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Friday, October 07, 2005

Romania Reports Bird Flu (in birds)

Reuters. Samples from the three dead domestic birds found in the Danube Delta will be sent to Britain for further testing to see what strain and whether it is H5N1. This is where you would expect migrating waterfowl to stop.

Dow Jones reports that Romania has banned hunting wild birds.

In the meantime, there is some advance word up in CurEvents.com about key assumptions for the US Pandemic Plan. The mortality rate is just a guess (as good as any other), but the predicted illness rate is alarming:
* 25 - 30% illness (20% - 30% in working age group), plus additional absenteeism for care-giving
* Outbreak period in a community of 6 to 8 weeks per wave, with possibly more than one wave in a community
* Length of illlness of an uncomplicated case, 5 days
* Hospitalization rate of 1 - 10% of those who are ill
* Mortality rate of .1 - 1%
Imagine what would happen if 25% of your employees were sick for a week and another 10% were out taking care of sick children, etc.

MOM--I am not sure those are the parameters developed by Meltzer at CDC-I think he assumes an infection rate of between 20 and 35% and a mortality rate of 2%. Nonetheless, the figures are staggering. And you correct in that the health care workers get hit hardest; we already have the data from the SARS thing in canada that health care workers got hit disproportionally.

As it stands, current licensing restrictions limit the ability of the local health system to employ health care volunteers. Its just one of the issues states have to face--further, hospital licensing restrictions usually require certificates of need to expand ICU facilities or add hospital beds--Not going to have time to do that when the flu hits the fan. So one shortfall is really the careful study of how to surge the system within existing law.

Keep up the good work!
These numbers are supposed to be from the current draft official US pandemic plan. I suppose we will find out when they finally release it. I would think the casualty rate is too low. Once the hospitals get overwhelmed the ability to treat all patients as they ordinarily would be will go, and that will increase the mortality rate.

The point about the licensing restrictions is a good one! It reminds me of the licensing issues for volunteer doctors in LA.

Don't you think there need to be special exceptions in law for a possible pandemic? I would think also some healthcare units would need exemptions for insurance liability purposes.
I can't see legal/licensing laws being issues in the event of a real pandemic- mostly because I believe there will be an acute shortage of medical personnel willing to take on the job.

Based on 1918 numbers, the potential deaths numer 150 million, worldwide.

Don't look to a huge response from the medical community. They're going to be duct taped in at home, like the rest of us.

They have families, too, as one MD told me last week.
You might be interested in this info on innovation in administering flu vaccine. I follow the stock and came across this news.
Ampligen (R) Enhances the Effectiveness of Tamiflu Against Avian Influenza
MOM--the sigmund guys have it about right--right now our current legal system works against the kind of flexibility we would need to combat a pandemic flu outbreak. Clearly the medical providers are at greater risk than the population as whole; my guess, however, would be that those that arent infected would rise to the occasion much like the valiant providers in New Orleans--that said, in addition to a shortage of ICU beds, ventilators, and the like
we will have an acute shortage of qualified Health care providers.
Existing systoms must be capable of providing personnel to staff patient care needs.
MOM--thanks for your help in picking up this thread--this is a very genuine and very real crisis confronting us--it has received virtually no publicity. By and large, academic reseach suggests the public will be the health response system ally if we treat them like adults.
Regretably, many of the emergency response departments in our fragmented federal system are run by elected law enforcement folks who neither understand public health issues or view the public as a resource rather than a threat.

There are two old jokes among public health folks: when you have seen one public health jurisidiction, you have seen one public health jurisidiction/

Unfortunately, the same aphoroism applies to county level emergency management operations.

All of this suggests that any response to a pandemic will be local---and spotty.

NOT a pretty picture. I wish I could reassure our citizens we are prepared--some jurisdictions are, others are not. It will make Katrina look like a very simple exercise.
Roger, you wrote:
many of the emergency response departments in our fragmented federal system are run by elected law enforcement folks who neither understand public health issues or view the public as a resource rather than a threat.

That's it in a nutshell. That mindset can become a self-fulfilling prophecy if we let it. It doesn't have to work out that way. I think most healthcare personnel will rise to the occasion. The public will if they are told how they can deal with the risks.

The thing is, cutting down the rate of contagion is key to allowing healthcare personnel to be effective. They are a limited resource. Other steps - establishing emergency medical overflow centers, etc, will also help, but the bottom line is lowering infection rates. And that is not impossible, but it takes some preparation and training. It requires changing our daily routines and we humans are creatures of habit.

SC&A, as long as doctors can do some good they will be out there doing it. If they find themselves unable to cope, out of supplies, etc they will conclude they can do no good.

But masking, gowning and gloving are steps that will prevent doctors from getting ill. It will take an adjustment on the part of the patients, but it will work.
Ilona, I am not so sure about Ampligen in a fast-growth virus. The idea of using it in combination with oseltamivir is interesting, but that's all. The 1918 flu was believed to kill young healthy people by cytokine storms, so futzing with immune responses this way might have more of an adverse effect than an advantage.

If you want a pretty safe investment bet, research medical supply houses. They will be doing a roaring business over the next year and a half.
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