Re: Osterholm warns about pandemic
Quote: gsgs:
I'm referring to the ,well, maybe 1000-10000 top-experts worldwide.
gsgs: I think I found that
one expert that will answer all your questions on the Pandemic. And he states in one of his articles that it is a mathematical certainty that the pandemic will arrive. Plus he states you cannot prepare for an 18 month pandemic, so maybe now you have no need to prepare at all. You can't get any better than that. So I don't see any need to question those 1000-10000 top-experts of yours. Maurice seems to have all the issues regarding this pandemic down in a nutshell.
Maurice is good with numbers, just like you, and he is so kind to give out his email address on his website also, so now you can inundate him with all your queries:
Maurice A. Ramirez, DO, CNS, CMRO
The Blog of Disaster Planning, Preparation, Education, Response & Recovery by the Founding Chair of the American Board of Disaster Medicine.
Here are two of his articles:
Pandemic / Avian Flu
March 18, 2007
I Will Watch My Friends Die
The most ominous words ever uttered by a disaster preparedness expert were voiced during a deep background interview. This expert stated simply that given the current state of hospital preparedness and the current rate at which facilities are becoming disaster ready, there will be no meaningful level of preparedness in this decade unless someone blows up a hospital. This may seem a bit extreme, but declassified documents show that Al Qaeda seeks to steal an ambulance and blow it up at a major American trauma center.
Unfortunately, this scenario is based on the lesser of the threats currently facing healthcare.
History over the last three centuries has taught us that novel avian pandemic flu occurs every 91 years (plus or minus 3.5 years for antigenic drift). Given that the last major pandemic was the 1917/1918 Spanish flu this means that we can expect a pandemic flu outbreak between 2006 and 2013.
It is a mathematical certainty.
Dr. Richard Garden and others have begun to discuss the impact on the healthcare workforce in accurate terms. These pundits are absolutely correct that up to 50 percent of the workforce may not report to duty. The reasons are well demonstrated in the history of pandemics.
The true impact of this disease lies in the numbers. In 1918 100 percent of the entire world was exposed to what would later be called the Spanish Flu. This new strain of avian flu had never been encountered before by a human population, and as a result, there was no immunity to this particular strain. Of that world population, one third would ultimately fall ill, in fact, 50 to 80 percent of the youngest, healthiest, and strongest would fall ill when future generations would divide out the victims.
When these ominous numbers were scrutinized further, a far more dire picture evolved. Research into the 1918 pandemic, as well as pandemics before and since 1918, have shown that the majority of illness and death occurred not in the very old or the very young, not in the sick and infirm, but in those who are in the "prime of life"; those age 18 to 40.
But there is a bigger problem.
Because of the way that novel avian viruses (pandemics) attack the lungs and cause "immune system storms", the ultimate irony of a pandemic is that the younger and stronger you are the more likely you are to die. In 1918 fully two-thirds of all those who became ill were in the age range of 18 to 40. More distressing is the fact that 98 percent of all of those who died were age 18 to 40 years.
In fact, those over age 55 had no greater rate of illness or death during the pandemic of 1918 than they did in any other flu season in the years immediately before or after that great pandemic. Similarly, those less than 18 years of age suffered no increase in death rate.
The implications for America's hospitals and healthcare institutions are inescapable.
Fully two-thirds of the active workforce will fall ill during the 16 to 18 months of the disease throughout the pandemic. Twenty-five percent of the young workforce (the 18 to 40 years) will die in that 18 months. Who will replace them?
Dr. Garden is also correct that correctional institutions as well as the disabled and children have not been considered in local, regional or state pandemic planning. In fact they are barely mentioned even in federal planning. In June of 2006 the Institute of Medicine published reports on the state of preparedness but pointed out that even emergency services had been left out of much planning.
It is imperative that healthcare professionals of all stripes become expert not only in pandemic planning but in the "All Hazards" approach to disaster and catastrophic event planning. Whether it is a pandemic, a hurricane, an earthquake, a forest fire, or a terrorist event that threatens the community, bitter experience has taught us that concentrations of individuals living in institutional settings whether in prisons, military barracks or university dormitories become the "cave canaries" of society.
In 1918 Spanish flu outbreaks, which actually began in Kansas, were first seen in epidemic form in U.S. military barracks. The outbreaks of measles in the 1980s were first seen in university dormitories across the United States. And the largest concentrations of the recurrence of tuberculosis, as we all know, is seen in correctional institutions.
The 2003 SARS outbreak also provided us a small scale example of the effects for a pandemic on healthcare. Following the outbreak of SARS in Canada, healthcare workers in 4 Toronto area hospitals began to fall ill. Soon nurses and doctors were looking through protective equipment at colleagues and friends. The disease had changed the normal ?us and them? relationship to ?us and me.? These professionals watched their friends die. The result of SARS on the healthcare professionals who worked in these 4 Toronto hospitals was that 50% left healthcare entirely.
What does all this mean for the healthcare industry?
During the outbreak, up to 50% healthcare workforce absenteeism
During the outbreak, up to 25% healthcare professionals death rate
Following the outbreak, 75% of healthcare professionals still alive
Following the outbreak, 50% of remaining healthcare workforce quits
The final outcome for healthcare:
25% will die
37.5% will resign
37.5% will remain
Lest healthcare embrace the lessons for preparedness this is the fate of us all.
Posted at 11:50 AM in Pandemic / Avian Flu | Permalink | Comments (0) | TrackBack (0)
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gsgs: I think this article will ease your mind on the need to prepare:
Quote:
And you cannot stock 18 months of food and water to safeguard yourself and your family during that event.
So what can you do?
Bring pressure to bear on the healthcare community to better prepare for surge capacity.....
December 17, 2006
Setting The Record Straight on Pandemic Preparedness
The November/December 2006 issue of the AARP magazine carried an interesting story on pandemic flu. The expert virologist who authored the article painted a grim picture of the future of the coming pandemic and gave one view of how to prepare.
Let's set the record straight.
Almost all of our predictive models for pandemic flu are based on 1917/1918 Spanish flu (which actually originated in Kansas); the 1957/1958 pandemic and the 1968/1969 pandemic. The 1918 Spanish flu is known in virology circles as H1:N1. Genetic reconstruction has allowed us to isolate this virus from pathologic specimens collected in 1917 and 1918 and stored by the U.S. military and other organizations. This means that we can now study the actual virus H1:N1 aka the Spanish flu and compare it to the current pandemic risk H5:N1 aka Avian flu. What makes avian flu more likely to be a pandemic?
As we all know now from the media, influenza virus mutates over time. Small mutations are known as antigenic drift while large mutations are known and antigenic shift. These drifts and shifts slowly change the virus from something that the human immune system can recognize and therefore protect against to something that is novel or new to the human population ? a pandemic. In short it is something that the human immune system has never seen before.
In 1918 the H1:N1 strain was seen. Like all of pandemics before, it struck with a predictable infection rate (attack rate); approximately 1 in 3. Of these 1 in 3 on average in the population half would become seriously ill. Half of those would develop severe lung disease and half of those with the severe lung disease would ultimately die.
The picture changes significantly, however when you look at the infection by age group. H1:N1 caused virtually no more deaths in those over age 65 than the average flu. In fact in 1918 you were no more likely to die of the pandemic if you were over age 65 than you had been in 1915 or than you would be in 1920.
So what does that mean for the coming Avian flu (H5:N1)?
Pandemics are very consistent. They act virtually the same every time they occur as long as they are a novel avian virus. H5:N1 has not been different to date. It is expected to cause no greater number of deaths in those greater than age 65 than the flu did last year in 2005 or the year before in 2004.
Yes, there will be an increase in the number of people who become ill across the age spectrum from birth to those over 100.
Yes, there will be a total increase in the number of people who die. Unfortunately the vast majority of those will be between the ages and 15 and 40. This was the age group that showed the greatest increase in death rate in 1918, in 1958 and 1969.
AARP magazine is to be tremendously complimented in their January/February edition they published an exquisite interview with
Anthony Fause, a noted expert in infectious disease and pandemic preparedness. That interview asked insightful questions and gave good, logical answers. Unfortunately the same cannot be said of the recommendations made in the November/December edition.
The article in the November/December edition recommended stockpiling food and other supplies in anticipation of infrastructure collapse and supply chain failure. This advice ignores the lessons learned from history. In 1918, as with all other pandemics, 100 percent of the population was exposed despite social isolation efforts. In 1918, one third of the working population was out of work and yet food was still delivered. Farms still produced. Society did not collapse. There is no reason for panic.
Stockpiling medication is also a formula for disaster and disappointment. The current strain of H5:N1 is already showing resistance to
Tamaflu, requiring far higher than usual and longer than usual doses to be effective.
Tamaflu's shelf life is also far shorter than the window of likely infection from the pandemic (as late as 2012). This means that you may purchase
Tamaflu and have it expire before the disease attacks.
Finally, previous pandemics have come in multiple waves over an 18 month period. In most cases the disease appears first as a low level infection in the population, followed by a large flood of influenza and then an aftershock of disease.
You simply cannot stock enough Tamaflu for all three events. You cannot prevent yourself from being exposed during those three events. And you cannot stock 18 months of food and water to safeguard yourself and your family during that event.
So what can you do?
Bring pressure to bear on the healthcare community to better prepare for surge capacity.
There are fewer than 1,000,000 hospital beds in the United States and in an average cold and flu season fewer than 40,000 hospital beds are empty. The federal government recommends between 150,000 and 190,000 available hospital beds even during the peak of an average cold and flu season. The United States is woefully short of hopsital beds and it falls to private hospital corporations to provide that surge capacity.
The New England Journal of Medicine in 2004 an article by Dr. Michael Osterholm they found there are 105,000 ventilators in the United States. Eighteen percent of those are either broken, in repair or in cleaning at any given moment. Sixty-seven of those are in chronic use for ventilator dependent patients outside of the hospital.
This leaves 16,000 ventilators available nationwide.
If we break down the expected number of illnesses just in those over age 65, those 16,000 ventilators will all be in use. What happens to those between age 15 and 40, the children and grandchildren of those who read the AARP magazine?
The healthcare community must step up to the plate rather than pedaling panic in the pages of the AARP magazine. The juxtaposition of the Avian flu article in the November/December issue and the far more insightful and useful interview in the January/February issue show the division within the house of medicine. The AARP magazine has the largest circulation and readership in the English-speaking world. Which side of that division will its members come down upon - Panic or preparedness?
It was once said of the generation that now reads the AARP magazine that they are the "Great Generation".
The Great Generation earned this title because of their self-sacrifice during World War II. They guided a great nation through an industrial revolution and a technological revolution that became an economic revolution that swept the planet. Many have tried to discount the Great Generation because they are now the "Geriatric Generation." I believe the Great Generation will lead us again not into panic but into a new era of preparedness.
http://www.disaster-blog.com/pandemic_avian_flu/index.html
:smartass:
I'm sure Maurice truly believes in his approach, but I think I will still go out and buy more beans and rice today.
"Worries go down better with soup than without."
- Jewish Proverb -
arty:
