counterproductive, on occasion, it put people's lives, uniformed and civilian at risk.

 

I am happy to say that my son doesn't labor under this archaic and "territorial" system because our county has gone to a county wide radio system and they use plain language to make sure that each department, whether police, fire, or EMS can not only communicate with each other, but they will be rapidly understood. In professions where even seconds can make the difference between life and death this is no small thing.

 

So as someone who's been-there-done-that, and as a mother who doesn't have to worry about her son doing the same, I was nothing short of thrilled to read about the nearly one billion dollars awarded in matching grant funds for radio upgrades for our emergency responders across the country and territories. In fact, I am so thrilled that for once I am not sitting here bemoaning the flagrant squandering of tax dollars. Of course, I guess you could say that this is "pork" that is ok with me because it's "my pork"… but we won't go there because this is genuinely a great thing that servers all citizens.

 

Secretaries Gutierrez, Chertoff Announce Nearly $1 Billion in First Responder Communications Grants Funds to Help Fire Fighters, Police and Other First Responders Communicate During a Disaster

Release Date: July 18, 2007

For Immediate Release
Office of the Press Secretary
Contact: 202-282-8010
Department of Commerce, 202-482-7002

(Excerpt)

U.S. Commerce Secretary Carlos M. Gutierrez and U.S. Homeland Security (DHS) Secretary Michael Chertoff announced today $968 million Public Safety Interoperable Communications (PSIC) Grants to help state and local first responders improve public safety communications and coordination during a natural or man-made disaster.

The PSIC grant program will assist public safety agencies in the acquisition, deployment, and training of interoperable communications systems to enhance interoperable communications of voice, data, and/or video signals. Also, released today are the grant guidance and application kits. Applications are due in 30 days, and grants will be awarded by September 30, 2007, as required by the Call Home Act of 2006.

The U.S. Congress authorized $1 billion to establish the PSIC program as a one-time, formula-based, matching grant program in the Deficit Reduction Act of 2005. The program will fast track awards to all 50 states, the District of Columbia, and U.S. territories.  

 "When disaster strikes, first responders must have the tools to communicate," said Secretary Gutierrez. "Under this streamlined program, states will be given grants to use technology that will make our cities and states safer."

"Achieving interoperable communications is a major priority for our department and should be a priority for every community across our nation," said Homeland Security Secretary Michael Chertoff. "These grants will help states and cities purchase equipment, conduct training and exercises, and develop effective interoperable communications plans to get this important job done."

First responders from different jurisdictions and agencies use disparate communication technologies that impede critical communication among fire fighters, police, and other emergency personnel during a disaster. Such differences can pose problems and impede the critical work of the nation's first responders.

Continues…

 

You may be asking how this relates to the issue of PanFlu, and since I am an expert at relating just about everything to PanFlu I will tell you…

 

Should we experience a moderate to severe Influenza Pandemic the Police/Fire/EMS will be stretched from thin to nearly invisible and those that are "out there" will need to be able to communicate with whoever else is "out there". Now all I have to hope for on this issue is that the departments laboring under the old, inefficient, 20^th Century technology, pony up with the matching funds to take advantage of this wonderful, potentially lifesaving opportunity, and join the others who are firmly in the 21^st Century world of Emergency Responders.

Our guys and gals in uniform serving and protecting us, sometimes with their very lives, are worth it.

 

SZ

Recommended Vaccines for Police and Paramedics in a PanFlu Situation

It is commonly assumed that should a severe Influenza Pandemic occur our health care system will collapse.  A large part of the day-to-day struggle that First Responders will face during a severe pandemic is staying healthy and uninjured.  The staying healthy part is somewhat under personal control. 

Since potable (safe for consumption) water may be questionable at times during a severe pandemic, and sewage has been listed as "at risk" infrastructure as well, water bourne illnesses may explode in areas were we currently never give them a consideration.

Illnesses in general may go untreated and have a greater opportunity to get loose in the community, especially the First Responder community where citizens will be looking for help when the hospitals no longer function, or doctors are no longer available. 

Given the reasonable assumptions of an explosion of communicable disease, at least in some areas, mainly cities, and the precarious safety of our water supplies during a severe pandemic, it is reasonable to go ahead and get the same vaccines NOW that are recommended for traveling to third-world countries.  Luckily, these should be covered by the department's/municipality's health care plan.

My own son has received four so far... we are working on the list... not fast enough to suit me, but any progress on this front is a potential life saver, maybe his... maybe yours.

• Seasonal Influenza
• Typhoid
• Meningitis
• Pneumococcal (pneumonia)
• Tetanus
• Japanese Encephalitis
• Hepatitis A and B
• Yellow Fever

 

SZ

A Homemade Mask that May Actually Work

This is one of my favorite do-it-yourself pandemic mitigation items.  Should a moderate to severe pandemic occur I plan on making up as many of these as I can and handing them out to Police and EMS in Son's area.  I also plan on printing up the plans and passing them out as well.  This is so simple that anyone can make up one or three and the beauty of them is that they can be washed and reused.  While not as good as a NIOSH approved N95 mask, it will be better than nothing and nothing is about what the Police and EMS crews will have about a week or two into a PanFlu, after all on-hand stock is depleted.

Please visit the link to see the photo in a larger format, the blog is limits the size of photos that will display, unfortunately, it is too small to fully appreciate, but it is large enough to show the concept and its wonderful simplicity.

I ask everyone to realize and remember, we are not helpless in the face of a pandemic, even a severe one.  There are things we can do for ourselves, and should be prepared to do for ourselves, because it doesn't look like anyone will be doing them for us.

http://www.cdc.gov/ncidod/EID/vol12no06/05-1468.htm
Simple Respiratory Mask
Virginia M. Dato,* David Hostler,* and Michael E. Hahn*
*University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Suggested citation for this article
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To the Editor: The US Department of Labor recommends air-purifying respirators (e.g., N95, N99, or N100) as part of a comprehensive respiratory protection program for workers directly involved with avian influenza–infected birds or patients (1). N95 respirators have 2 advantages over simple cloth or surgical masks; they are >95% efficient at filtering 0.3-μm particles (smaller than the 5-μm size of large droplets—created during talking, coughing, and sneezing—which usually transmit influenza) and are fit tested to ensure that infectious droplets and particles do not leak around the mask (2–4). Even if N95 filtration is unnecessary for avian influenza, N95 fit offers advantages over a loose-fitting surgical mask by eliminating leakage around the mask.

The World Health Organization recommends protective equipment including masks (if they not available, a cloth to cover the mouth is recommended) for persons who must handle dead or ill chickens in regions affected by H5N1 (5). Quality commercial masks are not always accessible., but anecdotal evidence has showed that handmade masks of cotton gauze were protective in military barracks and in healthcare workers during the Manchurian epidemic (6,7). A simple, locally made, washable mask may be a solution if commercial masks are not available. We describe the test results of 1 handmade, reusable, cotton mask.

Figure. Prototype mask. A) Side view. B) Face side. This mask consisted of 1 outer layer (37 cm × 72 cm) rolled and cut as in panel B ...

For material, we choose heavyweight T-shirts similar to the 2-ply battle dress uniform T-shirts used for protective masks against ricin and saxitoxin in mouse experiments (. Designs and T-shirts were initially screened with a short version of a qualitative Bitrex fit test (9) (Allegro Industries, Garden Grove, CA, USA). The best were tested by using a standard quantitative fit test, the Portacount Plus Respirator Fit Tester with N95-Companion (TSI, Shoreview, MN, USA) (10). Poor results from the initial quantitative fit testing on early prototypes resulted in the addition of 4 layers of material to the simplest mask design. This mask is referred to as the prototype mask (Figure).

A Hanes Heavyweight 100% preshrunk cotton T-shirt (made in Honduras) (http://www.hanesprintables.com/Globals/Faq.aspx) was boiled for 10 minutes and air-dried to maximize shrinkage and sterilize the material in a manner available in developing countries. A scissor, marker, and ruler were used to cut out 1 outer layer (≈37 × 72 cm) and 8 inner layers (<18 cm2). The mask was assembled and fitted as shown in the Figure.

A fit factor is the number generated during quantitative fit testing by simulating workplace activities (a series of exercises, each 1 minute in duration). The Portacount Plus Respirator Fit Tester with N95-Companion used for the test is an ambient aerosol instrument that measures aerosol concentration outside and inside the prototype mask. The challenge agent used is the ambient microscopic dust and other aerosols that are present in the air.

A commercially available N95 respirator requires a fit factor of 100 to be considered adequate in the workplace. The prototype mask achieved a fit factor of 67 for 1 author with a Los Alamos National Laboratory (LANL) panel face size of 4, a common size. Although insufficient for the workplace, this mask offered substantial protection from the challenge aerosol and showed good fit with minimal leakage. The other 2 authors with LANL panel face size 10, the largest size, achieved fit factors of 13 and 17 by making the prototype mask inner layers slightly larger (22 cm2).

We do not advocate use of this respirator in place of a properly fitted commercial respirator. Although subjectively we did not find the work of breathing required with the prototype mask to be different from that required with a standard N95 filtering facepiece, persons with respiratory compromise of any type should not use this mask. While testers wore the mask for an hour without difficulty, we cannot comment on its utility during strenuous work or adverse environmental conditions.

We showed that a hand-fashioned mask can provide a good fit and a measurable level of protection from a challenge aerosol. Problems remain. When made by naive users, this mask may be less effective because of variations in material, assembly, facial structure, cultural practices, and handling. No easy, definitive, and affordable test can demonstrate effectiveness before each use. Wearers may find the mask uncomfortable.

We encourage innovation to improve respiratory protection options. Future studies must be conducted to determine levels of protection achieved when naive users, following instructions, produce a similar mask from identical or similar raw materials. Research is needed to determine the minimal level of protection needed when resources are not available for N95 air-purifying respirators since the pandemic threat from H5N1 and other possible influenza strains will exist for the foreseeable future.