Granted but what excuse do the providers have? And the rest of the people who are not on dialysis?
[B][B]Study Confirms Limited Human-To-Human Spread of Avian-Flu Virus in Indonesia in 2006
[/B][/B]
“The containment strategy was implemented late in the game, so it could have been just luck that the virus burned out,” Longini said. “It went two generations and then just stopped, but it could have gotten out of control. The world really may have dodged a bullet with that one, and the next time we might not be so lucky,” he said.
When you read news articles about H5N1 that say there has been no H2H spread remember that those stories are not correct. Right now, in August 2007, there appears to be another H2H cluster flaring up in Bali.
Hi y’all,
Here’s the information (in pieces) from the link Bill P posted, from someone who calls him/herself “Monotreme.” Apologies to the original poster for duplicating it here, but it is extensively referenced, and I can only assume that the person who took the time to put this together would want it seen as widely as possible:
A Very Severe Pandemic is Likely
This opinion was initially the first post of a thread I started on FluWiki originally posted September 23, 2006.
In reviewing the US State Plans (http://www.fluwikie.com/index.php?n=Geographic.StatePlanList), I have come to the conclusion that there are many, including public health officials, who are apparently unaware of the facts pertaining to the risk of a severe pandemic. Since planning is heavily dependent on the assumptions made, it’s important that decision-makers, which includes the general public, understand why a severe pandemic is likely.
Definitions
I am defining a severe pandemic as a case fatality rate of at least 2%. I use the term very severe to mean a case fatality rate of at least 5%. I am only referring to virus, not to effect of the pandemic on society. I believe it is possible for society to survive a very severe pandemic, if adequate planning is done.
There is now online a four page PDF
PANDEMIC FLU PLANNING CHECKLIST FOR INDIVIDUALS WITH CHRONIC KIDNEY DISEASE AND THEIR FAMILIES
http://kcercoalition.com/pdf/PANDEMICFLUPLANNINGCHECKLIST.pdf
Take a look at it - I’d be interested in your reactions. The document suggest a minimum stockpile of 2 weeks, personally I have two months (including home dialysis supplies). I was on the subcommittee that helped to prepare this but they did not take one suggestion that I thought made preparing much easier - stockpile Coast Guard approved emergency rations - long shelf life, low sodium.
There is going to be a face to face meeting here in Seattle on Thursday of the Kidney Community Emergency Response pandemic preparedness team. I’ve been participating - I hope to share my thoughts over the next couple months.
The threat is real, preparation will help. Ask questions - demand answers.
The KCER pandemic preparedness team had a meeting in Seattle on Thursday. I think preparation should be more urgent. The provider industry has plans to purchase masks but I think it is a mistake to wait to purchase personal protective equipment and anti-virals for staff and dialyzors. If the thinking is that those purchases will be made once the WHO goes to stage four or the US goes to stage 2 then I think it will be too late to make those purchases. If you want “it” during a pandemic you need to buy “it” now. What ever "it’ is.
Looks like Utah has decided to be blunt about communicating the seriousness of the situation. Here is the latest commercial to run on Utah TV. I believe it standard operating procedure to have a one year stockpile among Mormons. That sounds like a very good idea at this point:
http://www.youtube.com/watch?v=51YmNBbBZa0
The message coming from all levels of government should be as clear, as graphic and as blunt.
[B] Likely Human to Human H5N1 Transmission in Pakistan
[/B][Recombinomics Commentary](http://www.recombinomics.com/News/12130705/H5N1_Pakistan_H2H.html)
December 13, 2007
[I]The deaths of two brothers of a veterinarian, who acquired the deadly H5N1 Avian Influenza virus after coming into contact with infected poultry at a farm in Abbottabad late-October, and the recent hospitalisation of a Mansehra-based poultry handler who has also tested positive for the disease, provide sufficient evidence for the government to institute concrete measures for interruption of human transmission of the disease from birds to poultry handlers and their close contacts.
Of the 40 suspected human samples collected from Peshawar and Abbottabad in the wake of the first-ever confirmed human transmission of H5N1 in Pakistan, 36 have tested negative, while four are positive, investigations conducted by ‘The News’ have revealed.
It is learnt that both the veterinarian, Dr. Ishtiaq Durrani, who is working as livestock production officer at the Department of Livestock and Dairy Development, NWFP, as well as the poultry handler from Mansehra, did not follow the recommended protective measures while handling infected birds.
Dr. Ishtiaq was involved in culling of 3,000 birds following the October 21 outbreak of bird flu at a poultry farm in Abbottabad. The other victim from Mansehra happens to be a daily wage labourer who was commissioned for culling without being advised on how he should protect himself. The labourer’s daughter, along with another male, is also under observation at a hospital in Abbottabad.
While Dr. Ishtiaq himself is on the path to recovery, his brothers Mohammad Ilyas Durrani and Mohammad Owais Durrani — both of who were attending him at the Khyber Teaching Hospital during his illness — died on November 19 and November 29, respectively.
[/I]
The above details suggest H5N1 in Pakistan was transmitted human-to-human in the three family members. Although disease onset dates were not given, the 10 day gap between the date of death strongly suggests one brother infected one or two other brothers. Moreover, the cluster of four positives in the same area, possibly involving five people since one of the dead brothers was not tested, highlight a relatively efficient transmission of H5N1, as do the two hospitalized contacts under observation
Hospitals in Pakistan have gone on [alert](http://www.recombinomics.com/News/12130704/H5N1_Pakistan_Alert.html).
Sequence data on the recent human and poultry cases, as well as earlier outbreaks would be useful.
http://www.recombinomics.com/News/12130705/H5N1_Pakistan_H2H.html
Hi Folks
I’ve been reading this thread since Bill first started. And I don’t mean to make lite of the subject. But is everyone ready for any or all things that could happen in life. Do you recall A-bomb issue where people who could afford a shelter build them and stocked up on water etc. Gus had posted about fires and earthquakes . what about terorist attacks in the form of water sytems ,food supplies etc. An attack on a city where or near by where you live, or just an normal truck, train, plane crash into a chemcal plant or oil tanks. The Gove’t on all levels works for most part on the risk management concept. Why do you think 9/11 happen? The Gove’t and airline companies knew that airplane hijacking was a real threat, but the cost to prevent or at least slow the event was too much before the event. I think the people who are in charge are more into the terorist threat right now. What do people who are in-center in the big city do if this happens? If the flu hits when would we know, more than likely when there are x # of confirmed cases. You site cases in India and other very rual countrys and the #'s you site seem small in relations to the whole pop. of the country. Now I’m not saying one should not be ready ,but I just look at it and say there are too many things that can happen for me to get ready. I just working on keeping my head above water as it is to look at the flu, terorist etc. Just my two cents.
Bob OBrien
Bob I truly hope this is not something that we will have to try to live through but if you read the federal government website http://www.pandemicflu.gov/takethelead/index.html it says: “The Centers for Disease Control and Prevention (CDC) and other public health experts agree that it is not a question of IF a pandemic will occur, but WHEN it will occur.”
That seems very clear to me. The situation in Pakistan is very alarming: Two of the brothers died from pneumonia-like symptoms but were buried by family members before health officials could take blood samples to test for the virus.
[B] A third brother who lives in the United States but was visiting Manshera at the time also tested positive for bird flu, but survived and has since returned to the US, Akhtar told dpa.
[/B]Where exactly is this person?
I feel like we’re all living in New Orleans and out in the Gulf there is a huge mother of a storm churning towards us - it might go a bit east or west but it is so big that the details really do not matter. The difference is that there is not a credible prediction history to project the path of this storm, there is not a compelling satellite image on the front page of the paper. Is the lack of a satellite image enough to dismiss the threat? What would it take to convince you that this is an imminent threat?
Bob what is the downside of having one month of food, medications and dialysis supplies on hand at all times?
Hi Folks
Hey Bill
I don’t disagree with you on being ready. I like your living in New Orleans outlook. But that is the sad truth about Life. Today there is so much that could hit us without notice. I just was wondering about why the Pandeimic? And yes I have a stand alone power station for my home , I grow my vegies We live away from the cities.
Thanks Bill
Bob OBrien
[QUOTE=Bill Peckham;15210]
I feel like we’re all living in New Orleans and out in the Gulf there is a huge mother of a storm churning towards us - it might go a bit east or west but it is so big that the details really do not matter. The difference is that there is not a credible prediction history to project the path of this storm, there is not a compelling satellite image on the front page of the paper. Is the lack of a satellite image enough to dismiss the threat? What would it take to convince you that this is an imminent threat?
Bob what is the downside of having one month of food, medications and dialysis supplies on hand at all times?[/QUOTE]
I understand now … why pandemic? The more I read the worse it gets. People who study this H5N1 bug have been concerned for 10 years.
“As a scientist, I have to say that I have no crystal ball: I have no idea what this virus will do,” Fukuda said. "But as a person who has worked in public health for a long time and who has a lot of experience with this virus, I have to say that it makes me really nervous.
"It is durable and persistent and still does things that take us by surprise. It has more staying power than the media or politicians have attention. We cannot second-guess it. So we should focus on the things that we can do."
Fukuda is an expert. Expert scientific points of view carry a lot of weight with me so from there I ask myself: what would a pandemic mean for me and the provision of dialysis generally?
For one thing the other threats are not as far reaching and difficult to prepare for. An earthquake or terrorist attack is a local event - help will be available from unaffected areas. And it is a one time event - an earthquake is over in minutes; a storm days.
A pandemic is happening everywhere at the same time, and it goes on for months … a year really. A novel influenza virus passing easily among people with a severe case fatality rate would disrupt the normal course of business and dialysis is particularly vulnerable. People on incenter dialysis are vulnerable in a logistical sense, not just a clinical sense. Incenter dialyzors have to congregate three times a week. They rely on a functioning supply chain.
I can’t think of anything short of a global geologic event more damaging than a severe pandemic. And the experts are concerned and we aren’t being told what’s going on - a guy is reported to have been visiting Pakistan, caught H5N1, survived and is now back in the US?? This happened weeks ago. Does he exist? Where is he? I don’t think it’s a sure thing that the powers that be would tell us if something wicked this way comes.
Ironically, a device called a hemopurifier may actually be used in treatment of Avian flu–so, you have to wonder if dialysis (presuming you can get it) might have some protective effect… http://www.wired.com/medtech/health/news/2006/03/70545
It’s a special device that looks like an artificial kidney but isn’t an artificial kidney. Rather than diffusion - moving waste across a semi-permeable membrane - this sounds like it would physically trap viruses, thereby reducing the viral load and allow the body’s immune system to fight back. To get people access to these virus filters the plan seems to be to use the existing incenter hemodialysis infrastructure to do a dialysis like process in which the blood is filtered of viruses. I’d just note that an obvious problem with this plan is that the infrastructure is currently in use.
Hi y’all,
Just found this AP story:
Flu Season, and Vaccine, Looking Worse
By MIKE STOBBE Associated Press Writer
Feb 15th, 2008 | ATLANTA – The flu season is getting worse, and U.S. health officials say it’s partly because the flu vaccine doesn’t protect against most of the spreading flu bugs.
The flu shot is a good match for only about 40 percent of this year’s flu viruses, officials at the U.S. Centers for Disease Control and Prevention said Friday.
The situation has even deteriorated since last week when the CDC said the vaccine was protective against roughly half the circulating strains. In good years, the vaccine can fend off 70 to 90 percent of flu bugs.
Infections from an unexpected strain have been booming, and now are the main agent behind most of the nation’s lab-confirmed flu cases, said Dr. Joe Bresee, the CDC’s chief of influenza epidemiology.
It’s too soon to know whether this will prove to be a bad flu season overall, but it’s fair to say a lot of people are suffering at the moment. “Every area of the country is experiencing lots of flu right now,” Bresee said.
This week, 44 states reported widespread flu activity, up from 31 last week. The number children who have died from the flu has risen to 10 since the flu season’s official Sept. 30 start.
Those numbers aren’t considered alarming. Early February is the time of year when flu cases tend to peak. The 10 pediatric deaths, though tragic, are about the same number as was reported at this time in the last two flu seasons, Bresee said.
The biggest surprise has been how poorly the vaccine has performed.
Each winter, experts try to predict which strains of flu will circulate so they can develop an appropriate vaccine for the following season. They choose three strains— two from the Type A family of influenza, and one from Type B.
Usually, the guesswork is pretty good: The vaccines have been a good match in 16 of the last 19 flu seasons, Bresee has said.
But the vaccine’s Type B component turned out not to be a good match for the B virus that has been most common this winter. And one of the Type A components turned out to be poorly suited for the Type A H3N2/Brisbane-like strain that now accounts for the largest portion of lab-confirmed cases.
Over the years, the H3N2 flu has tended to cause more deaths, Bresee said.
This week, the World Health Organization took the unusual step of recommending that next season’s flu vaccine have a completely different makeup from this year’s. The U.S. Food and Drug Administration is expected to make its decision about the U.S. vaccine next week.
H3N2 strains are treatable by Tamiflu and other antiviral drugs, but the other, H1N1 Type A strains are more resistant. Of all flu samples tested this year, 4.6 percent have been resistant to antiviral medications. That’s up from fewer than 1 percent last year.
“This represents a real increase in resistance,” Bresee said.
Hi y’all,
Amid reports of Indonesia no longer reporting bird flu cases (and Hong Kong slaughtering all of it’s market-bound poultry), it’s nice to see that there’s some new hope on the bird flu front–a promising vaccine!: http://my.earthlink.net/article/hea?guid=20080611/48509f40_3421_1334520080612-516213721.
Hi Folks
I guess one should be concerned with idea of the spread of the bird flu. But for me it just I can’t concern myself with the flu, with bad food outbreak ,drunk drivers and all the rest of the things that could do me in, i if I sat and try to to take in all the things that might happen . I’d be in a rubber room. Just dealing with some of issues of every day dialysis. Since I’ve came into dialysis I’ve worked hard to get to where I’m at now, doing nocturnal and looking for a full time job. I’ve love to find something that if my health stays the same as now that I can work a job for maybe another 10 or 15 yrs then retire with my wife.If we can do a bit of traveling.
thanks bob obrien
[QUOTE=Dori Schatell;16103]Hi y’all,
Amid reports of Indonesia no longer reporting bird flu cases (and Hong Kong slaughtering all of it’s market-bound poultry), it’s nice to see that there’s some new hope on the bird flu front–a promising vaccine!: http://my.earthlink.net/article/hea?guid=20080611/48509f40_3421_1334520080612-516213721.[/QUOTE]
Looking for a full-time job? Awesome!!! Good luck, Bobeleanor, I hope you find something you love to do. 
This is worrisome–it’s a different strain and from a completely different source than the bird flu researchers were worrying about.
Mexico swine flu deaths spur global epidemic fears
By MARK STEVENSON (Associated Press Writer)
From Associated Press
April 24, 2009 11:14 PM EDT
MEXICO CITY - A unique strain of swine flu is the suspected killer of dozens of people in Mexico, where authorities closed schools, museums, libraries and theaters in the capital on Friday to try to contain an outbreak that has spurred concerns of a global flu epidemic.
The worrisome new virus - which combines genetic material from pigs, birds and humans in a way researchers have not seen before - also sickened at least eight people in Texas and California, though there have been no deaths in the U.S.
“We are very, very concerned,” World Health Organization spokesman Thomas Abraham said. “We have what appears to be a novel virus and it has spread from human to human … It’s all hands on deck at the moment.”
The outbreak caused alarm in Mexico, where more than 1,000 people have been sickened. Residents of the capital donned surgical masks and authorities ordered the most sweeping shutdown of public gathering places in a quarter century.
President Felipe Calderon said his government only learned late Thursday, with the help of international laboratories, what kind of virus Mexico is faced with. “We are doing everything necessary,” he said after meeting with his Cabinet to coordinate a response. “We understand the seriousness of the problem.”
The WHO was convening an expert panel to consider whether to raise the pandemic alert level or issue travel advisories.
It might already be too late to contain the outbreak, a prominent U.S. pandemic flu expert said late Friday.
Given how quickly flu can spread around the globe, if these are the first signs of a pandemic, then there are probably cases incubating around the world already, said Dr. Michael Osterholm at the University of Minnesota.
In Mexico City, “literally hundreds and thousands of travelers come in and out every day,” Osterholm said. “You’d have to believe there’s been more unrecognized transmission that’s occurred.”
There is no vaccine that specifically protects against swine flu, and it was unclear how much protection current human flu vaccines might offer. A “seed stock” genetically matched to the new swine flu virus has been created by the U.S. Centers for Disease Control, said Dr. Richard Besser, the agency’s acting director. If the government decides vaccine production is necessary, manufacturers would need that stock to get started.
Authorities in Mexico urged people to avoid hospitals unless they had a medical emergency, since hospitals are centers of infection. They also said Mexicans should refrain from customary greetings such as shaking hands or kissing cheeks. At Mexico City’s international airport, passengers were questioned to try to prevent anyone with flu symptoms from boarding airplanes and spreading the disease.
Epidemiologists are particularly concerned because the only fatalities so far were in young people and adults.
The eight U.S. victims recovered from symptoms that were like those of the regular flu, mostly fever, cough and sore throat, though some also experienced vomiting and diarrhea.
U.S. health officials announced an outbreak notice to travelers, urging caution and frequent handwashing, but stopping short of telling Americans to avoid Mexico.
Mexico’s Health Secretary Jose Angel Cordova said 68 people have died of flu and the new swine flu strain had been confirmed in 20 of those deaths. At least 1,004 people nationwide were sick from the suspected flu, he said.
The geographical spread of the outbreaks also concerned the WHO - while 13 of the 20 deaths were in Mexico City, the rest were spread across Mexico - four in central San Luis Potosi, two up near the U.S. border in Baja California, and one in southern Oaxaca state.
Scientists have long been concerned that a new flu virus could launch a worldwide pandemic of a killer disease. A new virus could evolve when different flu viruses infect a pig, a person or a bird, mingling their genetic material. The resulting hybrid could spread quickly because people would have no natural defenses against it.
Still, flu experts were concerned but not alarmed about the latest outbreak.
“We’ve seen swine influenza in humans over the past several years, and in most cases, it’s come from direct pig contact. This seems to be different,” said Dr. Arnold Monto, a flu expert with the University of Michigan.
“I think we need to be careful and not apprehensive, but certainly paying attention to new developments as they proceed.”
The CDC says two flu drugs, Tamiflu and Relenza, seem effective against the new strain. Roche, the maker of Tamiflu, said the company is prepared to immediately deploy a stockpile of the drug if requested.
Both drugs must be taken early, within a few days of the onset of symptoms, to be most effective.
Cordova said Mexico has enough Tamiflu to treat 1 million people, but the medicine will be strictly controlled and handed out only by doctors.
Mexico’s government had maintained until late Thursday that there was nothing unusual about the flu cases, although this year’s flu season had been worse and longer than past years.
The sudden turnaround by public health officials angered many Mexicans.
“They could have stopped it in time,” said Araceli Cruz, 24, a university student who emerged from the subway wearing a surgical mask. “Now they’ve let it spread to other people.”
The city was handing out free surgical masks to passengers on buses and the subway system, which carries 5 million people each day. Government workers were ordered to wear the masks, and authorities urged residents to stay home from work if they felt ill.
Closing schools across Mexico’s capital of 20 million kept 6.1 million students home, as well as thousands of university students. All state and city-run cultural activities were suspended, including libraries, state-run theaters, and at least 14 museums. Private athletic clubs closed down and soccer leagues were considering canceling weekend games.
The closures were the first citywide shutdown of public gathering places since thousands died in the devastating 1985 earthquake.
Mexico’s response brought to mind other major outbreaks, such as when SARS hit Asia. At its peak in 2003, Beijing shuttered schools, cinemas and restaurants, and thousands of people were quarantined at home.
In March 2008, Hong Kong ordered more than a half-million students to stay home for two weeks because of a flu outbreak. It was the first such closure in Hong Kong since the outbreak of SARS, or severe acute respiratory syndrome.
“It’s great they are taking precautions,” said Lillian Molina, a teacher at the Montessori’s World preschool in Mexico City, who scrubbed down empty classrooms with Clorox, soap and Lysol between fielding calls from worried parents.
U.S. health officials said the outbreak is not yet a reason for alarm in the United States. The five people sickened in California and three in Texas have all recovered.
It’s unclear how the eight, who became ill between late March and mid-April, contracted the virus because none were in contact with pigs, which is how people usually catch swine flu. And only a few were in contact with each other.
CDC officials described the virus as having a unique combination of gene segments not seen before in people or pigs. The bug contains human virus, avian virus from North America and pig viruses from North America, Europe and Asia. It may be completely new, or it may have been around for a while and was only detected now through improved testing and surveillance, CDC officials said.
The most notorious flu pandemic is thought to have killed at least 40 million people worldwide in 1918-19. Two other, less deadly flu pandemics struck in 1957 and 1968.
Associated Press Writers Maria Cheng in London; Traci Carl in Mexico City; Mike Stobbe in Atlanta, Georgia; and Malcolm Ritter in New York contributed to this report.
(This version CORRECTS health secretary’s name to Cordova sted Cordoba)
Any novel influenza virus is a tremendous worry. If I was flying to San Diego (or anywhere) I would want to have Tamiflu with me.
Heh heh heh. Well, here I am in San Diego without that–and given the possible shortages of it, I don’t know that any doctor would prescribe it IN CASE of exposure. But the paranoia level is high enough that if any symptoms developed, I’m pretty sure it’d be easy to get ahold of some. What does give me hope for this new virus is that both Tamiflu and Relenza work for it.
Here’s a link to a handy pandemic checklist that the NKF put together: http://www.kidney.org/help/pdf/PANDEMICFLUPLANNINGCHECKLIST.pdf