So much of what goes under the name of pandemic planning at the governmental level iks extremely narrowly construed. Should a pre-pandemic (not precisely matched) vaccine that might offer some cross protection be used? What should be the mix with antivirals (and which one)? Should antivirals be stockpiled, and if so where and for what purpose? Just treatment or should prophylaxis be part of the plan? And who should get the antivirals? When should schools be closed and what should trigger a closing? Air travel? Quarantine? Isolation? Etc., etc. Restricted as they are as pandemic planning goes, there is more than enough complication to occupy the entire thoughts of an army of health planners. Consider this:
Public health officials across Canada are grappling with the medical and ethical issues of giving front-line health-care workers preventive antiviral drugs if a flu pandemic strikes.The federal and provincial governments have stockpiled more than 500 million doses of antiviral drugs to prepare for a pandemic.
Under the current federal plan, the drugs may only be used to treat people once they are ill, a reversal of an original decision two years ago to stockpile antivirals as a preventive treatment or prophylaxis for front-line health-care workers as well.
Antiviral drugs such as Tamiflu offer the best hope of protecting health-care workers in the event of a pandemic and keeping them on the job to treat patients, said Dr. Michael Gardam, an infectious disease expert at Toronto's University Health Network.
Following the outbreak of SARS in 2003 that killed 44 people in Toronto, most large hospitals in Ontario decided not to take chances and have stockpiled Tamiflu for their employees.
If there is a shortage of Tamiflu, [Dr. Michael] Gardam said, hospitals have been told the Ontario government has the right to confiscate the drugs bought for preventive purposes, but he disagrees with that approach. (Canadian Broadcasting)
Tough questions and no doubt arguments to be made on both sides. We simply don't know with confidence how to handle scarce resources in this situation. Thinking and arguing about it ahead of time is a good thing.
But it's not the only thing, or, we would claim, even the most important thing. Because a pandemic, whether of H5N1, another subtype or another pathogen altogether, will be a shock to the system, and it is the system that has to be hardened and made resilient. The system, in this case, is our web of interdependent communities at various scales from households and neighborhoods to towns to cities to states to the nation and then globally. At each scale we need to strengthen the sinews of the public health and social service infrastructure, the bonds of community and neighborliness, the impulse to cooperation and service.
Some of this we can all do in our own communities. But wouldn't it be nice if there were some leadership from those we call "leaders"?
I know. Too much to hope for.
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This is a chronically revolving discussion, Revere. And it runs parallel to a much, much slower chronologicaly evolving construct: "The Plan."
First, you recognize that there is a need for "something." You, I, and many others were at this stage four-or-so-years ago.
Then, you ruminate on, and discuss the nature, and possible extent of the "potential" incipient catastrophe. As the potential clearly, unmistakeably, appears to visibly expand, you discuss the need for "the plan."
Then, you discuss "the plan." You consider, to the extent possible, all of the aggregate elements that must be "assumed" to be subject to the forces of the incipient catastrophe. You grow more and more apprehensive, as you necessarily regognize the vast scope, and nature of the problem. At this stage, however, you are still only talking about "the plan." There is no plan. Yet. But the forces governing the evolution of the nascent catastrophe continue to evolve. The implementation of "the plan," that is not yet "a plan," becomes increasingly difficult; that the circumstances suggest that the catastrophe looms larger with each passing day, only adds to the increasingly
This may have been one of your best posts ever Revere. I am not liking what I hear though. There is in our future a pandemic...type and severity unknown. Canada sounds like they might have to declare a state of emergency early on because like the US they cant "confiscate" anything without that in place. Local officials cant do it. The State could but they would be liable for whatever happened to you post of the flu. If your plan was in writing, shelter in place with enough supplies for you and your family and they come in and take it, then the attorneys of the post pandemic world would have a field day. Cant sit there and say prepare and when you do, they take it later? What is this, government prepping light?
What happens if you have had the presence of mind to prepare. The neighborhood knows you have food, water, medicines, maybe even masks. The declaration of a state of emergency suddenly makes you a target not only of your neighbors, but your government too? They didnt have the foresight to prepare so now they take your stuff? Uh, with all due respect to both the governments of the US and Canada they will draw back a bloody stump if and when they come here. They might get the stuff but they would pay a heavy, heavy toll. We are talking about a taking and its not illegal under a state of emergency but they do have to compensate you for it. Post of this taking if a family member died of BF because they then had to go out and forage for food and got sick, the governments would be out hundreds of millions, maybe billions. Tamiflu or other antivirals might be more ambiguous to prove that you would have survived if the Feds hadnt taken it from you but the juries would be very, very sympathetic.
We are told every day by the federal governments of both countries to prepare. Then when they, the people dont and especially the government doesnt either they come and take your stuff and this is supposed to be acceptable? Not on my shift they dont.
New recommendation. Prep, file a copy of your pandemic plan with an attorneys office under seal of notary . They come and take your stuff and put you into the mill with everyone else, then they are liable plain and simple. Michael P....... New business not unlike the Katrina mess.
(Accidental, unintended posting.) To continue:
...congruent symphony of voices that are all repeating that we must have "a plan."
For a plan to be of any value, there must necessarily be mechanisms in place to "test it." Only testing can reveal strengths, and weaknesses of "the plan." You must, without possibility of taking anything for granted, have (as you have noted) all of the salient issues addressed; and have the necessary structures in place to deal with them on a level that at least allows for some possibility of their succeeding.
When the Storm comes, "the plan" will be put to the test. There is no "Plan B."
As I see it, we collectively reside at the level where we admit (increasingly) that there must be "a plan." That is not a good place to be, at this, possibly, very late stage of the game.
Dylan: I think I have a slightly different take. My view is more along the lines of Eisenhower's, "The plan is nothing. Planning is everything" adage. Planning includes testing various plans so we get to know each other, but I don't think The Plan is going to be of much value. Most likely it will be out the window on day 3. That's why I lay so much emphasis on strenghtening the infrastructure. If the structure holds, we can find a way through. If we have a plan but no way to implement it it doesn't matter.
Some of these issues were addressed last year in terms of international flu pandemics - http://www.hopkinsmedicine.org/bioethics/bellagio
With support from the Rockefeller Foundation, an international group of experts in public health, animal health, virology, medicine, public policy, economics, bioethics, law and human rights met in Bellagio, Italy from 24 to 28 July 2006 to consider questions of social justice and the threat of avian and human pandemic influenza, with a particular remit to focus on the needs and interests of the world?s disadvantaged.
Although it is generally recognized that the next influenza pandemic could have far-reaching consequences in terms of morbidity and mortality, comparatively little attention has been paid to the ways in which a pandemic could have a disproportionately negative impact on socially and economically disadvantaged groups. As an example, even before a pandemic occurs, poultry farmers, are currently bearing a large part of the burden of efforts to contain the spread of highly pathogenic avian influenza in domestic birds. The last severe influenza pandemic, which occurred in 1918, resulted in particularly high mortality rates in developing countries, as well as among the poor in developed countries, such as the United States. These and other considerations suggest there is a particular need to address the needs and interests of the world?s disadvantaged while preparing for, and responding to, the threat of an influenza pandemic.
Revere: I really don't think that we are that far apart, here. Here is a Silicon Valley simile that approximates my view of the Government's current level of preparation, with regard to the infrastructure that we both realize is "key" to managing this increasingly likely event:
(Courtesy of PCMag.com, encyclopedia)
Definition of: vaporware
Software that is not yet in production, but the announced delivery date has long since passed. At times, software vendors are criticized for intentionally producing vaporware in order to keep customers from switching to competitive products that offer more features. However, programmers are notorious for being awful estimators of time. As a result, shipping dates often slip over and over again.
Sometimes, the gap between management and technical staff in software companies is just as large as in user organizations. Dates slip because the project is not managed properly, which can be caused by management's lack of understanding of the scope of the project as well as a lack of knowledge of the competence of the technical staff. In addition, as software projects progress from stage to stage, new functions and changes always seem to creep in.
Remember This Well
"As bad as programmers are at estimating the length of a project, they are equally as optimistic about their ability to meet the requirements and deadlines."
Joe: Thanks for reminding me. We took note of it here at the time.
Dylan: Yes.
WHAT?? Randy Kruger being nice to a lawyer?? What has the world come to?
Michael please, I have always had a place in society for lawyers....you know groups of them used as anchors on our merchant marine fleet.
I think its officially coming now. Louisiana started mailing 1.8 million pamphlets out on Monday to heads of registered households. Now this is one of the poorest states in the US and they are doing it. Might it be because they harbor a huge bird refuge in the s. part of the state. Could it be that one duck hunter takes us out? I dunno.
Its a good move and brings awareness. With awareness comes preparedness and there is damned sure little of that. My two street long preparedness is now broaching over into the next subdivsion. Thats good. I might not make it myself but I know that many will. A county commissioner is now looking at this as well so the eyebrows are raising.
"[W]ouldn't it be nice if there were some leadership from those we call "leaders"?" -- Revere
"With awareness comes preparedness and there is damned sure little of that [in general society vis a vis H5N1 eg. coordinated planning around the viable treatment options available]" -- Randy Kruger
"[Jon, your] pseudo-scientific theories are based on self-serving delusions, and have no basis in fact or worthwhile science. It is a terrible shame that your energies are poured into blogging, making no useful contribution whatsoever to sensible debate." -- Ric Chaney
Howdy Randy, we freethinkers showing foresight often end up "despised" by tedioous medicolegal and gov tossers with imaginations akin to bowls of cold porridge...
The manner thru which these sad and boring people inflict violence is their employment -- they abuse the system to kick the motherhuggin' shit outta people like you or me. Yes Randy, homophobic Aussie medicolegal and governmental agencies are (((STILL))) making me feel excrutiating pain for the crime of attempting to save the life of my cousin Kerry's four year old daughter, Ruby!?!
H5N1 treatment options available...
1ne: Tamiflu (oseltamivir), an oral antiviral (not a vaccine!) also called neuraminidase inhibitors (NAI).
2wo: Steroids/ACE inhibitors (ARBs), in the correct doses, can be used to treat a variety of inflammatory conditions (eg. SARS, H5N1) where hypercytokinaemia (deadly symptom of H5N1 -- aka "Cytokine Storm") is present in the transgenic pathogen infected patient.
See:
Society for General Microbiology -- A rationale for using steroids in the treatment of severe cases of H5N1 avian influenza (2007) By Marissa J. Carter @ [http]://jmm.sgmjournals.org/cgi/content/abstract/56/7/875?ct
GenoMed.com: Influenza & Avian Influenza ("Bird Flu") Trials - 2005 Clinical Trial Information By David W. Moskowitz MD (CEO, GenoMed) @
[http]://www.b2i.us/profiles/investor/fullpage.asp?f=1&BzID=571&to=cp&Nav=1&Lang…
3hree: Blood-based H5 prophylaxis and therapy. Using blood from H5N1 survivors to generate neutralizing anti-H5N1 human monoclonal antibodies (mAbs)...
See: PLoS Medicine -- Prophylactic and Therapeutic Efficacy of Human Monoclonal Antibodies against H5N1 Influenza By Simmons CP, Bernasconi NL, Suguitan AL, Mills K, Ward JM, et al.
Read the open-access, full-text article here:
[http]://dx.doi.org/10.1371/journal.pmed.0040178
[Note: To quote Marissa from another EM posting, "Links available on request; the blog compiler wouldn't let me post them" on Wednesday nite, Oz time]
"[W]ouldn't it be nice if there were some leadership
from those we call "leaders"?" -- Revere
"With awareness comes preparedness and there is damned
sure little of that [in general society vis a vis H5N1
eg. coordinated planning around the viable treatment
options available]" -- Randy Kruger
"[Jon, your] pseudo-scientific theories are based on
self-serving delusions, and have no basis in fact or
worthwhile science. It is a terrible shame that your
energies are poured into blogging, making no useful
contribution whatsoever to sensible debate." -- Ric
Chaney
Howdy Randy, we freethinkers showing foresight often
end up "despised" by medicolegal and gov tossers with
imaginations akin to bowls of cold porridge...
The manner thru which these sad boring people inflict
violence is their employment -- they abuse the system
to kick the motherhuggin' shit outta people like you
or me. Yes Randy, homophobic Aussie medicolegal and
governmental agencies are (((STILL))) making me feel
excrutiating pain for the crime of attempting to save
the life of my cousin Kerry's four year old daughter,
Ruby!?!
I'm a freelance transgenic pathogen research analyst being driven into extreme poverty -- I've nearly run of money to buy food and wealthy homophobic Aussies (gay & hetero) are arrogantly laughing at my online attempts at inquiring why this is so!
H5N1 treatment options available...
1ne: Tamiflu (oseltamivir), an oral antiviral (not a
vaccine!) also called neuraminidase inhibitors (NAI).
2wo: Steroids/ACE inhibitors (ARBs), in the correct
doses, can be used to treat a variety of inflammatory
conditions (eg. SARS, H5N1) where hypercytokinaemia
(deadly symptom of H5N1 -- aka "Cytokine Storm") is
present in the transgenic pathogen infected patient.
See:
* Society for General Microbiology -- A rationale for
using steroids in the treatment of severe cases of
H5N1 avian influenza (2007) By Marissa J. Carter
* GenoMed: Influenza & Avian Influenza ("Bird Flu")
Trials - 2005 Clinical Trial Information By David W.
Moskowitz MD (CEO, GenoMed)
3hree: Blood-based H5 prophylaxis and therapy. Using
blood from H5N1 survivors to generate neutralizing
anti-H5N1 human monoclonal antibodies (mAbs)...
See: PLoS Medicine -- Prophylactic and Therapeutic
Efficacy of Human Monoclonal Antibodies against H5N1
Influenza By Simmons CP, Bernasconi NL, Suguitan AL,
Mills K, Ward JM, et al.
500 million doses ?
dose=75mg?
Tamiflu stockpiles are normally quoted in packs i.e. season flu recommended 5days@75mg but given Canada's population this seems an unusually high number even if we are talking tablets.
The staff of Obama should be well-equipped in all aspect with this regard to the term that he/she may qualified for the position she/he may applied for that how it works of being an staff of Obama.
Obama wants to know all about you if you plan to work in his Cabinet or staff. Makes sense, doesn�t it? If a person is going to hold a high-responsibility position in America�s federal government, it is in the best interests of the nation and its people that the employee meets the qualifications and not be a security risk. However, it seems to me that there are limits to what is reasonable. With as much information as Obama asks for in his seven-page, 63-question application, you�d think the administration would have enough to perform credit repair for everyone who applies. CNN leaked a copy of the questionnaire, which requires applicants not only to talk in detail about nearly everything they�ve done over the past 10 years or more, but also to do the same for their spouse. Here are a few of my favorite questions. I hope applicants do indeed get free credit repair as part of the deal� (1) Writings: Please list and, if readily available, provide a copy of each book, article, column or publication (including but not limited to any posts or comments on blogs or other Web sites) you have authored, individually or with others. Please list all aliases or �handles� you have used to communicate over the Internet. (2) Electronic communications: If you have ever sent an electronic communication, including but not limited to an E-mail, text message or instant message, that could suggest a conflict of interest or be a possible source of embarrassment to you, your family, or the President-Elect if it were made public, please describe. (3) Please provide the URL address of any Web sites that feature you in either a personal or professional capacity (e.g., Facebook, MySpace, etc.) This only scratches the surface of how deep the application goes. If you�re going to serve under the �change� president and you don�t have all your ducks in a row, you�ll have to change that right away! Click to read more on Credit Repair.
Question for the community. If an employer takes the role of physician and pharmacist and an employee has an adverse reaction to a prophylactic medication, is is a workman's compensation claim? I realize that the employee has the choice to take or decline the meds but if they do indeed decide to take it and then they experience any adverse event (either immediate or long term), who takes responsibility? Also consider that an employee is not required to provide a full medical history.....can an employer really "prescribe" these meds without it?
Does the adverse event just get reported to the Public Health agency? What about private employers (in contrast to governments), would they offer this information to PH?
As we build our prophylactic antiviral distribution plan, we are struggling with some of these issues.
Any thoughts?