Influenza Plans...

[CanDo]

This will be hardest on the medical professionals, firefighters, police officers etc. Second hardest hit will be the people with various responsibilities. If you just have a wife and a couple of kids, you could conceivably go into lock down for a while and watch the world burn. If you have to take care of other family members or parents you can't move you'll be exposed to the road and everything else in between. If you own a couple of properties, a car lot, or a boat, you'll have to stay on top of them to prevent looting.

In 1919, there were no commercial jets or interstate highways - when this thing comes it'll hit everywhere FAST.

 

[Diomedes Industries]

I teach biomedical ethics and thus review cases of all sorts all the time. If you want a primer on how the government can act review:

The Tuskegee Syphilis Study.
Eugenics and Sterilization in America.
The Internment Camps of WWII

These will tell you these are no conspiracies.

Now - on to the O.P. This is called Triage - it goes on all the time. Any time there is scarce resources a Utilitarian mindset takes over. It is the harsh reality of the medical world. This is also why paying customers are treated before non paying customers with similar non life threatening ailments at the hospital. The hospital has to remain open for the greater good.

I am not saying it is right - I am saying it is policy.

TF

 

[Diomedes Industries]

In 1919, there were no commercial jets or interstate highways - when this thing comes it'll hit everywhere FAST.

Have you ever seen the 'Where's George' dollar bill tracking experiments. This tells us exactly how the flu will spread and you are right. It will move in real quick fashions out of travel hubs. Where money moves - disease moves.

http://www.wheresgeorge.com/

TF

 

[tarmix101]

The difference between triage and eugenics is immense. A government program to pick which people or groups to put out of the way is inhumane. A medical program to treat the most likely individuals to survive first is a logical necessity. The prospect of running out of resources and people to help everyone in case of a widespread disaster is best approached by planning, of which triage is a part.

Increasing resources to match likely threats is another part. People getting vaccinated for flu cuts back on potential victims, releasing scarce resources for others. Stockpiling food in case of civil breakdown helps also.

Complaining that the government isn't doing enough for all of us is lame. Let's raise taxes and increase Homeland Security's authority, then we'll all be all right, huh?

Very well said. :thumbup:

 

[Don Rearic]

The difference between triage and eugenics is immense.

Yes, it is.

A government program to pick which people or groups to put out of the way is inhumane. A medical program to treat the most likely individuals to survive first is a logical necessity.

The fear is that they will expand the dementia portion of that and people who have Down's Syndrome and a host of other maladies will be allowed to suffer and die or be euthanized.

I don't want to get into a long, drawn out argument with you or anyone else about it, but when you start talking about people that could survive if they received help but they won't receive it because they have something else wrong with them like mental retardation, etc., then you really are talking about euthanizing the "useless eaters."

Make no mistake, that will happen in most places.

The prospect of running out of resources and people to help everyone in case of a widespread disaster is best approached by planning, of which triage is a part.

If this influenza hits, it has the capability of killing a lot of people in eight hours. Most of them won't be well enough to even make it to a hospital so a lot of this discussion is highly theoretical.

Increasing resources to match likely threats is another part. People getting vaccinated for flu cuts back on potential victims, releasing scarce resources for others.

When you receive a flu shot, you are not necessarily being vaccinated against the strain going around, you are being vaccinated against the last strain that already went around.

This flu (vaccine) that we are talking about cannot be made via the old method of inserting it into an egg, this flu kills the egg. This is a major problem.

Complaining that the government isn't doing enough for all of us is lame. Let's raise taxes and increase Homeland Security's authority, then we'll all be all right, huh?

I don't think that is the point at all. But I understand your sentiment when it comes to other issues.

The best way to prepare for this on a hospital-level is to make sure you have enough morphine and body bags. They really think this one is going to be a bad one and they think it is "when" and not "if." Rather unsettling but there is really nothing we can do about it.

Another thing that makes a lot of the talk of the policies highly theoretical is the fact that Nurses, Doctors, other healthcare professionals, Police, EMTs, Firefighters, power plant personnel...these people are not immune and they will be dying as well. A hospital that has two surviving Doctors, four Nurses and a guy with a mop bucket is not going to be able to treat very many people.

 

[Stainz]

Wow, that is very cold. As the years mount up behind me, and most think I am nuts anyway, just don't let them add 'fat and ugly' to that list - or my days will really be numbered in a flu outbreak!

As an aside, my wife drug me to an ER eight years ago (8/2000) in the wee hours of the AM. They got to me immediately - I had my second seizure there - my doc was on duty - I went immediately to the cardiac catheter lab, where they put a drill head valve in my chest - and into my pericardium (The sac around the heart.), where they drew out 2.5 liters of fluid. I spent a day in the CIC - and, after an operation to remove a piece of the pericardium ('window') to test, six days on the cardiac ward - with chest drain. My doc said I was blessed and that I had arrived there an hour ahead of needing a toe tag. Fortunately, no heart damage - just the return of my childhood asthma. I had been to a doc-in-the-box the day before - given wide ranging treatment for bronchitis and sent home, told to return the next week, if needed. Obeying him would have killed me.

I mention my only hospitilization for a reason. I have excellent medical coverage. Had I gone to the county's 'public' hospital, I would have been the fat guy sitting in the corner doing an interpretation of a new member of the Blue Man Group for some hours before anyone would have gotten to me. Flu infection there (around the heart) is statistically low in probability. In a flu outbreak, with high numbers infected, there will be a number of such infections - and it has the highest morbidity. My symptoms were flu-like except for no coughing up phlegm. It is fast - and deadly - be aware - get to a decent ER.

We have to learn how to minimize our exposure. Sanitary wipes should be a mainstay. Living 'off the grid' and 'in the boonies' will help - but a return to civilization is always within a few days of necessity. One of the highest demand items most necessary to fight the flu is water... good sources should be available - probably an overlooked necessity.

Stainz

 

[Don Rearic]

If this hits, I think so many people are going to go down for the count so quick it's going to be one of the most horrific things people have ever witnessed. Many societally key people are going to die or otherwise be incapacitated if they do survive and others are going to stay home because of this and they will probably survive if they can seclude themselves for 10-14 days. But this also comes in waves, etc. So there are going to be more cases of it...

IF it happens and IF it is as bad as they think it will be, you want to talk about a "collapse?" I mean, most people think "Red Dawn" when they think of stuff like "societal collapse." Think more along the lines of Stephen King's "The Stand" without the supernatural overtones.

 

[coffeecup]

Has anyone seen the actual report, or is everyone just blue-skying based on a reporter's interpretation of a press release? I can understand the concerns about announcing a list of priorities and the way it places a greater value on some people than others (and anyone who doesn't might want to check into the history of Aktion T4), but I can't see getting too concerned until I've read the actual paper.

The paper was published as a supplement to the journal Chest; the title is "Definitive Care for the Critically Ill During a Disaster." Original press release is at http://www.chestnet.org/about/press/releases/2008/080505.php and they do briefly address the question of liability. According to that page, a complimentary copy of the supplement is available from the journal page--but I couldn't find the link. If anyone accesses it please post the link; you might also want to see if they can get a copy of one of the editorials: "Can There Be a Consensus on Critical Care in Disasters?" This probably considers some of the ethical questions.

 

[kvaughn]

As a first responder for major disasters, including a flu pandemic, I assure you plans are in place for forced quarantine of whole communities--KV

 

[akennedy73]

To prepare, hospitals health insurance companies should designate a triage profit-driven team with the Godlike task of deciding who will and who won't get lifesaving care, the task force wrote.

hmmm, better to decide based on the welfare of the majority than the greed of a few - compared to the current US health-care system, it's downright humane

but back to the OP - although i do believe a lot of people will die from H5N1, on the scale of things it will be small.

From wiki:

"In September 2005, David Nabarro, a lead UN health official warned that a bird flu outbreak could happen anytime and had the potential to kill 5-150 million people"

There are are over 10 million people born every month on this planet. If 150 million people die, they'll be replaced within a year and a half. I don't mean to discount such a large number of deaths - I live in a city of 8 million and to think of over 100 million dead is beyond my comprehension. But objectively it's a small percentage of people in a world of over 6 billion.

I also don't think it will be as bad as people think (except for the fear and hysteria it generates). There has been a great deal of genetic mixing within the world population since the Second World War. All that cross breeding means that there will be a wide and varied immunological response to a viral pathogen. Populations without a high degree of genetic diversity will fare the worse since they will have a similar immunological response by all their members rather than a highly varied one.

From Wiki:
"In U.S. Army camps where reasonably reliable statistics were kept, case mortality often exceeded 5 percent, and in some circumstances exceeded 10 percent. In the British Army in India, case mortality for white troops was 9.6 percent, for Indian troops 21.9 percent. In isolated human populations, the virus killed at even higher rates. In the Fiji islands, it killed 14 percent of the entire population in 16 days. In Labrador and Alaska, it killed at least one-third of the entire native population."

This is why European diseases were so devastating in the Americas. There wasn't a varied immunological response due to the lack of genetic diversity in the Western Hemisphere. Some put the death rates at above 90% for native populations in the Americas after 1492.

I doubt H5N1 will achieve mortality rates above 5% overall (and it will likely be about 2%). That 5% won't matter if it's your family or friends. But we're not facing societal collapse from the bird flu IMO.

The best survival plan is to exercise, eat right (dark leafy greens, cod liver oil, etc), get plenty of sleep, don't get stressed out a lot. Basically stay healthy. And when the pandemic hits, stay calm. Freaking out and taking rash actions may be more detrimental than anything else.

 

[coffeecup]

Shotgunner11, it looks like your little one would be in the clear, assuming no other health problems. In other words, criteria for exclusion seem based in chances for survival rather than criteria that might be perverted to eugenics-like practices on a broad scale.

They've got the supplement posted, in the form of several files. From the summary, they call for rationing of care only when all other measures are exhausted; they also call for legal protection for providers when "following accepted protocols." (I don't think that should be the case--it sounds too much like "sovereign immunity." People are more accepting of such things if they have the belief that decisions are made by someone who will at some point be held accountable for their actions.)

Exclusionary procedures/criteria are contained in the paper "Definitive Care for the Critically Ill During a Disaster:A Framework for Allocation of Scarce Resources in Mass Critical Care." It looks like the first exclusion would be done with an objective test (Sequential organ Failure Assessment), followed by a reasonably objective (i.e., not subject to too much interpretation) series of criteria.

While I have not studied all of the papers in the supplement, it is my impression that a major factor in these criteria is how quickly the patient would recover and be out of the way, freeing resources for other patients. Anyone with an interest in this (triage or mass critical care) might want to take a look at all of the papers. I just looked at it from a rather narrow perspective.

 

[Sgt. Art]

Personally I believe this to be the most real and far reaching global disaster on the horizon. I feel that there is great potential for rebellion when and if these types of guidelines are put into effect. People riot for much less then the life of a family member. Stock up and be prepared to go it on your own for up to 3 months, taking care of family at home is going to be a standard. Be able to keep sick people hydrated 50% gatorade (type drink) 50% water works best. Be prepared for loss of services, food shortages, schools/business closings for up to 3 months. Work places should expect a 30 +% loss of work force. Getting a flu shot will not protect you but may help reduce the effects of the strain. It will take 6 - 1 year to develope and distribute a vaccine.

Remember in the 1918 flu 21.5 millions died world wide including 675.000 Americans and we were still at the horse and buggy level this time it will travel much quicker and spread faster.


More information about the 1918 pandemic can be found at: http://1918.pandemicflu.gov/the_pandemic/index.htm

 

[Khalnath]

Every health care professional knows that triage is the hardest thing you will ever be involved in. Deciding who lives and who dies is a terrible job, but someone has to do it. It sounds cold and heartless because... it is. It has to be.

 

[Tractorshaft]

It sounds like the goal is to use resources as efficiently as possible rather than to implement some sort of darwinian plan or eugenics program. I don't know much about Down syndrome, but unless it would reduce the effectiveness of the influenza treatment, I don't see the report as arguing that those affected shouldn't be treated.



In a SHTF situation of this sort, there will be a lot of violence in that nature. I can see National Guardsmen being stationed in hospitals to keep order and protect medical professionals.

Dont expect to see your friendly National Guard in a situation like that, more like the boys in the "Blue Berets" :barf: or some Blackwater types...

 

[Don Rearic]

Attention AKennedy:

"To prepare, hospitals health insurance companies should designate a triage profit-driven team with the Godlike task of deciding who will and who won't get lifesaving care, the task force wrote."

You attributed this to me with the neat little strike marks, etc., please do not do this. I know it is popular when there is a dogpile to attribute things to other people, like the incident with "nephildevil" or whatever his name is where people were re-working his words. Hell, some people even insert things like...well, I better not do that.

If you want to say something, SAY IT. Don't make it appear to other people who might not know any better that I said something I didn't, arrite? Arrite!

Not that I disagree with the sentiment expressed, it's just a thorn to me.

...but back to the OP - although i do believe a lot of people will die from H5N1, on the scale of things it will be small.

Well, yeah! I mean, it's not going to kill everyone is it? When you start talking about "scale" and start wrestling with numbers like you cited, well...what's the old saying? "A single death is a tragedy, a million deaths is a statistic." Yeah, I think that's how it goes.

This is a prime example of a numbers game that is basically stupid.

"In September 2005, David Nabarro, a lead UN health official warned that a bird flu outbreak could happen anytime and had the potential to kill 5-150 million people"

There are are over 10 million people born every month on this planet. If 150 million people die, they'll be replaced within a year and a half. I don't mean to discount such a large number of deaths - I live in a city of 8 million and to think of over 100 million dead is beyond my comprehension. But objectively it's a small percentage of people in a world of over 6 billion.

IF it happens and it's really bad, this country might not ever be the same. Numbermonkies are betting that only the weak and sick are killed off. The thing of it is, the better your immune system is, well, that's how this particular flu kills you. Your immune system overreacts and your lungs dissolve and you cough them up. So, all bets are off as to the "bestest and brightest" making it through this. It ended World War One, it brought Germany to the table to end the war.

I also don't think it will be as bad as people think (except for the fear and hysteria it generates). There has been a great deal of genetic mixing within the world population since the Second World War. All that cross breeding means that there will be a wide and varied immunological response to a viral pathogen. Populations without a high degree of genetic diversity will fare the worse since they will have a similar immunological response by all their members rather than a highly varied one.

If you are talking about people having a stronger immune system, this will kill them faster with this particular bug. This is really not the good old regular flu we're talking about here where orange juice and vaccinations are going to carry us through.

"In U.S. Army camps where reasonably reliable statistics were kept, case mortality often exceeded 5 percent, and in some circumstances exceeded 10 percent. In the British Army in India, case mortality for white troops was 9.6 percent, for Indian troops 21.9 percent. In isolated human populations, the virus killed at even higher rates. In the Fiji islands, it killed 14 percent of the entire population in 16 days. In Labrador and Alaska, it killed at least one-third of the entire native population."

Apparently the person that wrote that, and you must remember that Wiki is driven by regular people like us...is that there were several waves of the flu back then, what was known for years as "The Spanish Flu." Which wave were they talking about where "reasonably reliable statistics were kept?"

I doubt H5N1 will achieve mortality rates above 5% overall (and it will likely be about 2%). That 5% won't matter if it's your family or friends. But we're not facing societal collapse from the bird flu IMO.

Dr. Gary C. Ridenour would object. I believe him more than wikipedia. All in all, you don't really know how this flu works yet you start quoting stats from wikipedia.

The best survival plan is to exercise, eat right (dark leafy greens, cod liver oil, etc), get plenty of sleep, don't get stressed out a lot. Basically stay healthy. And when the pandemic hits, stay calm. Freaking out and taking rash actions may be more detrimental than anything else.

I think Joe Average will fare better than the person who focuses on boosting his immune system. This is really a strange bug, this flu.

Then some with compromised immune systems will die from secondary infections, so...be normal.