GhostRN's Journal

[GhostRN]

Sunday 5/3 00:27: I just finished making a margaretta(sp?) because I am convinced that there will be a national 2 week closure of schools next week. The data I've been working with today suggests the situation is heating up not cooling down!!!!!! I invested way more hours of work today on School closure threads and hospitalization threads than I intended...and now I am on a quest to list the few states that don't haven't had school closures. As I am doing that I'm finding more hospitalizations....and many of those mention critical care. I am a certified critical care nurse and I can tell you that you don't get a critical care bed these days without earning one...and I can tell you that few critical care rooms are designed for negative pressure...so they'll have to be made into negative pressure rooms. Critical care nurses and nurses in general are already maxed out...isolation rooms take up significantly more time to care for patients....we're headed into a crisis....the hospital system has been saying this for years....it's on the brink already....back to my work.... I am also bummed because this event may impact my sons UNC graduation celebration. My mom is now afraid to go to it and understandably so as she is immunocompromised. Placed my order with Edwards Medical today. As Eckhardt Tolle would say.... It is as it is.
Sunday 5/3 23:23: We'll I've spent a significant part of my weekend at this computer on this site - in a compulsive manner and I know I can't and don't want to sustain this compulsivity. I need to set a time limit. I do enjoy "belonging" to a group of folks who are interested in the topic. I lost interest in 2006/07 talking up the flu with friends - when they are interested - they'll approach me. The school thread is getting very long and at this point I'm questioning if its of any value now that over 50% states have had a school closed due to flu. I'll keep it up until each state has closed a school. It was interesting to read about the prison with a case, and I'm keeping an eye on the military picture as best "they" permit us to. I posted a Flutrackers link on my facebook page (which I rarely use). I believe the next flu season will be challenging and that we're being given this epidemic as a warning to really get ready.

[NurseNalts]

Margarita is the spelling, and I wish I had one (or three), too! I'm a heart/lung nurse with certified in Med/Surg. I hear/feel exactly what you're saying. Thank you for all your time and investment to the posts! I've been watching and researching and am trying to quell the sense of anxiety, (again, need the maragaritas!). You are SO accurate in the hospital bed situation. On ANY given day, our hospital could be WITHOUT ICU beds and they spend nearly all of flu season in some phase of divert! And our metro area just went through a big layoff over the last 4 months - not good!

I feel SUCH a burden to inform co-workers and loved ones, site the scientific sources and info from those on the ground, but so many just blow me off, remind me to not over-react, and reiterate the latest B.S. from the local news. In MN, the TV and radio are all saying "no more severe than the seasonal flu" - Well, the seasonal flu goes far less noticed when its the "old and already sick in a nursing home" that die, what about when it's the "young and healthy" on ventilators??

I've pulled my kids from public school on Wed. at Phase 5 with MN first case (I have 2 immunocompromised kids) and my family, who are all neighbors, think I'm cracked! As nurses, we've learned to deal with alot, to take care of business, to keep going. I just want my loved ones to LISTEN and PREPARE!

Save a drink for me (I haven't prepped for the margs .... yet!)

[GhostRN]

NurseNalt - Same here, although now I'm not talking it up to anyone but family. All the hospitals and staff can do at this point is just get through this but I believe the healthcare system is looking at something much worse than Katrina within the next few year.... hopefully not the next few months. The sad thing is I think its too big to make any major improvements that quickly. Chins up - we're survivors...and dedicated......but RN mothers will declare family will come first if its a dire situation and most nurses are women and over 40. tks for the spelling lesson.

[Laidback Al]

GhostRN, thanks for all of your effort on the school closure thread. The graph I posted earlier on case counts from official WHO notices indicates that the spread of the disease has not yet tapered off.

I have started a thread in the Health Care Workers (HCW) forum requesting first hand observations on the status of critical care units in their hospital. This will give us an informal idea of how many cases are now receiving treatment for respiratory related illnesses that might be related to S-OI A/H1N1.

Link to thread: http://www.flutrackers.com/forum/sho...d.php?t=102308

[GhostRN]

Some nurses like myself may be hesitant to report many details as we know ISP addresses can provide a good bit of info. That's why I registered as GhostRN and I'm very careful not to say anything I wouldn't say publicly. Tks for the support - had no idea I would do this....

[Cairelle RN]

I have to chime in with agreement about the critical care bed situation. It's rough in the good times to get an ICU bed where I worked, and it's been like that at every hospital I've worked at (and I've been a traveler in California, Arizona, and Mississippi, in addition to my home state of Louisiana).

Fortunately for me, or unfortunately, depending on one's view - I am not working at the moment due to an injury on the job in 11/07 (me versus combative patient - patient won - my hip cartilage is now shredded and I walk with a cane). It's fortunate in that I don't have that ICU exposure as I did previously, but it's also unfortunate in that I'm also "out of the loop", so to speak. The residents have all rotated and I don't know the newest interns, and I'm just not there on a daily basis to keep my finger on the pulse of things...

It makes me nervous because when I was working (I was a Clinical Supervisor in an SICU) I KNEW what was going on with Admin because I was part of staffing meetings twice a day, etc.

I never thought I'd say I miss nursing but it sure was comforting to be one of those "insiders"...

Sorry to hijack your thread, Ghost...

[Cairelle RN]

Pooksmom... I recognize your name from allnurses... I'm over there under another user name, SICU Queen. :-)

*waving hello*

[pooksmom]

Originally Posted by Laidback Al

GhostRN, thanks for all of your effort on the school closure thread. The graph I posted earlier on case counts from official WHO notices indicates that the spread of the disease has not yet tapered off.

I have started a thread in the Health Care Workers (HCW) forum requesting first hand observations on the status of critical care units in their hospital. This will give us an informal idea of how many cases are now receiving treatment for respiratory related illnesses that might be related to S-OI A/H1N1.

Link to thread: http://www.flutrackers.com/forum/sho...d.php?t=102308

Thank you for starting that thread, Al. That will be very interesting to watch.

Pooksmom

[pooksmom]

Thank you for your hard work in bringing together this information and sharing it with us on this forum. You have done great work!

I am an RN and have been combing the news and forums for the past few weeks on swine flu, and I agree that we are probably going to see a major problem soon. Trying to get good info is so difficult.
This is a huge topic, so I will just share my thoughts on one little corner of it that to me is a very concrete example of how unclear of a picture we have.

One bit of news that really bothers me, as I try to sift through what I can, is the story about the 2 Washington state teens. Three students in one high school get sick, and two end up in intensive care with suspected flu.

The news says today that the sick kids have no flu. (Thanks for the link.)

Okay...two kids in ICU with what, exactly??? Ticks? Fleas?

I expect that you are asking the same sorts of questions and feeling frustrated about it too. Ditto for much of the rest of the news.

My friends and family don't see this picture-it is nice to be able to visit here.

Thanks for listening,
Pooksmom

[hornblower]

Originally Posted by pooksmom

One bit of news that really bothers me, as I try to sift through what I can, is the story about the 2 Washington state teens. Three students in one high school get sick, and two end up in intensive care with suspected flu.

The news says today that the sick kids have no flu. (Thanks for the link.)

Okay...two kids in ICU with what, exactly??? Ticks? Fleas?

The report I read indicated that they do have flu, just not this one.
http://www.theolympian.com/localnews...ry/838398.html

Which seems weird as seasonal flu activity is really winding down - though it's hard to tell exactly the state of seasonal flu since the weekly report isn't out.

Interestingly, the Canadian seasonal flu tracker has updated its map for week 16 but hasn't put up the week 16 report.
http://www.phac-aspc.gc.ca/fluwatch/



So - do we have any idea at all what the hospitalization rate in US/Canada is for the swine flu? Why is this data not being released?

[pooksmom]

So - do we have any idea at all what the hospitalization rate in US/Canada is for the swine flu? Why is this data not being released?[/QUOTE]

I have been looking for that info. as well, and can't find anything other than that is contained in scattered news reports.

[kent nickell]

ghost RN, my interpretation of that would be if someone presents with true influenza like illness and has a negative rapid test at the local hospital but is then forwarded to a state lab. The state lab then gets a positive type A with their more comprehensive reagents but get a negative when they try and type it with their H3N2 or H1N1 sera. At this point it would seem to have a 95% chance of being positive at CDC for novel H1N1 (2009). I think CDC was going to be shipping the specific novel H1N1 (2009) pcr primers to state labs soon.....

[Laidback Al]

Originally Posted by kent nickell

ghost RN, my interpretation of that would be if someone presents with true influenza like illness and has a negative rapid test at the local hospital but is then forwarded to a state lab. The state lab then gets a positive type A with their more comprehensive reagents but get a negative when they try and type it with their H3N2 or H1N1 sera. At this point it would seem to have a 95% chance of being positive at CDC for novel H1N1 (2009). I think CDC was going to be shipping the specific novel H1N1 (2009) pcr primers to state labs soon.....

What Kent outlines is exactly my understanding as well.

[ldaziens]

What you are doing is really important, because based on the comments to Washington Post articles, most people in my area seem to think this is a joke. I am very concerned that media is presenting these numbers to the public w/o the proper context, which seems to me to be that we have no clue what the actual numbers are. I base this on the diagnostic process detailed at Effect Measure, Swine flu: case definitions and tough decisions, http://scienceblogs.com/effectmeasur...itions_and.php.

And, the latest CDC guidance, Use of Rapid Influenza Diagnostic Tests for Patients with Influenza-like Illness during the Novel H1N1 Influenza Virus (Swine Flu) Outbreak, http://www.cdc.gov/h1n1flu/guidance/rapid_testing.htm, reiterates
"CDC has received anecdotal reports of false positive and false negative results. Clinicians may consider using rapid diagnostic tests as part of their evaluation of patients with signs and symptoms compatible with influenza, but results should be interpreted with caution. Confirmation of novel H1N1 flu infection can only be made by reverse-transcription polymerase chain reaction (RT-PCR) or viral culture."

As a case study example, here is the WaPo account of the Federal Agent, Griswold, who traveled to Mexico w/ Obama, which highlights the problems w/ false negatives in testing as well as the unorganized response by the school, health department, and random comments by the governor.

http://mobile.washingtonpost.com/det...c=me&p=1&all=1
"When he got home, he chalked up the cough to Mexico's pollution and thought nothing of it the night after his return when he brought a present from Mexico to his brother's house and stayed for dinner.

Griswold's wife, Alison, a registered nurse, was the first to notice something wrong in the family. When she checked on her 7-year-old son at school April 21, something about him seemed off. He said he felt fine and he looked all right, Alison Griswold said. But the school nurse said he had a low fever, so Alison took him home and kept him there for two days until he recovered.

Then she started getting sick: a cough, a high fever and chills. Last Friday, Griswold and his wife went to a doctor, who wasn't overly concerned. On Sunday, they saw another doctor, who gave them a flu test that came back negative. On Tuesday, on advice from health officials, the couple and their youngest child got the more thorough nasal swab test.

The results came in Wednesday morning: positive for Type A influenza, probably the swine flu."

"Meanwhile, at home, Griswold and his wife tried to help their children get back into school. It was only at the advice of health officials that they kept their two unaffected children at school and sent the sick one back Wednesday, they said."

The sick child's elementary school was notified late Wednesday, 4/29...

"Folger McKinsey was scrubbed with disinfectant last night, and health authorities told school officials that it was safe for it to be open today." (Thursday, 4/30) http://mobile.washingtonpost.com/det...c=to&p=1&all=1

From 5/1 WaPo, http://www.washingtonpost.com/wp-dyn...043001734.html
"Gov. Martin O'Malley (D) and state health officials said there was no need to cancel school because the infected students had not been in school since last Friday -- a span of time beyond the suspected incubation period -- and because they could tie each case to a relative who had been to Mexico, where the disease is believed to have originated."

From Sat, 5/2 WaPo, http://mobile.washingtonpost.com/det...c=to&p=1&all=1
"Anne Arundel officials announced closure of Folger McKinsey Elementary in Severna Park for at least a week because of a likely flu case in the family of an Obama administration security worker, probably infected during an official trip to Mexico. The closure alarmed parents, who had been told that the ill family members were recovering. As it turned out, that had not changed. School officials were simply following direction from the federal Centers for Disease Control and Prevention. In a conference call with governors of all 50 states yesterday, the CDC said any school with possible cases should be closed."

According to WaPo, http://www.washingtonpost.com/wp-dyn...0100461_2.html, Griswold was recovered and back at work on Friday, 5/1, but I still don't think CDC has officially "confirmed" him.

[GhostRN]

I posted this in the diagnostics area but no responses yet.

Is this true?

"This child definitely has influenza. The question is whether it's the new H1N1 strain," said Dr. Fleming. "Experience around the country has been that when tests that our laboratories do are negative as they have been, that 95 percent of the time, when the confirmatory test is done at CDC, that confirmatory test is shows that it is Influenza A-H1N1."http://www.kpax.com/Global/story.asp?S=10286475