U.S. Working on Plan to Designate ( in Case of Flu Pandemic)

[cal04]

U.S. Working on Plan to Designate Who Cares for Sick, Who Will Keep Country Running in Case of Flu Pandemic Photo

A super-flu could kill up to 1.9 million Americans, according to a draft of the government's plan to fight a worldwide epidemic. Officials are rewriting that plan to designate not just who cares for the sick but who will keep the country running amid the chaos, said an influenza specialist who is advising the government on those decisions. "How do you provide food, water ... basic security for the population?" asked Michael Osterholm of the University of Minnesota, a government adviser who has a copy of the draft plan and described it for The Associated Press.

"This is a much more comprehensive view than has previously been detailed," he said in an interview Saturday. The Bush administration has spent the last year updating its plan for how to fight the next flu pandemic. While it is impossible to say when one will strike, the fear is that the bird flu in Asia could trigger one if it mutates to start spreading easily among people. A recent draft of the plan, first reported Saturday by The New York Times, models what might happen based on the last century's three pandemics. In a best-case scenario, about 200,000 people might die. But if the next pandemic resembles the birdlike 1918 Spanish flu, as many as 1.9 million could die, Osterholm said. Millions more would be ill, overwhelming hospitals. "You plan for the worst-case scenario," he said. "If it's less than that, thank God."

The government has on hand enough of the anti-flu drug Tamiflu to treat 4.3 million people. Manufacturing of $100 million worth of a bird flu vaccine just began. The draft makes clear that tens of millions more doses of each would be needed. That is far more than the world has the capacity to manufacture quickly.

To finish that draft plan, federal health officials for several weeks have been role-playing what would happen if a super-flu struck now - not next year, after more medicines and vaccines have been stockpiled. The strategy, Osterholm said, is, "Don't emphasize what you can buy, emphasize what you can get your hands on. If it happens tonight, how do you deal with order?"

http://ap.tbo.com/ap/breaking/MGB5O1IAKEE.html

http://www.nytimes.com/2005/10/08/politics/08flu.html?ei=5090&en=fe3a7bec6c129653&ex=1286424000&partner=rssuserland&emc=rss&pagewanted=print

[sam sarrha]

1. I am upgrading my Caliber... what else can you do..??

[rzemanfl]

5. Wanna sell your old gun? n/t

[SpiralHawk]

13. Catpult some propaganda?

Of course

[Endangered Specie]

15. get more ammo, pratice

[formercia]

43. Get more lethal ammo, practice

cheap at twice the price.

[formercia]

44. Going Bird hunting this Year?

I wouldn't if I were you. Nothing like bringing Bird Flu home and feeding it to your family.

[sam sarrha]

2. They couldn't just build a big factory and put Tech's like me to work..?

foreign factories wont let go of it when it hits..

[lovuian]

3. Well I wonder how the hospitals will be able to handle

when a flu victim comes through the door

Do you have Insurance can you pay???

this is where our Hospitals are sooo screwed!!!

and their workers are free to do what they want!!!

How many Hospital employess with get sick and die from this and dang may not be able to show up for work... get a clue our Medical System would be in a shambles!!!

[leesa]

10. Our medical system is already in shambles...thank managed care

[rzemanfl]

4. So, why not vaccinate anyone who leaves the country and

require anyone who comes into it from overseas to prove they were vaccinated? If it never gets here, problem is solved, no? It is likely to come on an airplane, people who got sick on a ship would get sick on the voyage and could be quarantined. What am I missing here? Why not just vaccinate everyone who travels internationally by air?

[carolinalady]

6. you can not vaccinate wild birds--n/t

[rzemanfl]

8. It's my understanding that they are not terribly worried about

bird to human transmission, but rather a mutation that would allow the virus to pass from human to human. At least that's what I am getting from what I have been reading.

[uppityperson]

7. Viruses mutate

[rzemanfl]

9. Then why make a vaccine? n/t

[kestrel91316]

14. Geez, here I go again, having to explain why vaccines can't just be

given willy nilly, just like I do at work every day.

First of all, vaccines are for PREVENTING infection prior to exposure. They are of no value in someone who has already been exposed to a virus, or certainly for one who is actually coming down with one.

Second, vaccines generally require two doses at a specified interval to induce immunity. It takes time, and it takes a schedule. For instance, when we vaccinate kittens against distemper and respiratory viruses, we do so at 8 weeks and 12 weeks and 16 weeks of age. You can't just give a dose one day, anothe dose the next, and a third dose the next. Won't work. The explanation for this took several days of college level immunology lectures, so please don't ask. Take my word for it, it's just how the immune system works.

Third, not everybody can BE vaccinated. Vaccines should not be administered within a week of a fever, at least in veterinary medicine, and I know of no reason why humans would be an exception. Some people with immunosuppressive disease cannot receive certain vaccinations.

I could go on at length, but basically it's a silly idea. You would have no way to enforce the rule for being vaccinated PROPERLY prior to entry to the US. And there is that little matter of the migrating birds anyway.


Edited for spelling

[carolinalady]

19. Based on what you are saying-- it seems to me that the flu

vaccine in general is a farce--you only receive one dose of that. What are your thoughts? Thanks.

[kestrel91316]

21. Some vaccines are considered effective after only one dose, but

the immunity is not instantaneous - it requires a response over several days by the immune system. The FDA or UDSA or whoever regulates biologicals (aka vaccines) approves vaccines only after appropriate testing for safety and effectiveness by the manufacturer (clinical trials). In the case of rabies vaccination of cats and dogs, for whatever reason, it only requires one dose that first year of life, with annual boosters (or every three years with one brand). Same with flu apparently. But when people get vaccinated for rabies (as I did in vet school) we had to get I think three initial doses on a monthly schedule IIRC. And kittens need a set of three FVRCP their first year, and two FeLV. So it really depends on the individual vaccine.

The point was, it wouldn't do any good to vaccinate people entering the US on the day they entered. Just like when I require appropriate vaccinations IN ADVANCE of admission for elective procedures at my cat hospital, they would have to have their flu shots some period of time prior to entry for it to have any meaning. A shot of vaccine is not a shot of immunity, it is a shot of the means to immunity.

FYI - I use lay terms such as "shots" rather than injections and "vaccination" rather than immunization primarily because it's faster to type, and people are more familiar with those terms. Hope I haven't stepped on any medical professionals' toes or offended anybody.

[carolinalady]

23. You do not offend me--I am a nurse, but pharmacology was

always my worst subject! Thanks for the info--I have learned and refreshed my memory alot from reading your posts.

[barb162]

27. You state:

"You would have no way to enforce the rule for being vaccinated PROPERLY ...."

What is the problem you see that any person coming to the US from anywhere else has to show a vaccination certificate from at least one to two weeks prior to boarding a plane for the US. You don't have that certificate with you, you don't board the plane. Just as now they require more ID at airports and more physical security, people can deal with it or get out of the airport. If a person has an immunology disorder and can't be vaccinated, then they can't come here (until the pandemic is over).


I think most birds migrate north/ south versus east/west and suspect we'll see more bird deaths now in southeast Europe (from Romania).

[kestrel91316]

29. I think that while your idea for a vaccination certificate is excellent

in and of itself, I can say categorically that it wouldn't work. Why not?? Too easy to fake it, or bribe somebody to issue one falsely.

The rabid cat I diagnosed years ago that came into the US from Mexico was issued a Health Certificate while it was CLINICALLY RABID and FEBRILE. The vet in Mexico had no business issuing a health certificate, but he did so, probably for a fee. People do these things, sad to say.

[barb162]

30. So what do you think of wearing masks?

Is that effective? Just heard on the news Turkey is saying it's there

[kestrel91316]

32. Unless they have human infections and the risk of p2p spread,

masks are probably silly. In the event of a true pandemic with propagation through the human population, masks will be de rigeur. It's called respiratory etiquette. The Japanese have been ridiculed for it, with their surgical masks in public, but it does help somewhat to keep from passing the bug to others. Maybe less effective at keeping the wearer from catching the bug.

Just as with normal flu, handwashing and disinfection of potential fomites is critical. And NOT TOUCHING YOUR FACE with unwashed hands.


Edit: left a critical word out, tired........

[mike_c]

17. can't make an effective vaccine until the virus mutates/recombines...

...and then there is very little time before the pandemic starts. There's no such thing as a generic flu vaccine.

[kestrel91316]

24. H5N1 is NOT a "generic" flu vaccine. It has been tested and is

apparently safe and effective. The primary antigens you need to stimulate immunity to are the HEMAGGLUTININ 5 and NEURAMINIDASE 1 antigens, for which the virus is named.

If you have factual information or better yet a link to valid medical information indicating I have got it wrong, please provide.

[mike_c]

35. the epitopes on those antigens aren't stable....

Influenza viruses undergo constant antigenic drift. The drift rate is presumably an evolutionary response to host immunity. Type A flue viruses are notorious for this-- that's why surviving a bout of this year's flu doesn't necessarily convey immunity to next year's. All influenza type A viruses have the hemagglutinin (H) and neuraminidase (N) antigens, so if those antigens were stable, immunity would be too. Unfortunately they're not, so a vaccine produced too early runs a high risk of being ineffective at the time of delivery, because the flu strain used to produce the vaccine no longer matches the wild type in circulation. The drift rate for H5N1 appears to be a bit below average, but this can change at any time, and still argues against too early vaccine production OR flexible production that doesn't commit all our resources to one strain. That sounds like a good idea, but in truth the present capacity is way too small to do this. It's probably going to be all or nothing, and that makes timing the vaccine production critical.

The second-- and even more intractable-- problem is antigenic shift. Unlike drift, which is more-or-less constant (but still unpredictable), antigenic shift occurs instantly when viral particles recombine with other viruses. It too is utterly unpredictable and often produces epitopes that are unrecognizable to previously selected antibodies. This is the major reason that viruses like the 1918 pandemic encountered human populations with NO immunity-- the Spanish flu still had the H and N antigens, but the antigens presented epitopes that were different from those of other type A flu viruses in concurrent circulation. A vaccine has the same problem, and H5N1 is very likely to undergo some degree of antigenic shift at the H and N epitopes when it recombines with another virus and acquires easy lateral transmissiblity in humans. Again, this makes early vaccine production a very dicey proposition, because once the limited production capacity is committed, it is virtually impossible to bob and weave with the virus and its changing protein conformations.

A third problem appears to have a potential solution (and perhaps this is what you were talking about?). Vaccine production relies on culturing flu virus in chicken embryos, but H5N1 is rapidly fatal to chickens. The current production trials are mainly designed to test a targeted gene disruption technique that is intended to replace the Ha and NA genes in the virus that contribute to chicken mortality WITHOUT altering the H and N antigen epitopes need by the human immune system to recognize the virus. So far the data are equivocal IIRC, with some success in stimulating human immunity, but at much higher required dosages than conventional flu vaccines, and the strength of immunity remains questionable.

Finally, I apologize if you already know all this-- it's distressingly easy to drop into prof mode. Here are a few relevant links:

http://www.cdc.gov/flu/about/fluviruses.htm
http://www.nature.com/news/2005/050808/full/050808-9.html
http://slate.msn.com/id/2124229/

[kestrel91316]

36. Thanks for an excellent explanation of the problem, and I do believe

you are right about this (I have been away from academia too long, and got some things wrong). Not what we all want to hear, but it's the way things are.

Sure wish I could go live in a cabin in the boondocks for the next few years, 'til the dust settles. Stuck in Lost Angeles won't be fun if this hits.

[leesa]

11. This scary propaganda is just a pretense to declare martial law

Every year we get the same song and dance and they hone their fascist plans a little more.

[Miss Chybil]

12. Is this for real? I mean is the threat any worse than it's ever been, or

are they trying to make it look like they actually care about our country and get their own little scandals off the front page? I wish I could trust our government.

[kestrel91316]

16. Well you might consider that it's the infectious disease doctors, the

epidemiology and virology experts who are in an uproar about this, and FINALLY the administration caught on. This whole thing is NOT something the Bush administration cooked up. Unlike the terrorism threat.

[mike_c]

18. yep-- public health officials are TERRIFIED of what H5N1 might do....

eom

[truth2power]

20. Gotta ask this...

If/when bird flu comes here, is it likely to affect ordinary birds (songbirds etc.) or just chickens, ducks, turkeys?

Maybe this is a stupid question, but I've been wondering about it for awhile. :shrug:

[kestrel91316]

25. Poultry is the main problem, I suspect. And I think there is some evidence

that ducks might be able to harbor the virus asymptomatically, which is NOT HELPFUL. Yikes. Ducks migrate all over the place, and if they are spreading it and not dying of it, look out!

[truth2power]

33. Thanks for clarifying that. I had envisioned

some sort of government ordered mass destruction of wild birds (songbirds etc.) which would be an environmental disaster.

[kestrel91316]

37. If it affects all the songbirds, raptors, etc, we won't have to go kill

them all. The virus itself will take care of that quite adequately.

Sad days are coming, I fear.

[nothometoday]

39. Also..is this similar

to the black plague, where fleas or parasties can transmit the virus?

[YouthInAsia]

22. I've stocked up on gas masks and GOOD NBC filters

[carolinalady]

26. you need FOX filters---lol n/t

[YouthInAsia]

40. It took me like 10 minutes to figure out what you meant. HAHAHAHA

[rfkrfk]

28. what about Canada?, I feel sorry for the people of Toronto

they seem to get everything first.

Sars, now Bird Flu

[Hekate]

31. What's crazy is the figure (8.5 M) of those needing hospitalization

That figure has been all over the broadcasts: 1.9 million dead, 8.5 million in hospitals.

Who are they kidding?! This country doesn't have that many hospital beds, probably never did even before all the hospital closings and regional "consolidations" of medical centers that have taken place in the past decade.

Read up on first aid, home care of the sick and injured, etc. Lay in a home supply of hospital masks, latex gloves, electrolytes, Pedialyte, alcohol, hydrogen peroxide, and whatever else you may need to nurse your family members through a potentially deadly illness. Form neighborhood networks and vow to check up on each other. Plan in advance how you will dispose of the dead if the usual means break down.

Remember the lessons of New Orleans. If it gets THAT bad, we're on our own.

In the meanwhile ... Idiot Boy gets another excuse to alarm the citizenry and talk up his big penis, oops, I mean his Commander In Chief status and his Big Army. Have you noticed how very much he wants to deploy his Big Army here at home?

Fegh.

Hekate

[area51]

34. Q: "How do you provide food, water ... basic security...."

A: We don't. See the results of hurricane Katrina. This nazi administration wants us to go on paying our tax $$ and get nothing in return. :mad: Plus, as other posters have basically said, w/o universal healthcare, only the über-wealthy will have access to medical care.

[Kailassa]

38. Some info we could need re face masks.

"Most low-end facemasks are N95 filters. However, efficiency decreases with overuse of disposable masks, which should be replaced every 8 hours."
http://xxydesign.ucsd.edu/twiki/bin/view/Experimentalproduct/AirQualityResearch

Disposable, NIOSH-certified, fit-tested N95 respirators should be worn when entering the room and removed immediately after leaving the room. Once worn in the presence of a SARS patient, the outside of the respirator should be considered potentially contaminated with infectious respiratory particles and touching the outside face piece of the device should be avoided. After leaving the patient's room the respirator should be removed by grasping only the head straps and discarded ..."

The article goes on to give advice as to what to do if one must be re-used, such as wearing a fresh surgical mask over it each time.

As Avian Influenza could be both more contagious and more deadly than SARS, the advice for it will be at least as stringent.
http://www.stanfordhospital.com/PDF/sarsCDHSinfectionControlRec060303.pdf

This article in Nature magazine also has relevant information.
http://bioterrorism.slu.edu/AvianJune05/MedicineCabinet.pdf

Remember, if you have been exposed to air-born viruses, you can infect yourself by touching the face-mask afterwards, and you can spread the virus through the community by re-using it.

[sarcasmo]

41. Bird Flu TERRA, run for your lives, TERRA TERRA

[LizW]

42. Oh. They're working on a plan. Well, I feel better already.

You know, if I was going to make a plan for a disaster of these proportions, and I had the power George bush does to suspend any laws he sees fit in times of national crisis, I would suspend patent law and force the patent holders of Tamiflu to allow other drug makers to start making it. That is, if it really will save lives. If this really is going to be a pandemic of epic proportions, the thing to do would be to work on getting enough of a life-saving drug into people's hands as soon as possible.

But sometimes my tinfoil hat slips a little and I start thinking this whole thing is just a sham to increase drug company profits and to terrorize us in the bargain.