Pandemic

With disaster planning, people think of tornadoes and earthquakes but overlook pandemics. What's a pandemic you ask?  According to Wikipedia:  A pandemic [from the Greek meaning "all" "people] is when an infectious disease spreads across a large region; even worldwide. But it is more than just a worldwide disease; the seasonal flu is not generally considered a pandemic. A pandemic is an aggressive disease, like smallpox and tuberculosis, affecting ever greater numbers of people until a cure is found or it burns itself out after massive deaths.

A worst case pandemic is a new disease (or mutation) that is easily spread, deadly, and with no cure. The US hasn't really seen this on a large scale since the Spanish flu of the 1910's although in some countries HIV has reached pandemic levels.

During a pandemic massive numbers of people become sick and/or die. The immediate effect is that hospitals become overwhelmed and unable to treat all patients. Then doctors & nurses become sick which makes the hospital problem even worse. Then services overall begin to worsen as workers for all types of jobs are sick, caring for the sick or dead. Bodies may pile up with no one to bury them. At some point fear may take over with everyone afraid to leave their home (or alternately fleeing the city to find health in isolation). The government may close schools, sport games, church services and other sites where people meet and mix to halt the spread of the disease.

How do you prepare for something like this? FEMA at www.ready.gov/pandemic suggests:

• Store a two week supply of water and food. During a pandemic, if you cannot get to a store, or if stores are out of supplies, it will be important for you to have extra supplies on hand.
• Periodically check your regular prescription drugs to ensure a continuous supply in your home.
• Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.
• Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home.
• Volunteer with local groups to prepare and assist with emergency response.
• Get involved in your community as it works to prepare for an influenza pandemic.

 When a pandemic begins,

• Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
• If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness.
• Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
• Washing your hands often will help protect you from germs.
• Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
• Practice other good health habits. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

Bird-Pig Flu

I’m still taking the weekends off from blogging, but wanted to include a link to this scary development with Swine Flu at a turkey farm in Chile: UN warns over swine flu in birds

Bottom Line

Why is this bad? Swine flu is very contagious but not deadly (not much worse than normal flu). Bird flu is deadly but not contagious. So far the world has avoided a deadly pandemic from both.

But viruses like to exchange DNA with each other when in the same host body. In a worst-case scenario a Bird-Swine super virus could develop that is contagious and deadly.

Swine Flu Update

“My dear doctor, I’m surprised to hear you say that I am coughing very badly, because I have been practicing all night.” - John Philpot Curran

Swine flu continues to spread around the world, even to remote locations like Fuji. The World Health Organization (WHO) has raised the alert phase to level 6, pandemic. One estimate is that up to half the population could become infected. But since it is no more lethal than a common flu, most people have written if off as no big deal. But there are a few things unique about Swine flu:

• This is a new flu so your flu shot won't help. Everyone is a target. (Exception: many persons over 60 are immune. It's possible that a close cousin of this flu spread widely 60 years ago)
  
• Most flu viruses die with the heat of spring and summer. Not Swine. This flu is going strong over the summer raising problems at summer camps and other summer events like weddings.

The impact is real:

• Delta Air Lines Inc. said the H1N1 virus, also known as Swine Flu, will have a $250 million impact on its earnings this year.

Bottom Line

Continue taking flu precautions like frequent hand washing and staying clear of anyone with a cold.

When to see a Doctor?

"An apple a day keeps the doctor away” – proverb

The media has had a field day with Swine Flu and the number of health related stories is up - way up! Swedish researcher, Hans Rosling (of Gapminder.org), published a video last month comparing Google news of Swine Flu versus Tuberculosis. For each Swine Flu death there were 8176 stories published between April 24 and May 6. For each Tuberculosis death there was one tenth (0.1) of a story. So while the flu is being overhyped there is a silver lining – this is a great time to find articles on health care.

When fighting a pandemic, the best weapon is quarantine; i.e. keep away from sick people. And where are you most likely to find sick people? The Hospital! You might visit the hospital for an injury and pick up the flu in the waiting room or emergency room. I read a story today by an EMT worker who was told if they carried a person with signs of the flu, the vehicle had to be completely scrubbed and disinfected and allowed to air dry for three hours before they could pick up another patient. During a pandemic the EMS fleet would be largely grounded (at most 8 passengers a day per vehicle) if this disinfection rule were maintained. In cases of large-scale emergencies like an earthquake or hurricane, 50% of the regional hospitals may be knocked out of service when needed most.

So what happens if you need medical care during a pandemic or disaster? Many sites promote being your own doctor and stocking up now for a first rate medical supply. But do not carry this to extremes. Certainly you can do more first aid and even advanced first aid at home. Many emergency rooms visits are for minor injuries or illnesses that don’t require a doctor or for which a doctor can do nothing (You paid good money to hear, “take two aspirin and get some rest”?).

My newest commuting CD is about the history of Medicine and disc one is about Hippocrates who started modern western medicine. The instructor points out that it was not easy convincing people that natural causes, not the gods, were responsible for illness. “Faith healers”, priests of Apollo, sacrifices, etc had an excellent reputation because 90% of the time a patient will recover regardless of what is done. The human body is very resilient.

Sadly our schools don’t teach the public how to distinguish the 9 times you’ll recover on your own from the 1 time profession help is required. “Doctors cannot give set guidelines for when to see a doctor and when it is unnecessary because symptoms with the same cause vary too much and symptoms with different causes overlap too much.” [Merck] Many people play it safe and see the doctor every time or for every sniffle. When SARs hit the world in 2002-2003, there were just 208 officially reported cases in the US but the number of calls to 911 and the number of EMS runs increased by 10%. In Maryland this meant an additional 60,000 EMS calls by those who thought they might have SARS. [Based on 2002 call volume of 600,000]

Here are some sites about when to see a doctor:

About.com: Cold & Flu
Merck.com
WebMD
MyDr.com.au

Bottom Line

We can all do more to be our own doctor at home. Yet don’t over do it. Don’t bleed to death from a serious injury or attempt surgery at home because you might catch the flu in an ambulance or at the hospital. During a pandemic or disaster you will most likely need to drive yourself the hospital (ambulances and EMS being overwhelmed). And once there, the hospital staff will be overwhelmed so bring your own facemasks, water, food, and be prepared for a long wait.

Here are some sites for stocking your medicine cabinet and learning advanced first aid:

How to Maintain a Good First Aid Kit
Stocking Up on Prescription Medicines (amazing details of what to buy)
Advanced Trauma Care First Aid Kit

Wilderness First Responder
Wilderness Medicine-Beyond First Aid
Where There Is No Doctor - (html)

Why does Flu Look Like?

A severe influenza pandemic would constitute a major disaster unlike anything experienced in the modern world, where we are almost totally reliant on … ‘just in time’ delivery of food and goods … to function in our every day lives. A pandemic will disrupt every aspect of our lives, from access to health care to availability of food and water, and result in an increase in death and disease in our communities. Even our disaster assistance and recovery plans have been based on ‘mutual aid’ – a system where resources and ‘first responders’ from an unaffected area can leap into action to help people in the area of an earthquake, hurricane, or terror attack. But in a pandemic, no such unaffected areas are likely to exist. You now understand that it is up to each individual to care for him- or herself and loved ones. – from the InSTEDD Pandemic Influenza Citizen’s Guide

Yesterday I gave some of the background on the origin of InSTEDD and its Citizen’s Guide to Pandemic Influenza. Today I’d like to include other interesting facts from the guide.

What does the seasonal flu look like?

Normal influenza can encompass any or all of the following symptoms:
• Begins abruptly
• Symptoms include fever, chills, body aches, loss of appetite, headache, and fatigue
• Fever (>100.4ºF) – usually lasts 2-3 days
• Respiratory tract symptoms include cough without phlegm, sore throat, and congestion
• Temperature greater than 100.4 ºF
• Stomach and intestinal issues, such as diarrhea, nausea, and vomiting.

Pandemic flu may look very different from seasonal flu symptoms
• Sluggishness or alterations in mental state (seen most often in the elderly and infants)
• The 1918 Spanish strain was unusual for killing many young adults and otherwise
healthy people. People were sometimes struck suddenly with illness and within hours were too feeble to walk; many died the next day. Symptoms included a blue tint to the face (due to
insufficient oxygen from lungs filled with fluid) and coughing up blood.

Children and adults may develop sinus problems and ear infections from the flu. In rare cases complications from bacterial pneumonia, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma or diabetes may be fatal.

Bottom Line
According to the Center for Disease Control, CDC, “It is very difficult to distinguish the flu from other infections on the basis of symptoms alone. A doctor's exam may be needed to tell whether you have developed the flu.” Healthy adults may be able to infect others 1 day before getting symptoms and up to 5 days after getting sick. Therefore, it is possible to give someone the flu before you know you are sick as well as while you are sick.

The InSTEDD guide recommends seeing a doctor immediately if you experience any of the following symptoms:

Adults & Children
• Blue discoloration skin, lips or nail beds
• Coughing up blood or foul-smelling sputum
• Bleeding from nose that cannot be stopped easily through pressure
• Bloody diarrhea
• Chest pain
• Difficulty or pain in breathing
• Shortness of breath when at rest
• Persistent vomiting or severe diarrhea not managed by standard measures
• Symptoms of severe dehydration, e.g., a significant reduction in urine output
• High fever for 3 or more days without improvement
• Sudden high fever with recurrence of symptoms
• Extreme drowsiness and difficulty waking
• Disorientation or confusion
• Seizures
• Severe earache
• A severe change in the ability to function, especially if elderly
• Flu-like symptoms with a pre-existing chronic condition like heart failure, asthma or diabetes
• Flu-like symptoms while under immuno-suppressive therapy

Additional Symptoms to Watch for in Children
• Flu-like symptoms or fever in any child less than 3-months old
• Flu-like symptoms with child taking aspirin regularly (could be Reye's Syndrome)
• Excessive irritability or listlessness
• Has a full or sunken fontanel (soft area on the top of a young child’s head)
• Is limp or unable to move

Impact of a flu pandemic

"I wish that you would help build a global system to detect each new disease or disaster as quickly as it emerges or occurs." – Larry Brilliant’s TED Prize wish

One of my favorite web sites is TED.com, “Ideas worth spreading”. TED stands for “Technology, Entertainment, Design” and holds an annual conference where fifty of the most creative minds in the world are given a brief chance (18 minutes) to present their beliefs or works. Over 400 of these talks can be freely viewed at TED.com.

In addition, each year three “exceptional individuals” are awared a TED Prize of $100,000 plus "One Wish to Change the World." Each recipient presents their World Changing Wish at the conference and TED helps organize companies and participants to bring the wish to life. For example, the 2006 TED Prize winner, Larry Brilliant, wished to build a global system for early disease and disaster detection.

Larry was one of the team leaders from WHO that helped eradicate Smallpox from the world. In response to his wish, Google donated $14 million to Larry and five other organizations trying to prevent pandemics. With his TED Prize and Google money, Larry created, InSTEDD, to serve as a free data collection and information organization for the current status of and best response to global infectious diseases. Whereas WHO collects data only from official (i.e slow) government sources, InsTEDD searches the Internet for live outbreaks of disease. The first hint of an outbreak may reveal itself with a spike in Google searches in a region for headaches, nausea, bleeding, etc.

Bottom Line

Everything above was a long introduction to the ideas I really wanted to present. In 2007 InSTEDD published a booklet called, Pandemic Influenza, Preparation and Response: A Citizen’s Guide which I recommend reading. It was updated this month to include Swine flu.

Here is what the guide says about the impact of a flu pandemic.

Communities will be affected simultaneously
• At least 30% of the overall population may become infected in a severe pandemic
• Absenteeism could be upward of 50% in a severe pandemic
• A pandemic is likely to last for 12 to 18 months
• Communities could be affected by several waves lasting 6 to 8 weeks each
• Vaccines and antiviral drugs for pandemic influenza will be in short supply, may be of limited effectiveness, and will likely not be available to most communities
• Most of the ill may wish to seek medical care [BUT ] All healthcare systems will be overwhelmed
• Health facilities … may be inadvisable to enter owing to increased chances of exposure to the virus
• People and communities will likely be on their own without the help of mutual aid from other communities, hospitals, or other public services

Routine services may be disrupted
• Hospitals, schools, government offices, and the post office may be disrupted
• Telephone service, the Internet, commercial radio and TV broadcasts could also be interrupted if the electric power grid falters or fails
• Stores and businesses may be closed and/or will have limited supplies
• Local ATMs and banks may be shut down, and cash will be in short supply
• Public transportation services and communication may be disrupted
• Gasoline supplies may be limited or unavailable
• Travel could be restricted by fear, quarantine or curfew
• Public gatherings may be canceled

Note that there is nothing said here about dying. If you’ve had a bad case of flu you’ll recall that you were sick as a dog for days and unable to work or do much of anything. Even a non-lethal flu can bring a country to its knees if enough people are sick. A pandemic means widespread sickness, not necessarily widespread death. (Altough at times I wised I was dead the last time I had the flu. Ugh!)

UPDATE on Swine Flu:
A new study suggests that Swine flu has a basic reproductive rate between 2.2 and 3.1 others. This means that every sick person will on average infect 2 or 3 other people. Normal flu has a rate of 1.2 and the Spanish flu of 1918 had a rate of 2-3. (Interestingly measles has a rate of 12-18! Very infectious!)
The death rate for Swine flu is now estimated at 0.4%. The Spanish flu US death rate was 0.64% but as high as 2.0% worldwide.

For the US we are not talking about huge differences here. By my calculation, Swine flu is equally as contagious and two-thirds as deadly as the great 1918 pandemic in America. This does not make it “safe”. And yet nations are asking WHO to downgrade the alert, Scale for Flu Warnings Overly Simplistic, Countries Tell WHO.

UPDATE 2
Some Elderly Immune to Swine Flu? It seems that a close variant of this flu may have spread in the early half of the 20th century. Many seniors have antibodies to Swine Flu by surviving it decades ago.

The Return of Bird Flu

“I am no bird; and no net ensnares me; I am a free human being with an independent will . . .” - Charlotte Bronte

The Los Angeles Times recently published a story, New bird flu cases revive fears of human pandemic.

"Hong Kong, believed to have been free of H5N1 [for six years], is forced to cull [80,000] poultry after an outbreak. Two [human] avian flu deaths are reported in Egypt and Indonesia. ... India, Bangladesh, Vietnam and mainland China also experienced new outbreaks in December."

Frequent bird slaughtering and constant monitoring have kept the flu in check so far. Yet it continues to smolder with occasional flare ups. Fortunately the risk to humans is still low,

To fuel a pandemic, a virus must be able to both infect humans and spread readily from person to person. The currently circulating H5N1 strain does neither well.

But low risk does not mean no risk. Mutations are random and could occur at any time.

"What alarms me is that we have developed a sense of pandemic-preparedness
fatigue," [commented one scientist]. ...

Bottom Line

It is unlikely that Bird Flu will be 100% eliminated anytime soon. "The virus appears to be entrenched in Indonesia, parts of China, Vietnam, Egypt and other countries where backyard flocks are more difficult to regulate than commercial chicken farms, according to the United Nations' Food and Agriculture Organization."

Scientists have little experience with which to gauge how H5N1 will evolve. "We still have to treat this as a potentially very, very dangerous virus."

The Fall of the Roman Empire

"First the doctor told me the good news: I was going to have a disease named after me." - Steve Martin

When people today discuss the threat of Bird Flu, they often site the Spanish Influenza of 1918 (20-100 million killed) as an example of a pandemic. But today I learned of another much older example while looking up reasons for the Fall of the Roman Empire on Wikipedia.

Starting in 165 A.D. the Roman Empire suffered a severe and protracted pandemic, either of smallpox or measles, brought home by Roman troops fighting in the Near East. The epidemic claimed the lives of two Roman emperors — Lucius Verus (d. 169) and his co-regent Marcus Aurelius Antoninus (d 180). This pandemic was named the Antonine Plague, because no one, not even the emperor Aurelius Antoninus, was safe from it.

The disease broke out again nine years later, according to the Roman historian Dio Cassius, and caused up to 2,000 deaths a day at Rome, one quarter of those infected. Total deaths have been estimated at five million.[1] Disease killed as much as one-third to one-half of the Roman Empire, and decimated the Roman army.[2] According to the 5th century Spanish writer, Paulus Orosius, many towns and villages in the Italian peninsula and the European provinces lost all their inhabitants.

The pandemic had drastic social and political effects throughout the Roman Empire. A plague weakened Roman army was unable to hold back the advance of Germanic peoples across the Danube in 169. Over the next few centuries the German tribes grew stronger in central Europe while the Roman Legion grew weaker. The death of so many citizens started a chain of events leading to the economic ruin of Rome. There were expensive civil wars in the chaos after the plagues and fewer citizens to collect taxes from. To pay the military, coins were minted with less silver and gold content resulting in inflation. A smaller Army busy with civil wars meant the roads were no longer guarded. Merchants could no longer safely travel to distant parts of the Empire for profits (and taxes).

Eventually the Roman Empire could not afford to support its large Army. Roman swords and armor grew older and shabbier, the soldiers fewer and fewer, until eventually the Germans were better equipped and more numerous than the Romans. In 406 and 410 the German Vandals and Goths were able to sack the city of Rome - a city that had been undefeated for 800 years.

Bottom Line

The Health of a nation can depend on the health of its people (and its military). While the death of millions might not result in an invasion of Goths, it can mean fields not farmed (less food), fewer police (more crime), fewer health care professions (more disease and death), and so on. Look at any natural disaster (like Katrina) and you'll find stories of looting and overwhelmed hospitals. Now multiply that by 10,000 and you can imagine a pandemic.