Pandemic Flu

[Plutarch]

http://news.yahoo.com/s/ap/20090821/...ne_flu_turkeys


I'm guessing this is bad?

[Paslode]

Originally Posted by jasonglh

Whats really frightening is the ignorance of the facts about the current virus from the MD's and management who are supposed to be having meetings about it.

If it isn't all hype that is frightening, but.....

I have asked my wife from the get go about what being said about it at the hospital. I ask my friend Mark who wife is a nurse what he has heard. I ask my friend Neal who wife is a nurse. I have asked Doctors who are clients of mine.

The response is nothing is going on, the media is blowing out of proportion. And each time I am reminded about how many people die each year from the flu. It is also mentioned that the flu virus continually mutates and there will always be new strains that will be immune to vaccines.

Then you have all those rumors of 'Forced/Mandatory Vaccination'. I asked my wife the other day what she would do if our kids were 'required' to have the 'rumored' H1N1 inoculation. Her response, they (.GOV) can't do that......remember we have Zero in at the Helm so never say never Honey and keep your eyes wide open!


Thus far my opinion is, it is a load of horse dung they are working to dump on a the US Taxpayer. Kitty Kat Sebelius and WHO cry the Sky is Falling and Big Pharma gets a cash cow.

You know, never let a crisis go to waste.....even if it is concocted.







So

[mugwump]

Paslode, if you are hearing rumors of forced immunization then it's time to question your sources of information. There isn't enough vaccine to go around as it is.

It's possible that individual school boards will make immunization for H1N1 a mandatory requirement for attendance (just as they do for MMR, meningitis, etc.) but that's highly doubtful given that two separate doses of the vaccine (and possibly three, they are still testing) will be required to confer even limited immunity.

BTW, this means that even in the best case scenario, the vaccine won't confer protection until Thanksgiving.

Physicians diagnose and nurses heal. God bless them both. But the nature of their jobs, and the emphasis of Western medicine, makes then reactive instead of proactive. They may be right and this may be nothing. But from the sounds of things I'm guessing that their current judgments are not informed ones.

[mugwump]

Full article here: WHO warns of severe form of swine flu.

The report below discusses ARDS in H1N1 patients. I have doubts about the 15% figure in the article because I doubt the denominator. If a doc sees 100 patients and 15 require hospitalization, he says 15%. But if another 900 patients get sick and stay home, it's 15 out of 1000, or 1.5%

The bottom line, though, is Southern hemisphere health systems are being overwhelmed even in the first wave (New Zealand, Argentina, etc.). The "expensive" ICU measures discussed include mechanical ventilation support and even extracorporeal membrane oxygenation (ECMO), where the blood is removed from the patient, oxygenated, and then returned. In other words, heroic measures because of complete collapse of lung function. Note that there are 51 hospitals in the world that can perform ECMO.

WASHINGTON (Reuters) – Doctors are reporting a severe form of swine flu that goes straight to the lungs, causing severe illness in otherwise healthy young people and requiring expensive hospital treatment, the World Health Organization said on Friday.

Some countries are reporting that as many as 15 percent of patients infected with the new H1N1 pandemic virus need hospital care, further straining already overburdened healthcare systems, WHO said in an update on the pandemic.

"During the winter season in the southern hemisphere, several countries have viewed the need for intensive care as the greatest burden on health services," it said.

"Preparedness measures need to anticipate this increased demand on intensive care units, which could be overwhelmed by a sudden surge in the number of severe cases."

Earlier, WHO reported that H1N1 had reached epidemic levels in Japan, signaling an early start to what may be a long influenza season this year, and that it was also worsening in tropical regions.

"Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections," WHO said.

"In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays."

Originally Posted by mugwump

Physicians diagnose and nurses heal. . But the nature of their jobs, and the emphasis of Western medicine, makes then reactive instead of proactive. They may be right and this may be nothing. But from the sounds of things I'm guessing that their current judgments are not informed ones.

I have to jump in her and disagree with that simplist view of what we nurses do.
Over the past 30 yrs. I have been around many, many MD's and nurses who do a lot more than heal. Teaching is a large part of our job. I have seen Docs take huge amounts of time to explain and teach a pt how to care for themselves. Nurses both teach and are proactive in our jobs. It is a part of our job.
Therefore to say we 'heal'...sorry I stopped laying on of hands yrs ago when I got poison ivy from a pt..

15% of patients is not a large number needing Hospitilzation from the Swine Flu. I think if you break it down to more logical and real components, one will find that the vast majority of them would have been hospitilized with any version of the flu.
The elderly, the very young, those with compromised (for whatever reason) immune systems, and so on. In any population with a virus of some sort, there will always be those who will get sicker for the above reasons. A homeless person with poor nutrition, an older person, a very young child, healthcare workers, HIV/bone marrow decreased/already sick...I look at more for a normal healthy individual population percentage then the above. To lump them all together is self serving for the rumour mongers and the media who make thier living and money off sensationalism. Not to mention, this whole deal is making drug companies major bucks. Sit back, take it into perspective, take a deep breath and do what you would do in a normal flu season and get on with life.

http://vsearch.nlm.nih.gov/vivisimo/...+flu&x=44&y=11

The above is enough info to keep you reading, and out of trouble, for the rest of the day. YMMV.
AM

[mugwump]

Originally Posted by armymom1228

15% of patients is not a large number needing Hospitilzation from the Swine Flu. I think if you break it down to more logical and real components, one will find that the vast majority of them would have been hospitilized with any version of the flu.

I didn't mean to offend and I don't think diagnosing and treating disease is simple. But I also think you've proved my point. Your examples all relate to an average year of seasonal flu, with typical hospitalization candidates. I am not talking about seasonal flu, I am talking about pandemic H1N1 influenza. See one of the web sites you cite for the differences: How Does Seasonal Flu Differ From Pandemic Flu?

The WHO report I cited says that forty percent of those hospitalized have no underlying conditions and are "young" (which in other reports -- see below -- is reported as "young adults"). This is certainly atypical of an average flu season.

Swine flu spreading at 'unbelievable' rate: WHO chief

Swine flu spreads four times faster than other viruses and 40 per cent of the fatalities are young adults in good health, the world's top health official says. "This virus travels at an unbelievable, almost unheard of speed," World Health Organisation Director General Margaret Chan told France's Le Monde daily in an interview on Saturday. In six weeks it travels the same distance that other viruses take six months to cover," Chan said. "Sixty per cent of the deaths cover those who have underlying health problems," Chan said. "This means that 40 per cent of the fatalities concern young adults - in good health - who die of a viral fever in five to seven days. This is the most worrying fact," she said, adding that "up to 30 per cent of people in densely populated countries risked getting infected."

If 1/3 of the population gets H1N1, as the CDC predicts, that's 100 million flu cases. If 15 million of those end up in the hospital, it will certainly be catastrophic. [As I said, I think the 15% statistic is highly suspect, but even if it's off by an order of magnitude it's worrying.]

In the 2007-2008 flu season, which was the worst in the last 5 years, the influenza-associated hospitalization rate reported by the CDC for children aged 0-17 years was 1.53 per 10,000 with 83 deaths. For children aged 0-4 years and 5-17 years, the rate was 4.03 per 10,000 and 0.55 per 10,000, respectively. Imagine if those hospitalization rates go up to 1,500 per 10,000 -- those 83 deaths in the 0-17 age group could rise to 83,000 deaths (asuming equivalent CFRs which I grant is a "who knows?") [cite]

I disagree with your position on "rumor mongering." I sometimes disagree with the CDC or WHO positions but back that up with facts, or at least historical precedents. To dismiss their research as rumor mongering is dangerous.

Two companies out of the 100 "large" pharmas make antivirals: Roche and Glaxo. Would you prefer the drugs weren't available? They make peanuts on those drugs compared with compounds for chronic conditions like hypertension and arthritis. For researchers, Roche is the best source for oseltamivir resistance information, even though it hurts sales to advertise that their drug is rapidly becoming ineffective. They have no obligation to do that but do it anyway.

I've been in more meetings where the financial liabilities of producing a vaccine are discussed than ones where the word "profit" is even mentioned. I know that one company is looking at significantly less than a billion in total profits. Before you say that's a lot, Merck had a judgment against them of $24 million in actual damages, plus $229 million in punitive damages for a single Vioxx case. They know that there will be cases of GBS associated with their vaccines; it's as inevitable as taxes. And while they don't trust gov't assurances of indemnity they are still working full speed to get this vaccine out the door.

I'm more than happy to be called out on anything I cite or on any opinion I voice. I don't know what's going to happen in the upcoming pandemic (not seasonal) flu season. But it is my strong opinion that "Sit back, take it into perspective, take a deep breath and do what you would do in a normal flu season and get on with life" is the wrong message from a health care professional.

Prepare for a moderate pandemic with the potential for short-term disruption of the supply chain. Have at least two weeks of food, sufficient OTC medication and fluid replacement for everyone in the house. (Assume that you may not want to be standing in line getting sneezed on at the local megamart.) Be able to disinfect surfaces, have alcohol based hand sanitizers, and educate yourself regarding home care.

Now you've done the barebones minimum recommended in the .gov web sites you cite. Now you can forget about it and go on with your life.

My bad, I forgot to mention this...

There is a difference you should know between BIRD FLU and SWINE FLU

For BIRD FLU you need tweetment


For SWINE FLU you need oinkment

Sent to me by a MD freind.. who works at the CDC. HE is not running around panicked and saying,
"the sky is falling, the sky if falling." As I have known Mac since the 5th grade. I only get worried when HE gets worried. When HE gets truly worried, he sends out a mass email to all his freinds.. no email so far.. just one about 'reasonable precauations"...

Mugwump, I have lived on this earth long enough to know that there will aways be some sort of 'pandemic' illnness or another. I take it all in stride.. when it is my time, it is my time. It was a QP support person who taught me that atttitude. I quit panicking everytime he deployed, and now enjoy his trips abroad as much as he does.. it is the same with illness. Take reasonable precautions and get on with my life.

[mugwump]

Originally Posted by armymom1228

Mugwump, I have lived on this earth long enough to know that there will aways be some sort of 'pandemic' illnness or another. I take it all in stride.. when it is my time, it is my time. It was a QP support person who taught me that atttitude. I quit panicking everytime he deployed, and now enjoy his trips abroad as much as he does.. it is the same with illness. Take reasonable precautions and get on with my life.

Good attitude. Mine as well, personally. I have three kids who are in the "atypical demographic cohort", though, and about a hundred more that are under my "umbrella of concern" (ATTENTION: new corporate buzz-phrase, at least new to me). And I have to say that I'm scratching my head trying to come up with all the pandemics you've seen or heard about because the epidemiologists I work with generally have zero experience with a flu pandemic, or any pandemic for that matter.

Reasonable precautions in a pandemic year and reasonable precautions in a seasonal flu year are different -- and many people are still giving advise as if they are one and the same.

I've worked extensively on data analysis for the H5N1 vaccine, was out of the active loop with H1N1, but I am now back in that game as well. I'm not a major player by any means but many of the major players use my software. I'm in fairly regular contact with pharma researchers, WHO, CDC, and have occasional contact w labs on foreign soil. I carefully differentiate between personal opinion and Charter House statements, some of which are from a certain-to-be Nobel Laureate. Many times I am not at liberty to discuss what I hear, even on a Charter House basis, in which case I must wait until there is a MSM story, at which point I will post a citation.

I saw the data in a presentation weeks ago that underlies the "15% hospitalized" announcement from the WHO and it's real, although in my opinion it's badly skewed by a faulty denominator. It is mostly from northern Argentina. I hinted at it a couple of weeks ago because it was being reported in the blogs (which are perceived to be valuable sources of raw info and are watched carefully by the various orgs, BTW). I'm not panicking, hyperventilating, or saying the sky is falling. Just posting what I see as a relevant piece of the puzzle that grownups on this board (many of whom are experts at assessing intelligence data) can use to make their own assessments.

[mugwump]

Latest update and my assessment.

My pool bet is still a CFR of 0.1% (hey, we do ncaa basketball too), about what we see in a typical flu year. The attack rate, and therefore total deaths, will be about three times higher than normal. I see nothing to change the expectation that approx. 50% of the deaths will be in the young, healthy cohort.

Some groups have upped their planning CFR from 0.35% to 0.45% (total number infected * 0.0045 = number dead). Again, this is for planning purposes and is not a prediction. Call it the current worst-case scenario, based upon the facts on the ground. They never said why and I was in no position to ask but the recent uptick in the southern hemisphere death rate is the only reason for the the change that I can see. There's talk of significant ICU overload as well.

Again, none of the muckmucks I talk to would be surprised if this was significantly milder or significanlty worse than expected, and they each have a diffferent expectation that they keep close to their vest. It's all a crap shoot.

The most interesting use of the CFR data was by a guy modeling the "infodemic" potential of a pandemic. It was all very interesting, but it 'felt' flawed. A guy in WHO once told me that everything in a society holds together pretty well until you start driving by bodies in the street (when that's not typically the case).

More random notes: "they" know that up to 50% of the H1N1 infections present with no fever and GI symptoms but cannot change the diagnostic criteria or "back to work" recommendation (stay home until fever-free for 24 hours with no meds) -- change it to what?; there's more evidence that old farts (pre-1957) who were exposed to the last H1N1 pandemic have some immunity; HIV and immunocompromised are not dieing at a higher rate -- no one knows why (I wanted to go "Ooh! Ooh! Weak immune system = weak cytokine cascade" but flies on walls don't speak or they get swatted); as has been published, concerns remain about original antigenic sin and administering two similar flu vaccines -- seasonal and pandemic -- within a week or two of each other (Google original antigenic sin if you're interested); the next 'bugs and drugs' show (ISIRV) is in Miami :-( ; no one voiced concerns about vaccine safety but I wouldn't expect that from this group.

Mugwump.. since we seem to be at the end of the Southern Hemisphere flu season.. with thier spring approaching fast can you answer the following quesitons with numbers not statistics, that can and are always skewed to the support the analystis goals.

1. Exactly how man people in the entire southern hemisphere were diagnosed with the swine flu? Entire means ALL the countries not just Argentina.

2. How many of that group died with the swine flu as the only diagnosis that caused death.

3. How many diagnosed with swine flu in the southern hemisphere died of other underlying causes that the swine flu contributed to, or that simply had the swine flu and the listed caused of death was something elese?

4. Of the group diagnosed with the swine flu, how many fall into the "at risk" group based on age, and diagnosis of other 'at risk' medical conditions.

5. On a per million grouping... how man people per million in the entire southern hemisphere were diagnosed with swine flu and of that group how many died?

Please to note: I did not mention getting hospitalized. First it is a virus we can only treat the symptons and secondally.. There are quite a few docs out there that will stick a pt in the hospital if they bitch enough, therefore that is not an accurate methodology to use for data research.

There will always be something that is going to kill us.. ebola, bird flu, cancer, hangnails.. something.. and that was the point I was making, that you missed.

[mugwump]

Originally Posted by armymom1228

Please to note: I did not mention getting hospitalized. First it is a virus we can only treat the symptons and secondally.. There are quite a few docs out there that will stick a pt in the hospital if they bitch enough, therefore that is not an accurate methodology to use for data research.

There will always be something that is going to kill us.. ebola, bird flu, cancer, hangnails.. something.. and that was the point I was making, that you missed.

I didn't miss anything. I get it...Don't worry, be happy. Go find your own data. If you have anything else, please take it offline.

[Sacamuelas]

Armymom-
Everyone who has been on this board for any length of time can decipher for themselves how to react to the updated information from MW. If this entire thread is read, it has been made crystal clear by several posters, including MW, that the information is not being posted to scare or shock people.

You pose some legitimate questions. However, it would appear from the other threads that you are educated enough to research and then discuss the answers to the questions you pose. Why not do that instead of sniper MW with lots of questions? I doubt anyone on this site has the time to do the research for the opposing side of the every debate.

Let's leave MW alone concerning his zest for this topic and his posting style...
Your points about prudent actions and attitudes were made and taken by all.

Back to topic....

[mugwump]

No one should be surprised to hear that I have an executive VP who is in charge of client relations. Besides being incredibly competant technically, he is also suave, handsome, and nice. He can simultaneously discuss, flatter, and redirect in a way only the classically educated Oxford Brit can. And chicks dig the accent.

That ain't me. Except the accent part...when I'm over there then chicks dig my accent. It's a Krypton thing; you only gain the power when you're away from home. As long as you don't say auto-MO-bile or IN-sur-ance. Then you're a hick...just sayin'.

[mugwump]

Here's a good, recent summary ArmyMom. I hope your ICU chief has seen it.

Helen Branswell is the top science reporter in the world, in my opinion. And note that the war stories in her article are from the mild first wave this last spring, which in the US was estimated to comprise 1 million cases (and no, I don't have figures for Canada and Uruguay ). I hope the second wave is equally mild, but even so the conventional wisdom is for 30% to 50% of the population to contract the virus. Conventional wisdom could be wrong and I hope it is. But if it isn't, consider 100 to 150 million cases in five months and remember what Uncle Joe said: "Quantity has a quality all its own."

===========================

The Pulitzer prize winning Helen Branswell discusses the impact of the quantity of flu cases here : War against H1N1 likely to be fought in intensive care units

Note the references to the hallmarks of pandemic flu, and what sets it apart from seasonal flu: ARDS, CNS involvement (agitation), multiple organ involvement, and the young median age being reported.

I've heard the following, in many different ways, from many different people working on this issue:

No one knows what this new flu virus has in store for humans. But health-care professionals who've dealt with the sickest pandemic flu patients say it makes sense to prepare for tough times.

``I always say that the one thing I don't want to do is in a year look back and say `I could have done this' or `I should have done that' kind of thing,'' Kumar says. ``I'd rather look back and say: `Man, I really over-reacted.'''

Originally Posted by Sacamuelas

Armymom-
Everyone who has been on this board for any length of time can decipher for themselves how to react to the updated information from MW. If this entire thread is read, it has been made crystal clear by several posters, including MW, that the information is not being posted to scare or shock people.

You pose some legitimate questions. However, it would appear from the other threads that you are educated enough to research and then discuss the answers to the questions you pose. Why not do that instead of sniper MW with lots of questions? I doubt anyone on this site has the time to do the research for the opposing side of the every debate.

Let's leave MW alone concerning his zest for this topic and his posting style...
Your points about prudent actions and attitudes were made and taken by all.

Back to topic....

Sorry to be a bother... I was just curious as to what the raw data was that was all. So far I haven't really seen much..
I just assumed MW had that at hand.. it was not meant to be a bother, honest it wasn't.. it was all born of nothing more than
curiousity.

Forgive the intrusion..
AM