Pandemic Flu

[InTheBlack]

I have a degree in Biology, but when I read medical literature its like reading the King James Bible -I grok the gist of it, but need to go to a Concordance to figure out details.

This thread is a long primer on how pandemic flu will kill you. SO you must be able to explain the worst case hypothesis which you are willing to fight, and ask for scrips to hold in hand.

My worst case:
Pandemic flu with high mortality rate strikes my family.
Doctors are not quickly available to diagnose.
Can't send victim to the hospital because there is no space, all the ventilators are in use.
Meds might not be available, or its too risky to go get them.
Have to treat at home using antivirals, drugs to fight ARDS (acute respiratory distress syndrome) and the "cytokine storm." After surviving that, I need antibiotics to prevent a pneumonia infection. Of varieties that my family member is not allergic to.

[Monsoon65]

Originally Posted by InTheBlack

This thread is a long primer on how pandemic flu will kill you. SO you must be able to explain the worst case hypothesis which you are willing to fight, and ask for scrips to hold in hand.

My worst case:
Pandemic flu with high mortality rate strikes my family.
Doctors are not quickly available to diagnose.
Can't send victim to the hospital because there is no space, all the ventilators are in use.
Meds might not be available, or its too risky to go get them.
Have to treat at home using antivirals, drugs to fight ARDS (acute respiratory distress syndrome) and the "cytokine storm." After surviving that, I need antibiotics to prevent a pneumonia infection. Of varieties that my family member is not allergic to.

That's just what I was looking for! Without being sick, I wanted a good, convincing argument about getting meds prior to getting sick.

[Penn]

Thank you!!!

[6.8SPC_DUMP]

Sharp Corp.'s Plasmacluster Ion Generators have proved to be effective in fighting H1N1 and H5N1.

H1N1 Inactivation ratio: 99.7%
H5N1 Inactivation ratio: 99.0%
Link

The technology has been adapted to portable home units, air conditioning systems, car air conditioners, duct systems, public transportation and light fixtures.
Link


avianfludefence.com writes (about H5N1 not Swine Flu H1N1):

What is Plasmacluster technology?

Originally developed as an air quality technology, Plasmacluster Ion attacks impurities and diseases in the air.

How does it work?

Plasmacluster Ion generates positive and negative ions in the air. These ‘cling’ to airborne impurities and diseases, attacking the cell membranes of their bacteria. In turn, this neutralizes them.

So where could Plasmacluster be put to work?

Plasmacluster could play an important role in removing the H5N1 virus if it is present in doctors’ surgeries, hospitals, offices, homes and confined spaces such as airplanes.

Could Plasmacluster be the answer to the risk of a pandemic?

Not on its own, no. Influenza viruses are complex, but Plasmacluster would provide a valuable extra layer of defence against H5N1, complementing retro-viral drugs, vaccines, hygiene practices and ‘social distancing’ measures to keep people away from the infection.

[InTheBlack]

Something to clean the air in the sickroom can't hurt - ions, UV light, or just a big fan with a big HEPA filter. I try to sneeze into the trash can; the used kleenex absorbs the air burst & droplets.

Coughs & sneezed produce mostly aerodynamically large droplets which fall out quickly (IIRC 60 seconds) so you need to disinfect surfaces.

Hmmm... maybe just old fashioned draping around the sickbed to contain aerosols, with a HEPA filtered fan to aim your sneezes into...

[Penn]

All the US Via Bloomberg News...I think its the last thing the BHO admin wants to announce. The article notes the coming fall flu season....
http://www.bloomberg.com/apps/news?p...d=a11JbSV5RlwI

[temsmedic]

Originally Posted by Penn

All the US Via Bloomberg News...I think its the last thing the BHO admin wants to announce. The article notes the coming fall flu season....
http://www.bloomberg.com/apps/news?p...d=a11JbSV5RlwI

This article states:
"The CDC says people with the swine flu are more likely to have diarrhea"



The CDC Case Definition for H1N1 [Swine] flu does not mention diarrhea.



Case Definitions for Infection with Swine-origin Influenza A (H1N1) Virus (S-OIV)
A confirmed case of S-OIV infection is defined as a person with an acute febrile respiratory illness with laboratory confirmed S-OIV infection at CDC by one or more of the following tests:

real-time RT-PCR
viral culture

A probable case of S-OIV infection is defined as a person with an acute febrile respiratory illness who is positive for influenza A, but negative for H1 and H3 by influenza RT-PCR

A suspected case of S-OIV infection is defined as a person with acute febrile respiratory illness with onset

within 7 days of close contact with a person who is a confirmed case of S-OIV infection, or
within 7 days of travel to community either within the United States or internationally where there are one or more confirmed cases of S-OIV infection, or
resides in a community where there are one or more confirmed cases of S-OIV infection.

Infectious period for a confirmed case of swine influenza A (H1N1) virus infection is defined as 1 day prior to the case’s illness onset to 7 days after onset.

Close contact is defined as: within about 6 feet of an ill person who is a confirmed or suspected case of swine-origin influenza A (H1N1) virus infection during the case’s infectious period.

Acute respiratory illness is defined as recent onset of at least two of the following: rhinorrhea or nasal congestion, sore throat, cough (with or without fever or feverishness) [no mention of diarrhea]

[temsmedic]

Interesting, Fox News is now reporting diarrhea as a symptom. A google search showed some state health depts listing vomiting and diarrhea as a symptom. I reviewed again this AM, the CDC and WHO case definitions, and they still do not list diarrhea.

This is pretty important because if it doesn't meet the case definition, I don't order the Influenza tests, and send a sample off to the health dept. I've already had one pt that had returned from CA, and had vomiting and diarrhea. I did not run the test, because he didn't meet the case definition.

If vomiting and diarrhea is part of the illness, the CDC/WHO are NOT getting the word out, which means that this is being under-reported, and the numbers are likely even bigger. Also, it will spread more rapidly, because we aren't isolating those with vomiting & diarrhea, except for the usual infectious diarrhea precautions.

[InTheBlack]

The seasonal flu "culls the herd" by killing the already weak & infirm. Comparing this to seasonal flu might be a misrepresentation to the public; the pandemic we are on the alert for kills people whom you would not _expect_ to die from a bad infection.

I'm hoping to soon see statistics on _who_ is being killed by H1N1, so we can determine which this is.

The local health department has for the very first time made use of the emergency telephone notification system, with a tape recording saying to wash hands & stay home if you have symptoms. This is a great drill for the government. I don't expect the sheeple to pay any attention beyond this wave, though.

[6.8SPC_DUMP]

Originally Posted by temsmedic

Interesting, Fox News is now reporting diarrhea as a symptom. A google search showed some state health depts listing vomiting and diarrhea as a symptom. I reviewed again this AM, the CDC and WHO case definitions, and they still do not list diarrhea.

This is pretty important because if it doesn't meet the case definition, I don't order the Influenza tests, and send a sample off to the health dept. I've already had one pt that had returned from CA, and had vomiting and diarrhea. I did not run the test, because he didn't meet the case definition.

If vomiting and diarrhea is part of the illness, the CDC/WHO are NOT getting the word out, which means that this is being under-reported, and the numbers are likely even bigger. Also, it will spread more rapidly, because we aren't isolating those with vomiting & diarrhea, except for the usual infectious diarrhea precautions.

You bring up a very interesting point about the definition not matching the symptoms Sir.

I do know that the CDC has consistently mentioned diarrhea and severe or persistent vomiting at the end of their list of symptoms when giving brief broadcasts - saying: "people have reported diarrhea and vomiting".

CDC has recently advised ppl with the following symptoms to immediately seek medical care:

• difficulty breathing / shortness of breath
• pressure or pain in the chest or abdomen
• sudden dizziness
• confusion

The general symptoms:

• fever
• cough
• sore throat
• body aches
• headache
• chills
• fatigue
• with some people reporting severe or persistent vomiting and diarrhea

http://www.youtube.com/watch?v=scGMU7TU8Cw

I don't understand how at first it was thought it was a never before seen bird/swine/human flu and now it's a pig/pig flu from both over seas and N. America pigs.

[mugwump]

Several researchers are working to calculate the Ro (the number of new cases produced from each infection) of the H1N1 virus currently circulating around the world. Remember that if Ro < 1 then the disease will burn out. A Ro > 1 means there is ongoing spread of the disease. The larger the Ro the faster the spread.

I'm told that one published result (haven't found it yet) puts the Ro at 1.16 and two other, unpublished, calculations put the Ro between 1.2 and 1.39. If the estimates are correct, the new H1N1 virus is spreading, but barely enough to keep it going.

As the MSM are reporting pretty extensively, the 1918 flu pandemic also started with a mild, first wave in late spring. The folks at Los Alamos National Laboratory (the ones who created the pandemic model posted early in the thread) estimate the R0 of the 1918 first wave at 1.45. When the second, lethal wave hit in the fall they think the Ro was 3.75.

[greenberetTFS]

Ist person to die from swine flu is a lady in Texas.......................

GB TFS

[temsmedic]

Second pt of the morning, 2 y/o hisp male with temp of 39.5, cough, and runny nose. He had spent two hours in the waiting room, and was in a shared room. He lived in a home with two families, two of whom were ill. Not very ill looking, when I peaked in, he was playing and smiling with mom. Influenza A positive, sent to health dept for confirmation. News reporting tonight that over 90% of the "probable's" are coming in positive for H1N1. He had normal lung sounds, oxygen level high normal, not dehydrated. He was discharged to home on tamiflu, health dept notified. Interestingly, I asked the health dept if I should drag in the person from the second family in the home, they told me not to bother. I treated the father of my pt.

[incarcerated]

Originally Posted by InTheBlack

Coughs & sneezed produce mostly aerodynamically large droplets which fall out quickly (IIRC 60 seconds) so you need to disinfect surfaces.

Great editorial liberties have been taken with this article in the interest of brevity.
Reminder: μm = micron (.001 millimeter)
http://www.cdc.gov/ncidod/EID/vol12no11/06-0426.htm

Volume 12, Number 11 November 2006
Perspective

Review of Aerosol Transmission of Influenza A Virus

By Dr. Raymond Tellier
In theory, influenza viruses can be transmitted through aerosols, large droplets, or direct contact with secretions (or fomites).
Several authors have stated that large-droplet transmission is the predominant mode by which influenza virus infection is acquired. As a consequence of this opinion, protection against infectious aerosols is often ignored for influenza, including in the context of influenza pandemic preparedness.

Influenza Virus Aerosols
By definition, aerosols are suspensions in air (or in a gas) of solid or liquid particles, small enough that they remain airborne for prolonged periods because of their low settling velocity. For spherical particles of unit density, settling times (for a 3-m fall) for specific diameters are 10 s for 100 μm, 4 min for 20 μm, 17 min for 10 μm, and 62 min for 5 μm; particles with a diameter <3 μm essentially do not settle. Settling times can be further affected by air turbulence.

The median diameters at which particles exhibit aerosol behavior also correspond to the sizes at which they are efficiently deposited in the lower respiratory tract when inhaled. Particles of >6 μm diameter are trapped increasingly in the upper respiratory tract; no substantial deposition in the lower respiratory tract occurs at >20 μm. Many authors adopt a size cutoff of <5 μm for aerosols. This convenient convention is, however, somewhat arbitrary, because the long settling time and the efficient deposition in the lower respiratory tract are properties that do not appear abruptly at a specific diameter value. Certainly, particles in the micron or submicron range will behave as aerosols, and particles >10 to 20 μm will settle rapidly, will not be deposited in the lower respiratory tract, and are referred to as large droplets.

Coughing or sneezing generates a substantial quantity of particles, a large number of which are <5 to 10 μm in diameter. In addition, particles expelled by coughing or sneezing rapidly shrink in size by evaporation, thereby increasing the number of particles that behave as aerosols. Particles shrunken by evaporation are referred to as droplet nuclei. This phenomenon affects particles with a diameter at emission of <20 μm, and complete desiccation would decrease the diameter to a little less than half the initial diameter. Droplet nuclei are hygroscopic. When exposed to humid air (as in the lungs), they will swell back. One would expect that inhaled hygroscopic particles would be retained in the lower respiratory tract with greater efficiency, and this hypothesis has been confirmed experimentally. Because aerosols remain airborne, they can be carried over large distances, which may create a potential for long-range infections. The occurrence of long-range infections is affected by several other factors. These include dilution, the infectious dose, the amount of infectious particles produced, the duration of shedding of the infectious agent, and the persistence of the agent in the environment. Inferring an absence of aerosols because long-range infections are not frequently observed is incorrect.

Humans acutely infected with influenza A virus have a high virus titer in their respiratory secretions, which will be aerosolized when the patient sneezes or coughs.

In natural infections, the postulated modes of transmission have included aerosols, large droplets, and direct contact with secretions or fomites because the virus can remain infectious on nonporous dry surfaces for <48 hours.

Whereas UV irradiation is highly effective in inactivating viruses in small-particle aerosols, it is ineffective for surface decontamination because of poor surface penetrations. It is also ineffective for large droplets because the germicidal activity sharply decreases as the relative humidity increases. Furthermore, because the installation of UV lights was set up in such a way as to decontaminate the upper air of rooms only, large droplets would not have been exposed to UV, whereas aerosols, carried by thermal air mixing, would have been exposed. So in effect in this study only the aerosol route of infection was blocked, and this step alone achieved near complete protection.

Dr Tellier is a microbiologist for the Hospital for Sick Children; senior associate scientist, Research Institute, Hospital for Sick Children; and associate professor, Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto.

[InTheBlack]

Very interesting cite. Wonder how the UV lights were set up -- how many watts or candlepower per cubic meter of room size? In 1958 they probably emitted a more dangerous spectra than what you can easily obtain today.

Footnote 10 seems to be the source of the aerosol size distribution data but its not free online:
http://www.informaworld.com/smpp/con...59620590918466

Anyway, putting a mask on the patient or tenting him, with negative ventilation into a filter, are methods to think about.