Announcement

**sharon sanders** · October 28, 2015, 12:10 PM

FluTrackers is mentioned in the National Geographics Channel blog:

snip

Editor-in-chief of FluTrackers, Sharon Sanders, addresses the need for concern in this area by explaining that her team “believes a mind shift can be created by increasing education and stressing the need for the general public to plan how they should respond on a personal level.” She continues, “Each person, each family and each local community needs to take responsibility and plan and prepare for their security.”

more....

http://tvblogs.nationalgeographic.co...erts-weigh-in/

**Michael Coston** · October 28, 2015, 03:03 PM

The Importance of Having `Flu Buddies’ In A Pandemic

Nearly 1 person in 10 in the United States lives alone. That’s roughly 27 million people who are particularly vulnerable during a pandemic. Millions of others are the sole adult caregiver in a home, and they (and their dependents) are also at risk.I began promoting the idea of `Flu Buddies’ in my blog back in 2007, but only really fleshed out the idea in a 2008 blog called Lifelines In A Pandemic, where I wrote:

Each of us need, in advance, to make `Flu Buddies'. And not just people who live alone, although they are at the greatest risk.
An arrangement with one or more people (or families) that you will come to their aid during a crisis, and that they will come to yours if needed. For most, these `buddies' will probably be family members, good friends, or neighbors.
People we care about.
If someone on your `buddy list' gets sick, they will have buddies to help them through it. Someone to fetch medicine, bring food and water, and make sure they take their meds.

After the pandemic receded I reworked the idea into a more generic `Disaster Buddy " concept in a blog called In An Emergency, Who Has Your Back?. But whether it is a pandemic, or some other disaster, having a network of friends you can depend on (and who, in turn, can depend on you) is your best insurance policy.
For this to work, it must be reciprocal. And you need to discuss it in advance.

Frankly, having (and being) a `Pandemic/Disaster Buddy" to friends, neighbors, and relatives should be part of everyones family disaster plan. In the parlance of paramedics, cops, firefighters and the military . . . "you have their back, and in return, they have yours."

**Pathfinder** · October 28, 2015, 04:44 PM

The importance of risk communication:

404

http://www.who.int/risk-communication/faq/en/

Erreur 404

"Risk communication refers to the real-time exchange of information, advice and opinions between experts or officials and people who face a threat (hazard) to their survival, health or economic or social well-being.Its ultimate purpose is that everyone at risk is able to take informed decisions to mitigate the effects of the threat (hazard) such as a disease outbreak and take protective and preventive action.
...
In public health emergencies, one essential lifesaving action is risk communication. People have a right to know how to protect their health and have a responsibility to take informed decisions to protect themselves, their loved ones and those around them...
...
Risk communication only works when there is communication based on trust between those who know (experts), those in charge (authorities) and those affected. Without trust, people are unlikely to follow the advice given. Listening to and understanding peoples’ beliefs, concerns and perceptions is just as important as providing them with facts and advice.

Explaining honestly what is known and admitting what is uncertain is essential.
...

-----------------------------------------------------------------------------------------------------------------------------

Existing guidance documents

Behavioural change communication

Effective media communication during public health emergencies

Handbook and field guide

Outbreak communication

http://www.who.int/risk-communication/guidance/en/

**Gert van der Hoek** · October 30, 2015, 08:48 AM

Impending Pandemic : Chronic Diseases

"The leading causes of death and disability have changed from communicable diseases in children to noncommunicable diseases in adults”".

"Twenty or 30 years ago, we were dealing with diseases that were killers — childhood killers, infectious killers. Now we are dealing increasingly with diseases that are not primarily killing but causing chronic illness — heart disease, injuries, mental health."

"“And those issues are increasing in virtually all parts of the world, even in low- and middle-income countries".”

http://www.npr.org/sections/health-s...lers-worldwide

"Infectious diseases (such as seasonal influenza) can increase risk of hospital admission and death among people with pre‐existing chronic diseases (such as circulatory and respiratory diseases).3,4 Most of those who died in the severe acute respiratory syndrome (SARS) epidemic in Canada had pre‐existing chronic conditions, such as diabetes.5"

"Although it is common to approach chronic and infectious diseases as having completely distinct aetiologies, there is an increasing appreciation for the common determinants of health that underlie both, such as housing and socioeconomic status."

"Segregation of epidemiology into chronic and infectious diseases has led to a neglected area in public health – the interface between chronic disease and infectious disease. Indeed, this neglected area requires increased public health attention across a broad spectrum of activity, including research, surveillance, prevention and control. It is time to bring chronic disease epidemiology and infectious disease epidemiology back together."

Page not available - PMC

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660008/

WHO - Preventing Chronic Diseases a Vital Investment

“The great epidemics of tomorrow are unlikely to resemble those that have previously swept the world, thanks to progress in infectious disease control. The risk of outbreaks – a new influenza pandemic, for example – will require constant vigilance".

"But it is the looming epidemics of heart disease, stroke, cancer and other chronic diseases that for the foreseeable future will take the greatest toll in deaths and disability. It is vitally important that the impending chronic disease pandemic is recognized, understood and acted on urgently.”

http://www.who.int/chp/chronic_disea...ents/part2.pdf

**JJackson** · October 31, 2015, 12:28 PM

This thread has been created specifically to be crosslinked with the National Geographic blog in the hope of reaching a wider audience with an interest in understanding zoonotic disease emergence and its possible range of impacts.

If you are new to FluTrackers, Welcome!
We have been here for about a decade and have accumulated hundreds of thousands of posts, in several languages, on and around this area of interest. Amongst these you will find abstracts, and links, from journal articles in the Scientific Library, information on personal and institutional preparedness, forums by geographic area, by disease and discussion forums amongst many others. This site has acquired the rare distinction of being highly trusted as a source of information in an age of spin, bias, commercial pressure and propaganda. We have no advertising, no commercial/institutional or government funding and none of us gets paid anything. We run on the generosity of our members with the odd PayPal contribution by those who find the site useful and worth keeping on-air. This has been key as the comments by regulars here are only personal opinions but by people who have been following events closely for a long time and who I, and I hope one day you, would trust to interpret reality in a severe pandemic where the authorities are singing '?don?t worry be happy'?, the media are sticking with '?if it bleeds it leads'? and the internet generally has opted for '?It?'s the Apocalypse'?. To build trust takes time.

With so much information the problem becomes finding what you want. I would recommend you start by clicking on the ?'Forums?' link and just slowly browsing down the list of top level forums for a feel for what we cover (the numbers, after the forum name, are the threads followed by the posts). Each forum will have multiple sub forums which should get you close to what you want at which point you can use the site search tool to narrow by keyword -? or just brows. If you have come looking for up-to-date information on a breaking news story your best bet is the ?'Latest Posts'? link which will list all the threads with new posts in the last two days. Have a browse and bookmark us for if, and when, you need us.

**Amish Country** · November 2, 2015, 07:51 AM

Pandemic Preparation

This is post is my opinion. It is not advice medial or otherwise and should not be taken as such. Anyone preparing for emergencies should in my humble opinion do their own due diligence and obtain guidance from licensed professionals where needed and appropriate. It is my hope this post provides a starting point for a responsible discussion on pandemic preparedness. There is a lot that individuals, families communities and faith based organizations can do to prepare for or help mitigate a pandemic or other disasters. The "All Hazards" approach to emergency preparedness, which works relatively well for most short term emergencies will not begin to cut it for a pandemic. I don't believe governments can afford to provide food, water and supplies for their entire population for a longer term emergencies like a pandemic. Individuals and families will have to step up and take responsibility for their own well being and safety.

In the beginning of a pandemic there will be no magic bullet vaccine. There are no guarantees that vaccines for related disease will prove effective against an out break of a new strain. Even if a new vaccine can be quickly generated there are no guarantees that while the vaccine is being researched and produced the virus or disease causing the pandemic will not have mutated to the point that "new" vaccine is ineffective or less effective than hoped. Unfortunately that is the nature of disease. What can be done is to minimize exposure to the disease. It's much harder to catch a contagious disease if a person is not exposed to it.This can be done by self quarantining or sheltering in place. The proper safe use of appropriate PPE's, proper hygiene, sanitation, sneeze etiquette and social distancing may help as well. The following preparations and training may mean the difference between a tragedy and an inconvenience during a long term emergency.

The list is not in any order of priority and does not cover all contingencies. I imagine it as preparing for a blizzard or hurricane that lasts three months. Why three months? Because flu pandemics occur in waves of about three months each. The deadly 1918 pandemic came in three waves of varying severity.There is also no guarantee that a pandemic will limit it's self to three waves.

Be ready to shelter in place.
Know what a quarantine is and how and why to do it.
Are there crafts, projects, books, toys, puzzles, (electronic and non electronic) games that will help keep children safely occupied?
Know how to set up a sick room and provide supportive care.
Have supplies on hand to set up a sick room or know how to improvise them from what is on hand.
Hopefully the knowledge will never be needed, but during the 1918 pandemic some families were forced to deal not only with the sick and dying but the dead as well. The Coroner would have to be notified. Here we have the ability and property to dig a grave. Others may not.
Basic first aid training as well as CPR and rescue breathing. Other emergencies can happen during a pandemic.
Make sure the first aid kit is stocked and tailored to met the needs of the family or individual it is meant to help, The advice of a professional health care provider may be appropriate.
A dentist should be able to provided information for first aid kit items and their use for emergency treatment for dental first aid until professional help can be had.
An eye doctor should be able to provided information for first aid kit items and their use for at home treatment for eye injuries until professional help ban be reached.
Make sure tools and equipment (blood pressure kit, thermometer, generators) etc. are working correctly.
If you have a generator do you know how to use it safely? Fumes can be dangerous.
Has it been checked and maintained periodically to make sure it is working order?
Is there fuel for the generator? Is it properly and safely stored? Was an appropriate stabilizing agent put into it to keep it from going stale if it was to be stored for a significant length of time?
Are vehicles kept in good repair with timely and appropriate maintenance and fueled?
If the phone lines are down or inoperative other forms of communication may be helpful. For example: battery operated one and two way radios.
Make sure over the counter drugs are on hand and in date. A healthcare professional may provide information on OTC medications that might be needed and appropriate.
Know how to implement procedures to more safely bring supplies and people into and out of a quarantine situation.*
Have a few months of shelf stable food and water in the pantry for all family members (including pets).
Don't forget cleaning and hygiene supplies. Paper plates and towels make meal clean up easier and save on potable water.
Consider any family members with special needs (example infants: formula), dietary and other wise.
Have water stored of be ready to put some by in case the tap water becomes unsafe.
Know how to purify water and have the equipment and supplies on hand to do it.
The one gallon of water per person per day is a minimum mentioned by many sources.
One gallon of water may not be enough especially when dealing with hot weather, pregnancy or other sanitary needs .
Have PPE's on hand. See CDC web site for details. Some would be better than none.
Keep preventive maintenance on the home up to date.
Have major system checked periodically; heating/cooling, septic, fire places, smoke alarms and chimneys etc.
Preventive health care checkups and screenings, dental care, eye exams, prescription glasses etc.
Talk to physicians, insurance companies about the possibility of covering at least 3 months of maintenance drugs.
Have safe alternate sources for heating, lighting, cooking and cooling.
Having operational smoke detectors and appropriate fire extinguishers and know how and when to use them safely. First responders will be very busy.
If sewers fail do you have a plan for safely and appropriately disposing of human waste?
Do you have a way of safely dealing with trash and house hold waste?
Provide school age children the ability to take classes via the internet, TV or in home lessons/homework during a pandemic.
A process in place that can put a moratorium on rents and mortgages during a pandemic would help limit the number of people forced to break quarantine.
Some of FEMA's regulations on standers for shelters may need modification. Not all areas have buildings available that meet their strict standards.
Some provisions will have to be made for essential workers, their families, travelers and the homeless.

Here are some informational links related to the topics.above.

Preventing transmission of Pandemic Flu and Other Viral disease
http://www.cdc.gov/niosh/docket/revi..._IOMreport.pdf

Caring for the sick at home when it's the only option
http://www.cidrap.umn.edu/practice/c...only-option-wy

Learn how to Shelter in Place

http://emergency.cdc.gov/preparedness/shelter/

Pandemic

Pandemics | Ready.gov

http://www.ready.gov/pandemic

Learn what to do if a pandemic is declared and how to stay safe when a pandemic threatens. Prepare for Pandemic Stay Safe During Stay Safe After Associated Content A pandemic is a disease outbreak that spans several countries and affects a large number of people. Pandemics are most often caused by viruses which can easily spread from person to person.

Coughing and Sneezing Etiquette
http://www.cdc.gov/healthywater/hygi..._sneezing.html

Guidelines-for-Social-Distancing-Pandemic-Readiness
https://www.colorado.gov/pacific/sit...-Readiness.pdf

Social Distancing Fact Sheet
http://www.publichealth.va.gov/docs/...-factsheet.pdf

Cyber Schooling
https://flutrackers.com/forum/forum/...g-for-children

For more posts on Personal, family emergency preparedness
https://flutrackers.com/forum/forum/...y-preparedness

For more posts on local community and organization emergency preparedness
https://flutrackers.com/forum/forum/...-organizations

For posts on National & International Government & NGO Preparation & Response
https://flutrackers.com/forum/forum/...ation-response

*During the 1918 Influenza pandemic Postal workers spread the flu while delivering mail.
The Great Influenza - Author John Barry

**JJackson** · November 2, 2015, 11:40 AM

I would like to pick one word from Sharon?s opening post and talk a little about what it means in this context.

Education.
If education is an increase in knowledge and understanding then the question becomes who do we need to educate and what do we need them to understand? The ?who? is easy it is everyone. For the ?what? part of the question we need to divide the who into sub groups and identify what has caused a problem in the past and see if there is anything we can do about it.

So sub-groups. Political decision makers, Research Scientists, The Media (MSM), Health Care Workers (HCW), the general public and the patients. For most of these groups (with the exception of the Scientists & HCWs) the main problem is general science and maths. Trying to evaluate risk based on statistical and scientific data is not the forte of Lawyers turned politician or Arts graduates turned journalist (with some notable exceptions) and it is the MSM that guide the public who have neither the time, inclination or, in general, the knowledge to read and weigh the data. The public then want ?action? without a clear understanding of exactly what they mean by that. The politicians then go to their preferred advisors for their options and cause change usually by redistributing funding.

As Ebola is the main focus of the NatGeo ?Pandemic program? (although not a particularly high risk as a pandemic candidate) I will look at some of these groups through that lens and how they react and interact.
First a quick look at Ebola which is a very bizarre disease. When it comes to transmission method Ebola drew the short straw, no easy airborne transmission for Ebola, it has to get its host to get their body fluids inside someone else, if the virus is to move to a new host, and while they are obviously sick. The virus needs to get blood, faeces or vomit inside - not just on to the skin ? so via eyes, mouth or a break in the skin. From the virus? point of view its chance of success look slim but it is doing pretty well aided by the fact it needs an unusually small amount of virus to start an infection and is expert at supressing the host?s immune response.

The patients ?- In this case they were generally poor with a low level of basic education particularly in the rural areas where the epidemic gained a foothold. The problem was to increase their knowledge of what was happening to them and how to prevent it but given that some of these groups believed illness was due to evil spirits - and had no knowledge of microbial pathogens as a cause of disease - they were inclined to put their faith in traditional healers not western medicine. So we think we know what needs to be done (patient isolation, contact tracing and no post mortem contact) but how do you achieve that in a population with a very low level of trust in ?the authorities?? I will look at that a bit more in the HCW section but errors were made. For now it is clear to me that this was a very important factor in the early explosion of cases. It was noticeable in later stages that reintroductions into areas that had been hard hit earlier were much more quickly contained than similar new outbreaks in previously unaffected regions. This could just be due to the placement of resources but I think that it had more to do with the local population?s acceptance that the HCW were their best hope and could help if you asked for it early enough. This was a learning curve that had to be surmounted the question is how to create a system that does it faster?

HCW -? The education needed here was twofold. To learn how to stay safe with very limited experience of this disease, this was largely learning on the job to create a ?best practice? and then share what works, and what doesn?t. The other lesson, not done as well, was the patient communication mentioned earlier. There was a plan but it did not take sufficient account of the knowledge, traditions, and social structures of the target population. Where, for you or I, a media campaign explaining how to stay safe would work fairly well. For this population, without adequate preparation, the arrival of men in space suits wanting to take away your love ones either for burial, in a manner against your deeply held beliefs, or to a treatment centre that seemed, to them, to be akin to a death camp was met with hostility. Locals hid bodies, or denied there were any, vanished into the woods or resisted by force ? even to the extent of killing HCWs and hiding their bodies. Over time it was learnt that the best route to change behaviour was to target the village chiefs, religious leaders and anyone else who was already trusted locally. If these people could be won over then they could win over the population, control movement and report cases in their area. This was a major turning point in the campaign and a lesson that must be learnt for next time when a completely different set of local conditions will need to be assessed and the built into the plan of campaign, preferably from day one.

MSM News -? They are a problem. As commercial organisations they rely on revenue streams which have all but disappeared caused by the advent of the internet. The print media is dying. All the major players have been savagely cutting staff. Overseas bureaus and foreign correspondents, being expensive, are the first to go. Citizen journalist and bloggers are providing excellent analysis but not field reporting. We badly need a new funding model that allows for fulltime on the spot reporters with experience and local knowledge who we can learn to trust so that FluTrackers, and others, can provide analysis but the quality and quantity of this data is falling. Some media are now printing government, corporate or lobby group prepared copy as if it was their own work with little or no editing or fact checking and, given the pressure to do more with less, this trend is likely to increase. While larger organisations may have knowledgeable science writers they are by necessity generalist and at the editorial level Arts, rather than Science, backgrounds predominate. Their main problem is short termism (shared by the politicians). H5N1, MERS, HIV and Ebola (if you thought this outbreak was over think again) are all still busy infecting and killing people but are no longer very news worthy so the focus shifts elsewhere and a public, who seldom get past the TV news headlines, also lose interest.

Politicians and the public ?- Here I am dealing with the current democratic western model. To get anything done you need money and in the area of global public health, and especially zoonotic disease emergence, that means government funding. Politicians are beholden to whoever got them into power and can keep them there. Big pharmaceutical companies are probably the only relevant lobby with money and access but pandemic diseases are not a lot of good to them as there is no money in them until they explode. When an epidemic looks imminent it is unrealistic to expect the production of a drug or vaccine until after the disease has done its damage. Even if there was some useful low volume drug it is a big ask just to increase its production sufficiently to cope with a fast moving infectious disease. The 2009 pandemic flu vaccine was available towards the end of the pandemic, despite only needing a reformulation of an existing technology, and had little if any breaking effect. Ebola drugs are in clinical trials, despite an enormous effort and influx of funds, and in practical terms have not been a factor in controlling the outbreak. Governments like pharmaceutical intervention but report after report has highlighted the best solution across the board for pandemics, and everything else, is improved basic healthcare infrastructure but that is not very sexy. To make matters worse it is a hard sell to convince the public it is worth spending their money helping some dirt poor State, who we aren?t particularly friendly with anyway, to build their health infrastructure so a zoonotic event is killed at source. If it works, and saves us from the likes of HIV or Ebola, the end result is nothing happens, which is what we wanted, but how do you prove it was because of the investment in basic healthcare and diagnostic labs? The public will just see it as unnecessary spending to prevent something that didn?t happen anyway.

The Researchers ?- Last but not least. Funding again or, more precisely, stability in funding. To make real progress takes continuity in funding so research teams and their labs, complete with equipment and techniques, stay together. Not easy when you are working on some obscure pathogen with pandemic potential but no commercial value.

All of the above is written as a purely personal take on the situation, others here may well differ, and, if they are true to form, will probably say so. I hope they do, it is good for my Education.

Announcement

National Geographic - " Breakthrough: Fighting Pandemics " on Sunday, November 1 at 9 pm ET on National Geographic Channel.

National Geographic - " Breakthrough: Fighting Pandemics " on Sunday, November 1 at 9 pm ET on National Geographic Channel.

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