There are many local stories about pandemic flu planning and they all sound pretty much the same. Local officials saying they are making good progress but there's still much left to do and if a pandemic struck they'd be in trouble. Yawn. But every once in a while you read one where you say to yourself, "Some of this has sunk in. They're asking the right questions." Not often, or at least not often enough, but when we started talking about this no one was asking questions like this:
Meals on Wheels delivers 850 meals a day in Rockingham County [New Hampshire], relying on 35-40 drivers and hundreds of volunteers who package the food for delivery.What happens if these folks get sick in a flu pandemic? Will elders go hungry?
The New Horizons shelter for men and Angie's Shelter for women in Manchester typically serve 95-120 people a night with a staff of 17, three of whom work overnight. If their staff is ill, where will the homeless go?
This is when statewide avian flu planning gets down to the nuts and bolts. (Boston Globe)
Recognizing the problem isn't solving it, but it's a damn sight further on than not recognizing it at all. Much of the rest of the story is the usual stuff, including the obligatory self-congratulations with the caveat kicker:
The state's efforts led to a 99-page document on pandemic preparedness that talks about how state health officials, hospitals and the state Emergency Operations Center will work together.
Another fat document looks at the numbers of hospital beds and how to provide extra beds in an emergency. That report found the state has room to accommodate 2,149 patients in regular beds and 374 in intensive care units. The goal is to find room for up to 30 percent more.
"I believe strongly that New Hampshire is leading the way on pandemic planning. I'm not going to say that I'm satisfied with our efforts. We do have gaps that we need to fill," said Health Commissioner John Stephen.
While the plan will probably be overrun by events in the first two weeks of a pandemic, the planning process will pay off. And while some public health officials fall in love with their state plans, many local public health officials understand they will be on their own and planning should take that into account:
[Dr. Robert Gougelet, who directs the Northern New England Metropolitan Medical Response System.] said the regions all are at different points in the process but after studying what went wrong following Hurricane Katrina on the Gulf Coast, he's convinced that localizing the planning will be key to a successful response in New Hampshire whatever the threat.
"You're not waiting for the state. You're not waiting for the feds. They can still go into action without anyone's permission," he said.
Local planning means local community mobilization. We talk a lot here about strengthening the public health infrastructure, but we always couple it with the need to strengthen the social services infrastructure with it. Meals on Wheels is part of the social service infrastructure and so is Angie's Shelter:
And what will Meals on Wheels do if its volunteers are laid low by the flu? The agency keeps a supply of frozen meals to deliver extras if bad weather or a shortage of delivery people makes daily delivery impossible. It also has a collection of meals that don't require refrigeration in case of a prolonged power outage.
"We see ourselves as having to keep going no matter what. So many people depend on us," said Executive Director Debra Perou-Hermans.
And at Angie's Shelter and New Horizons, officials said shelters have a broad base of volunteers to provide extra hands in an emergency, especially since New Horizons also houses the local health clinic.
"A lot of what is done is done by volunteers," said Tim Soucy who's vice president of the board and a Manchester public health administrator.
"It could be the saving grace. I'm sure people would still say: what needs to be done? I think we're very fortunate," he said.
Many flu watchers who read and comment here are deeply pessimistic if not outright cynical about how people will act if there is a pandemic. No doubt many people will falter when it comes to helping their neighbors and some will behave very badly indeed and take advantage of the sick and helpless. But experience has shown that a significant number of people rise to the occasion, for whatever reason. This was true in 1918, it was true during the plague visitations of the 14th and 17th centuries, it was true during SARS and it will be true again if fate brings a pandemic to us in the next few years.
Lack of foresight and failure to prepare may be our enemies, but so is cynicism. It prevents us from encouraging, preparing for and taking advantage of the selflessness, spirit of sacrifice and desire to help that will inevitably emerge in a pandemic emergency, just as it has in past pandemics. Failure to appreciate this will result in wasting a resource more valuable than antiviral stocks and warehouses full of masks.
There is a lot of hand wringing by commenters here about public officials and our neighbors who don't seem to get it. There are a lot of things to "get," however, and maybe some things they "don't get," too.
The Meals on Wheels and Angie's Shelter folks get it. Do you?
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Hear, Here!
Good post.
Some folks locally do 'get' it, including health officials. The biggest and most important non-pharmaceutical intervention is going to be closing the schools, early and completely.
If you want a gauge of where your community is at, ask whether that's been considered. All the answers as to what to do with the kids might not be there, but recognition of that step is a necessary part of local prep.
And ask, while you're at it, if the local water people have more than one guy who knows how to run the place.
Well said! If only we could get this idea into the head of every person at FEMA. Immediately after hurricanes in our area, it's been the individual and volunteer groups (including religious) who have done the basic work of keeping society going. It was horrifying to hear on the news after Katrina stories of volunteers being prevented from going into New Orleans to deliver water and to bring people out.
We need to be educating the public on how to help in health and natural disaster emergencies. The last few years, I've heard the message repeatedly from our local government, "In the event of a disaster, you need to be prepared to be your own for awhile." I'd rather hear them say to the public, "You need to be prepared to help each other."
http://www.bloomberg.com/apps/news?pid=20601202&sid=aCAuCdDjwXIE&refer=…
Revere, what is your opinion about an approval for a mock-up vaccine, so bureacracy will be passed when a pandemic starts? IMO it's prepping in advance and positive, but the dark side of it is the question about how well the product is when not well tested at all. Maybe GlaxoSmithKline is trustworthy and will deliver quality vaccines, but what about factories in other countries where fraude has already happened by dilution of vaccine serum etc?
Perhaps Revere what we all need to do is take some time to contemplate our own mortality. We are all going to die. The questions are when, in what way, do we leave some of our genes in the next generation. Further for atheist or god believer one needs to ask the question - will I be ashamed of myself when I die - is it better to risk dying early feeling I have lived as a decent human being or live longer as I watch those around me die without assistance. God believers may not think that atheists are capable of such thoughts, but since I am an atheist and I have a desire to die unashamed I disprove that theory. I don't think it will matter one iota after I am gone but up until the moment of my death it will. Christians who want extra reinforcing can recall the Sermon on the Mount where Jesus says "I was sick and you did not visit me - off to hell" (loosely translated). For me shame while i am living is enough motivation. For Christians perhaps we should remind them that failure to help neighbors might result in endless damnation.
Unrelated but needs to be looked at: Recent dieoff of 2500 mallard ducks near a creek in the US. It appears to be bacterial due to findings related to lesions in the heart and lungs, but the final word is not in yet. It also appears to not be avian flu, and other bird species in t he area were not affected. However something tells me that this deserves further attention. Revere, would this deserve a new topic posting from you, if for no other reason to go over the evidence that it is probably not BF in order to dampen down any paranoia that might be out there about this? (Pardon my crappy writing today, I'm actually in the middle of work right now..)
K: My sentiments. Exactly.
g510: I watched the mallard issue, but it was so localized to the creek I thought it unlikely to be H5N1 and anyway usually wait for more info with something like this. All I would be able to do is speculate along with everyone else and my speculations wouldn't be worth any more than anyone else's. My impression was that they have determined this is aspergillosis (fungus), right?
"My impression was that they have determined this is aspergillosis (fungus), right?" Wow, really? I worked with asper in grad school. It was a disease of VERY distressed birds, not otherwise vaguely healthy ones. Hard to see what would send a large wild flock over the edge like that.
Was it so localized to the creek? Did all those agencies who went out there look around very far?
Picking up dead ducks with no PPE and throwing them in pickup trucks, and mentioning carnivores had been eating the ducks (but not dead yet that they saw) - the bird species that were not dead- did they test those species for HP-AI?
I thought they only had unconfirmed assumptions - if the test results are bad, do they think the media will get distracted and forget to ask, "Whahappen?" (Maybe I just missed test results reported, and haven't seen the article.)
Hey! Any stealth scientists'-helpers bringing home any holiday surprises?
;-) Storm chasers exist: Avian Influenza-Chasers?
(Wonder what their specialized vehicles would look like?)
As a NH resident who has communicated directly with John Stephen's office on the issue of the state's pandemic preparedness, I can tell you I was very skeptical at first. I've come to believe that Stephen is very committed to preparedness. His committee is not letting the different regions off the hook in terms of milestone deadlines, etc.
I, along with a couple other EM frequent flyers, met with our region's pandemic planning coordinator (they call it All Hazards, but it is clearly pandemic planning) last month. I fully expected to be underwhelmed. I was really pleasantly surprised, though. The thought and planning going on is significant. The planners have no illusion that all cities/towns are or will be equally prepared, but they are making a best effort. Sadly, the message from the state to citizens is prepare for (ack!) three days, work your way up to seven, and if you're feeling particularly vigilant, break the bank on two weeks of preps. That's a huge bummer.
I went into the meeting all hot to trot to push the early school closure agenda. Come to find out, I didn't really have to. As it turns out NH actually came very close to passing legislation last year that would have given the governor the authority to declare early school closures as mandatory. It failed, alas, because some dodo attached language to it related to the Real ID brouhaha (which NH is refusing to go along with).
As I understand it, the legislation will be reintroduced in the next session and, assuming no more bogus cling-ons, should pass with a handy margin.
As to how the homeless populations will fare, that's a much sadder story. Individual non-profits catering to that demographic will be on their own. The mid-level administrators in charge of pandemic planning for the homeless population are in total denial and directing practically no resources to that area of need.
For anyone interested, here is a link to the bill that failed to pass in NH last year. Not sure if the one to be introduced will substantially mirror this one, but I believe it will.
http://www.gencourt.state.nh.us/legislation/2006/SB0399.html
I saw a picture of an autopsy of the inside of one of these birds and it was bloodied up and especially around the heart and lungs. I dont know what it means in relation to aspergilliosis or H5N1. Damned strange and the geese in the area were not getting it, only local mallards and inbound mallards. If it is H5N1 we will find out soon enough. I find it very hard to believe that local ducks hadnt been dying or the geese until these guys showed up. If it were pesticides, hmmm well who uses pesticides in the wintertime? Also bacteria might have been brought in just as a H5N1 might have. But its not so warm in Idaho, which would suppress it to a large degree. That creek by the way is about 5 inches deep and only about 20 yards wide (Natalie at a local Boise I, TV station).
Santa's helpers will be hard at work if this stuff comes and the wheels are starting to turn slowly. I am becoming a little more optimistic about our local situation but it would take at least three years to be able to respond a single wave, much less a multiple wave event. The numbers that are shown in the WPRO region of WHO indicate that we who are just about 50 are pretty much at the break point. We get sick and a few will die. Kids though are going to go down like they were hit by napalm. 2-1 one about on average for boys until about 29, and then after that 2-1 girls until about 50. We are going to get sick in droves and the question is the downtime for even the older people. Many will die just because they didnt get a little help. Meal on Wheels? They arent going to let those people move Revere-vector transfer and those that need those meals are going to become casualties.Three or four days is all they will have up to about two weeks. Its reality and people had better start getting used to it.
MIH has some robust kids who wont even pay attention to her and she sits in Hawaii trying daily to get them to move. So we have the dumbing down effect of media down playing this. They ought to get the pictures of these people as they die of SARS or PanFlu and put them on the tube. THAT would get them moving and also government as they feel the boot of the people in their collective political asses.
So what do we do if they dont? Triage of the young ones might be just checking to see if they are mottling up with the blotches and giving them morphine because there isnt any way to force oxygen into them. I'll be out there because even though my kids are hard core to the bone and will go full military on anyone, I want them to have world to exist in afterwards. Aint any defeatists here, just realists. A four wave 1918 event taking 5% each time is 20% and thats about 60 million and change. The change would be those that starved to death or died from secondary causes give or take another 10 million-meals on wheels types. So Revere is right, better be prepared as an older one to suck it up and help the younger ones or this country falls apart like a two dollar watch.
Katrina was a wake up call but it wasnt so much the Federal Government as it was the failure of the State Government to relinquish control. Blanco "assessed" for three days just as Lawton Chiles "assessed" during Andrew. Next Dem that "assesses" while a Republican President is in office is going to get ripped wide open by the party in political ads. The gloves will come off.
The Federal Government by law Julia is prevented from taking action unless there is a direct threat to the security of the US. Katrina was bad but it wasnt a security threatening issue so Bush(s) both had to wait while they legalities were sorted. Why? Because its an impeachable offense to send troops into a state without that states permission. Blanco wanted those troops under her control and sorry when you federalize it, thats when the feds take over. Thats the reason they call it federalization and FEMA is just a little agency with a lot of money. The people like now were warned and they like the local government that was responsible for them...did nothing. Blanco was either political, stupid or both. She knew the law and refused to put it into effect. Did people die unnecessarily? Maybe not. Their deaths point out a glaring hole in the ability to respond to this. You ought to see the lead in to my "Total Disaster List" as it describes in graphics the effects of a panflu, CAT 5 hurricane, or a New Madrid fault quake.Pack your lunch, its going to be bad.
When the bug comes as a pandemic in High Path we are going to see little fiefdoms of governorships. Oh believe me they will federalize this problem in a heartbeat but they have covered their asses in the National Pandemic Flu Plan. The governors will be screaming but 5000 Katrina's going off at once in America and you might have well sent a letter to Santa with your wish list. Thats what high path anything will do. The government is warning and warning about personal preparedness and those that dont will simply die this time around. Wont be any finger pointing or shouting that they didnt do enough because other than body bags and keeping the gas, electricity and fuel going there isnt squat they can do. I hear a lot about surge and ventilators and etc. I challenge anyone here to prove that having a surge capacity or extra ventilators will save more than a few dozen out of a couple of thousand. The cost to save that few dozen will be astronomical and it will finish the coffers of this country. A ventilator costs about 100,000. Healthcare is a business and not a right. They arent going to blow the bucks for that for a one off event. Cant amortize death. Like I said get used to the fact that they literally will be stacking bodies up like cordwood. 1347-1348 Cairo the bandits hid behind the bodies of the dead along the road so they could ambush people. How many bodies does it take to be able to hide behind them?
A lot!
So how to ensure you will be around is based upon preparedness. We will have a truly limited government afterwards... Kind of like what the Founding Fathers envisaged. So you either have the govenment completely in charge, or not in charge of your personal life. Make your decisions known now and act accordingly. Failure to do anything will result in a catastrophic change in your life. WE here get it, those that DONT will die either from the flu or at the end of a rope when they are hung for stealing food or property. The post pandemic era will be fraught with war, pestilence and a major shift in the balance of power on this planet... China is my bet as the next super power.
I live in NH, and have spent time researching our state's pandemic preparedness plan, and all-hazards plans which are the overarching expression of the pandemic planning. What troubles me greatly is that the attack rate and casulty rate scenarios being used are, IMHO, insanely low. Estimated deaths run in the few thousands. In reality, I fear those 2000+ beds will be over-run in short order, and the 200+ ventilators long before that. Soup kitchens? Meals on wheels? How much more walking into the future can we tolerate?? Far too much business as usual framing, again IMHO. I would agree with Revere, et al, however, that there is an unestimated power in people rising to the crisis. I just hope they are deployed wisely, and not relegated to filling sandbags at a failing levee.
Make that: Walking into the future backwards...the point being that even our state plan cannot seem to turn into the strong wind that is blowing at us. Enough metaphors for tonight. I agree with MRK: it is going to be bad, folks; the consensus trance is going to evaporate very quickly.
Dinkers-You have the right thoughts in this because the total thrust of my blurb above was that its going to get down to personal preparedness. Screw 'em. Be the Chicken Little in your neighborhood and get in the faces of your neighbors. Download some of those graphic pictures and movies of what it does to chickens and geese and play them.
My next door neighbor who is my State Senator took my manual to Nashville and now they are reprinting and handing it out. I am prepared for a two wave event but not a four. I dont know how long a four wave event will last. I have the model that was produced in the spring and carefully they left off the CFR's and allowed only the "cases" to be shown and how it would spread. It stated green, then as the virus spread it went to red, then yellow and back to green with the non-populated areas being white. So theoretically everyone lived. But with a 100% kill rate in Indonesia for the last two months and even if we took it at 80% rather than 100% a lot of those red and yellows will give way to pockets of white or a lot less green.
I cant understand why they keep soft pedaling it. There are videos out there of these people and they should be showing that. Panic? Sure, a little panic that would make people prepare. When SARS was coming they were putting plastic on their houses-panic and ignorant panic. What they should do is show graphics each week and whats happening. That would scare people into action. We ARE going to have a pandemic...Flu? SARS? Preps are the same otherwise decide which one you want to go from.
The mallards could have fowl cholera (Pasteurella multocida). I haven't seen photos, but it's not an uncommon disease of ducks, and could fit in with the described symptoms.
Baited grain rodenticides, if eaten by ducks, might produce a haemorrhagic syndrome.
I am one who has expressed profound cynicism here and elsewhere... in fact, I think I triggered an outburst of cynical comments here some time back. I remain cynical.
My municipality has recently published a pamphlet, which among ten most likely public emergencies lists breathlessly "an influenza pandemic is the number one threat!" It says, one in three could become ill, most would need to stay home, "quite ill", for up to three weeks. It says, we should keep in a portable container three *days* supply of candles, batteries, whistle(?), passports, cash, gasoline, flashlights, maps, etc; and arrange for somebody to look after our kids and pets, and get groceries... and, we look back frantically rereading, finally to discover that food and water are mentioned, buried in the longest paragraph of the 'three days' list.
The pamphlet also contains scattered lists of teckie gadgets to be utilized by nobody, and advice to do arcane things such as "set up an emergency communication plan", learn "who is in charge", know the "schools emergency plan" and "when and how to evacuate",,, a lot of unexplained talking points, which amount to "wait for and obey orders".
However, you are right, revere : few will survive who are not part of, and willing to subordinate their own advantage to, a community.
But what is a community?
My cynicism was strongly provoked by MiH's discouraging tale, some time ago, about trying to interest politicians in planning. Cynicism is justified, whether they don't want to plan or they don't want to reveal the plan. There are too many "community-leaders" who know neither community nor leadership.
Most of my old political comrades would say at first sight of Kruger, "somebody ought to shoot that (expletive deleted)." Kruger, though, is more likely to survive. However, the truly significant point is that they would not say "I" or even "we". Indeed, few of my comrades have so much as touched a gun.
Remembering that MiH has also said she tried to interest her natural community, she is saying "somebody ought to make us survive". Neither my comrades nor MiH knows how to be a community.
Nevertheless, it is communities, not individuals, who will survive.
Greg-It will take a village but you have to have a chief in that village. Me, I will have to work on it and my neighborhood watch group elected wardens, all older guys (50-75) to act as triage people for the locals. My Pakistani family is now the communications director and 80 households will pull together, close the roads and they will be packing to protect. Law are different in NH and I can say that the right to keep and bear arms if this comes is going to be used time and again. Unfortunate but the military as long as we maintain our own perimeter and take care of our own will not bother us, nor will local law enforcement. No one that leaves (me) will be allowed back in. I have my area set now for decon showers, bunks, medical triage area, power production, and fuel. Those guys have agreed to take care of my family as they know the will have communications to me thru military spectra band radios that I have put into their hands and supplies will make it to my little town as a result.
If you dont have a gun, I would get one. Our military will be tagged just as bad if not worse than the general population because they will become vectors in their own right as they try to "rescue" those that didnt prepare or werent able to. Those kids are going to fall like flies either as cases or CFR's. Dont really have an answer for you up there except to have a bail out plan to get south if it comes. Toooo damned cold in NH to start with and New York, Boston, Philly, DC, Providence will get the majority of the support. Question is do you want to go and try to get it.
Remember, the power grid likely snaps at about the 25 day mark. Might be some shots at restarts but until the switches go off they wont be able to turn it back on. Deal with the realities of what MIGHT happen as best you can, thats all you can do. If you give it up fighting then its not so bad. Think about those that heard, knew, and didnt do anything.
Regarding the 2,500 mallard duck dieoff brought up by g510 which appeared bacterial,one of the articles out there describes the lungs of these fowl as being full of abscesses of pus. In humans this can be caused by bacteria (streptococcus), but also an abscess-like problem can occur in TB. Birds have their own variety of TB that infects only birds and HIV-infected humansmycobacterium avium.
However lets add this caveat for the sake of those of us who are benchtop (and not computor) scientists and really know what goes on inside diagnostic laboratories today: It will never be found because the appropriate cultures, growth factors, incubation time and PCRs will never be preformed. In one study human M. avium only showed up after 18 months and that was in cultures primed with mycobactin.