Pandemic Flu Preparedness for Dialyzors

The Department oh Health an Human Services has started what looks to be a tremendous resource a Pandemic Flu Leadership Blog. Secretary Levitt is blogging as well as a number of Pandemic discussion board luminaries, the founder of ebay … a number of interesting, thoughtful people.

We all have a responsibility for personal preparation, we should be able to be self sufficient for two weeks. I am nearly there - once I go to bagged dialysate next month I should be able to achieve a two week cushion by mid-summer.

Over the first part of this year I ordered medications five pills early and now have a month’s supply on hand when I reorder. I also have a five day supply in my car. I’m taking an all hazards approach to personal preparation. Water is the hole in my prep - really I’m dependent on public utilities but if the water and electricity stay on I can go two weeks and I’m working to four.

[quote=Bill Peckham;13665]The Department oh Health an Human Services has started what looks to be a tremendous resource a Pandemic Flu Leadership Blog. Secretary Levitt is blogging as well as a number of Pandemic discussion board luminaries, the founder of ebay … a number of interesting, thoughtful people.

We all have a responsibility for personal preparation, we should be able to be self sufficient for two weeks. I am nearly there - once I go to bagged dialysate next month I should be able to achieve a two week cushion by mid-summer.

Over the first part of this year I ordered medications five pills early and now have a month’s supply on hand when I reorder. I also have a five day supply in my car. I’m taking an all hazards approach to personal preparation. Water is the hole in my prep - really I’m dependent on public utilities but if the water and electricity stay on I can go two weeks and I’m working to four.[/quote]

Rather interesting, but don’t you think the Pureflow Sl would be a better choice Vs all the boxes of dialysate? You can triple the backup with the Pureflow Sl…more time without UPS coming by for a long time…

As for water and electricity…a generator will do, but gas prices going up who wants one? and maybe a water truck, hehehe…even the fire deaprtment. :stuck_out_tongue: …seriously, umm water shouldn’t be affected but it can…

Sorry Gus, In my estimation, dialysate will win over PF SL in a situation as a pandemic or disaster. . With a public or private water supply system(even one user wells) contamination is always a concern. And contaminated water is difficult get get out of the supply system and often takes days or weeks to return the system to normal. But with dialysate in bags one eliminates the water problem at least for dialysis. The trick with dialysate is having the space to store your back up supply. If and when I go with PF SL I plan to keep at least a weeks worth of bags on hand, more if the powers that be allow. As far as having a genset. It would also be prudent to have a supply of fuel on hand. If I had to make a choice of having a genset to power my machine ect, vs any of the alternatives, I would prepare ahead to have enough fuel to see me through for a while. By the way a good way to power a generator is propane. Small motors can be converted to run on propane fairly easily, or gensets can be purchased propane ready. Propane is arguably easier to store and has a very long shelf life compared to gasoline and prices at the propane pump have remained pretty stable for quite some time. A pair of batteries along with an inverter for short term power for the diaysis machine might also be a good investment(actually a pair of properly sized batteries can power a machine through an entire treatment, be it anywhere up to many hours long. If anybody is interested in my findings, let me know and I will share.) Of course everything mentioned above is always dependent on budgets. A little preparedness goes a long way. A lot of preparedness can save a life! Ours!

The bird flu is not water borne, plus the Pureflow Sl has Ultra Violet light…anyway, the whole point is human contact, so in the case versus bagged dialysate the Pureflow SL wins in terms of how much backup you can have. That way the UPS man will not stop by your home for a long time!

More News Update on Bird Flu
http://www.cnn.com/2007/HEALTH/conditions/05/28/bird.flu.ap/index.html

I’m not so sure.

60L of bagged dialysate could be used for a week of dialysis - 3 day/week schedule, 20L/treatment, low FF (FF=20? You’d want as long a treatment as 20L could provide, to minimize the UFR and get some solute transfer).

With 60L from a SAC you could dialyze three days in a row, with 20L; low FF but then what? Take four days off? or use another SAC? Bags would stretch your cartridge supply over the longest period.

If there is a breakdown in public utilities then with bags you could potentially go to where there is power. Bags maximize options; options are always an advantage.

One hopes NxStage is on UPS’s radar. UPS has a robust pandemic flu plan.

Bags or SACs either way you’re way ahead of someone who relies on incenter dialysis.

I am part of a pandemic planning group that is working to develop guidance for the provision of dialysis during a pandemic flu event. We have monthly conference calls and exchange emails – the effort is planned to lead to a face to face meeting in November. During this month’s call a doc from Canada shared a PowerPoint recap of the SARS experience in Ottawa in 2003. I paid no real attention to the event at the time but it seems we all dodged a bullet.

Most of the PowerPoint was drawn from the Executive Summary of the official Canadian government report posted here; the full report does include some dialysis specific situations or complications that were experienced by dialyzors and staff – for instance in Part 3 describing the quarantine effort’s impact:

Quarantine affected many people who had no risk of exposure to SARS until they had to visit a medical facility for treatment of an existing condition, or for examination and tests. A kidney dialysis patient told of how he had to take treatment three times a week at a hospital. He complained about confusion over SARS quarantine. After one treatment, public health authorities called him and said he must be in quarantine, which included wearing a mask at home and not sleeping with his wife. Other dialysis patients told him they were not quarantined. However, every time he went for dialysis he was placed under a new ten day quarantine. He complained to public health that he could be in quarantine for the rest of his life and maintained that only people sick with SARS should have been quarantined.

However, the PowerPoint also included this new vignette that I had never heard before:

“The second incident occurred on the morning of Thursday June 5, when two nursing home residents arrived on site for their morning dialysis. They proceeded through the screening process at the door, answered the required questions. They had their temperatures taken, and were escorted to their dialysis chairs for treatment. However, unknown to the screeners, both of these patients are somewhat vague and may not have really understood the importance of the screening process. It was soon discovered that each patient was carrying a note from the nursing home informing us that they were symptomatic and should be treated as potential SARS cases.

 I clearly remember the chill I felt when I was the nursing staff scrambling in to the protective gear.  Very quickly, all staff entering our dialysis units were in gowns, masks, gloves and goggles.  All patients were wearing masks and told not to remove them through the entire treatment.  Working under these conditions is extremely difficult.  The masks are hot and uncomfortable.  Anyone wearing glasses often had problems seeing due to fogging because of the masks. Communication was not easy when facial expression is covered and sound is muffled.  Stress levels were high because we were dealing with a new and unknown threat.  However, we adjusted to these new procedures reasonably quickly over the weekend, but the situation got much worse the following week.”
 “The absolute worst moments occurred on day two of the quarantine when problems piled on problems.  We were masked, gowned & and gloved all day long.  The media were camped out just off site.  There was an unfounded rumor that SARS had actually been confirmed in one of our dialysis patients.  Calls were received from nursing homes saying they would send patients for treatment but not accept them back after their dialysis.  Patients were furious or depressed after being informed that their ten day quarantine period was to be extended every time they came for dialysis.  On top of this, I received a phone call informing me that Public Health had ordered all local buses, including the accessible service to stop providing rides for dialysis patients out of fear of contaminating the vehicles.    Many of the local taxi services had already refused drop-offs & pick-ups at our facility.  At that moment, I really felt like events were spinning out of control and that we were in serious, serious trouble”.   

SARS BLUES, Stockwell, Lyle

When I read that I had an instant sense of dread. Imaging that situation being played out at dialysis units across the country and imagining the various permutations of people not wanting to come to dialysis, not wanting to leave dialysis, not being allowed to go to dialysis, not being allowed to return from treatment – we asked for some follow-up. What happened next?

One hopeful note, the different experience of British Columbia and Ottawa is encouraging. Planning and good habits made a huge difference. As individuals we need to cultivate good habits.

[quote=Bill Peckham;13924]I am part of a pandemic planning group that is working to develop guidance for the provision of dialysis during a pandemic flu event. We have monthly conference calls and exchange emails – the effort is planned to lead to a face to face meeting in November. During this month’s call a doc from Canada shared a PowerPoint recap of the SARS experience in Ottawa in 2003. I paid no real attention to the event at the time but it seems we all dodged a bullet.

Most of the PowerPoint was drawn from the Executive Summary of the official Canadian government report posted here; the full report does include some dialysis specific situations or complications that were experienced by dialyzors and staff – for instance in Part 3 describing the quarantine effort’s impact:
However, the PowerPoint also included this new vignette that I had never heard before:
When I read that I had an instant sense of dread. Imaging that situation being played out at dialysis units across the country and imagining the various permutations of people not wanting to come to dialysis, not wanting to leave dialysis, not being allowed to go to dialysis, not being allowed to return from treatment – we asked for some follow-up. What happened next?

One hopeful note, the different experience of British Columbia and Ottawa is encouraging. Planning and good habits made a huge difference. As individuals we need to cultivate good habits.[/quote]

That is quite disturbinbg and stressing! Once SARS is out, even as a rumor seems everyone is scared and don’t want to even be near somebody. Looks like it most likely to happen to home patients. As a home patient, they won’t want us to come in for our monthly appointment or even a check-up.

http://www.charlierose.com/shows/2007/08/15/1/the-charlie-rose-science-series-pandemics

The above link is to a full hour on pandemic flu with Sir Paul Nurse, David Nabarro, Laurie Garrett, Larry Brilliant, Jeff Koplan as panelist. At about the three minute mark co-moderator Sir Paul Nurse says “we’re looking at an influenza pandemic sometime, maybe soon, maybe not quite so soon … in a year or two”

The whole show is worth watching but it was hard for me to get beyond that initial assessment.

Pandemic Flu…
You need to be prepared for a natural disaster…
EarthQuake in the west,
Freezing Winter in the North
Hurricane in the south
Tornado in the central of the USA…
Floods during the rainy season…
Cause when these happen you will be in the dark, water and food will be scarce…
when the flu does happen you will get ample warning before it infects a large portion of the population…
Being prepared for any of the above for a couple of weeks is about the best one can expect to be prepared for… have been home for almost 16 years (9 yrs PD,7 yrs hemo) and have not tapped into my 2 wks emergency supplies… Knock on wood that I don’t have to in the future…

HemoHelper

Would we know “ample warning” if we saw it? Are we getting that warning right now?

I would like to have a p100 respirator available should there be an influenza pandemic which is why I bought one today. If the day ever comes when it is widely reported that a novel influenza strain is passing easily among humans these masks will not be available.

I started at two weeks of prep and have kept going. Pandemic flu waves are said to last 6 to 8 weeks. The same CDC source suggest the entire event would last 12 to 18 months.

Preparing for the pandemic flu year may be beyond our ability.

[quote=Bill Peckham;14223]Would we know “ample warning” if we saw it? Are we getting that warning right now?

I would like to have a p100 respirator available should there be an influenza pandemic which is why I bought one today. If the day ever comes when it is widely reported that a novel influenza strain is passing easily among humans these masks will not be available.

I started at two weeks of prep and have kept going. Pandemic flu waves are said to last 6 to 8 weeks. The same CDC source suggest the entire event would last 12 to 18 months.

Preparing for the pandemic flu year may be beyond our ability.[/quote]

C’mon…you really need a P100 Respirator? Why not a medical mask?

Have you ever tried to work in one of those masks? No way you could work a full shift in just one. They’re single use, so you’d need several - half a dozen? - to work a full shift, where as the p100 is multi-use and can be disinfected. The n95 that you pictured is about $1 a piece so I’d say they’re penny wise and pound foolish. You can spend $2 on n95 masks that include a small one way valve. These are more comfortable to wear but they are still single use and they do not offer protection to others if the wearer is the one spreading disease.

The other issue with the mask you pictured is that to work properly they have to be fit tested - I’m not aware of any dialysis program that is currently fit testing their staff. Faces come in a wide range of size and shapes - you’d have to match each staff person with the proper mask. The p100s feature a silicone seal which would give the average user better protection.

I figure I’ll be driving people to dialysis and helping out at the unit in the event of an event. I have over 100 n95 masks and boxes of surgical masks to give others but I want robust protection for myself. No matter which mask you choose you need to get them now because if you wait for the news to tell you that you need one it will be too late. Even surgical masks that offer very little protection to the wearer will be in short supply, very quickly.

[quote=Bill Peckham;14259]Have you ever tried to work in one of those masks? No way you could work a full shift in just one. They’re single use, so you’d need several - half a dozen? - to work a full shift, where as the p100 is multi-use and can be disinfected. The n95 that you pictured is about $1 a piece so I’d say they’re penny wise and pound foolish. You can spend $2 on n95 masks that include a small one way valve. These are more comfortable to wear but they are still single use and they do not offer protection to others if the wearer is the one spreading disease.

The other issue with the mask you pictured is that to work properly they have to be fit tested - I’m not aware of any dialysis program that is currently fit testing their staff. Faces come in a wide range of size and shapes - you’d have to match each staff person with the proper mask. The p100s feature a silicone seal which would give the average user better protection.

I figure I’ll be driving people to dialysis and helping out at the unit in the event of an event. I have over 100 n95 masks and boxes of surgical masks to give others but I want robust protection for myself. No matter which mask you choose you need to get them now because if you wait for the news to tell you that you need one it will be too late. Even surgical masks that offer very little protection to the wearer will be in short supply, very quickly.[/quote]

How and where will you wear your P100? During dialysis at home? While you drive? When you go to church? When you go shopping? Basicly, when is the right time to wear it? Now?

Do you think a mask will offer 100% protection? What about food contamination? The water?

The cost of a P100 is not a price for everyone…but if you can afford one then lucky you…

I wrote: I figure I’ll be driving people to dialysis and helping out at the unit in the event of an event.

Do I think it is 100% protection??? Of course not. Do I think n95s are flawed? Yes - for the reason’s I wrote. I think I also addressed the cost issue in what I wrote.

Remember:“A shawl has no pockets.”

[quote=Bill Peckham;14263]I wrote: I figure I’ll be driving people to dialysis and helping out at the unit in the event of an event.

Do I think it is 100% protection??? Of course not. Do I think n95s are flawed? Yes - for the reason’s I wrote. I think I also addressed the cost issue in what I wrote.

Remember:“A shawl has no pockets.”[/quote]

I guess its better than having nothing…so when that time comes it must be when reports of people affected in the U.S. are coming in and being equipped now would be much safer than waiting till it happens. However, I wonder whether preparing ourselves now would have any affect on the supplies…aging or wear and tear…;.

The aging of supplies is good news. I hope all my supplies grow old without ever being used. With regard to pandemic planning - if we can go five years, until 2012, without an influenza pandemic then we should see vast improvements in our immunization abilities that would make the danger less. So taking a five year planning horizon means that any non-perishable item will be fine over that period, so long as it stored out of direct sunlight or temperature extremes. Masks, bleach, garbage bags, will all be very useful and in short supply, if you’re going to want these items you need to get them now.

Food is another matter - almost everything you buy has a shelf life of less than five years. I have 2 weeks worth of MREs and Coast Guard Approved (low salt) rations which basically last forever plus months of additional food. I store this food in plastic bins by expiration date. Everything that expires in 2008 will be donated to my local food bank at the end of this year. Stuff that expires in 2009 will be donated in 2008, etc. I will be delighted if in five years I have made regular food bank donations - it seems like inexpensive insurance.

Take a look at this latest report from the [B]World Health Organization

Report on CNN
DISEASES SPREADING FASTER THAN EVER…

[/B]

For people on dialysis eating within dietary guidelines during an emergency can be difficult. MREs and most canned food (soups, stew, etc.) are very high in sodium. The Renal Emergency diet, which is almost always put forward as a three day bridge for those on an incenter schedule who miss one treatment, is designed to meet minimal nutrition requirements but how many of us have this ingrediant list on hand? And if you do have this diet stored, are you using and replacing these supplies as a way to keep them unexpired?

I think there is an easier option. All three of the Emergency Bars featured in this taste test are Coast Guard approved and are renal-ly equivalent to the suggested three day Emergency Renal Diet. I tried one last month (the lowest rated, the ER Bar) it’s not bad, kind of a peanut butter smell with a plain dense cracker taste. Not at all bad with coffee. And being Coast Guard approved they are very low salt since you don’t want to get thirsty if you find yourself adrift in a life raft.

Talking to Katy, the Northwest Kidney Centers go to dietitian on all things renal, she has priced out our currently suggested emergency renal diet and remembered it being more expensive then the per calorie price of the ER Bars. In addition, the ER Bar has a shelf life advantage and Katy gave the ER Bar the renal friendly stamp of approval.

If a dialyzor had to follow a schedule of diminished dialysis frequency they would ideally do that in conjunction with the emergency renal diet. All the recommondations that I’ve seen recommend storing three days worth of the emergency renal diet - preparing to bridge a single missed treatment. I don’t think that is enough, I think it makes sense to recommend two weeks of preparation. I think the recommendation should be two weeks even under an all hazards approach to preparedness (putting aside pandemic).

If you had to evacuate, for whatever reason, it’d be very handy to have at minimum a two week emergency diet stockpile - add two weeks worth of long shelf life water and two weeks of medications and one would have a minimum amount of preparedness. That seems easier to do using ER Bars v. the normally suggested renal emergency diet. The cost would be about $30 a person for food for two weeks (14 - 1,800 calorie portions). I wouldn’t want to live on them for two weeks but I could live on them for two weeks in conjunction with some minimum dose of dialysis.

Right now Washington State is saying have “enough food and water per person for a week or more” in reserve but WA is also recommending that people with chronic diseases should plan for longer disruptions, you just have to look hard to see that message. I think the conventional message to dialyzors should be to keep 14 days worth of renal friendly emergency food in reserve. For those on home dialysis we should have on hand, at a minimum: 7 treatments worth of supplies, 14 days worth of medicine, food and water.

You could create a bridge over a two week disruption by combining an every other day dialysis schedule with the emergency diet. Using the ER Bars to meet the food piece would cost about $30. Because the shelf life of the bars is over 5 years (they’re rated at five years but kept in a cool, dry & dark storage space they should be fine for much longer) that means that it is a $6 a year insurance policy. That’s a bargin in my book

Hereis a 47 minute video that gives a thorough overview of the H5NI (bird flu) situation and does a good job explaining the spread among wild birds and domesticated poultry. My take away message is that I do not understand why more people are not more worried.

Bill, maybe it’s because life is tough enough and just getting through day by day is hard enough. Other than the medical issues discussed here, there are financial issues, relationship issues, etc, etc, etc, that are not discussed on the forum. If it seems that some people don’t cover all of the bases talked about here like emergency prep, dealing with fires, etc, etc, is because there’s already so much your brain can deal with daily, especially when there are other issues as important, if not more important.

In trying to “Dialyze to Live”, rather “Living to Dialyze”, some of us let some things slide until they go up on the priority list. We all live our lives differently. So let me worry about some other things!