Very interesting..... bird flu, human-to-human transmission, and musings from others around "Flubogia"

There is an interesting thread posted on a pandemic flu-watching blog that I follow:

http://scienceblogs.com/effectmeasure/2008/04/bird_flu_staying_calm_about_pa.php

First interesting point: It refers to the recent release of information about human-to-human transmission of bird flu in China, just published in the British medical journal The Lancet. The case reported, which actually occurred in December, was a transmission from son to father.

So far, all of the human-to-human (H2H) transmission has been between family members, mostly family members with a genetic relationship rather than marital relationship (second interesting point!). That is leading some of the scientists to believe that there could be a genetic predisposition to infection with this H5N1 virus.

Another interesting aspect of this report was how the father was treated. He was vaccinated by transfusing him with blood from someone who had been vaccinated with a trial H5N1 vaccine. Wow. However, a noted health reporter, Helen Branswell (The Canadian Press), emphasizes that there is no way to be sure that the transfusion is what led to the father's recovery.

The follow-up postings meander from the report to Chinese motives, to authenticity of the information, to the pan flu threat (more "interesting points").

There are some conversations about being too melodramatic about pandemic flu. One person feels that all this pandemic flu stuff is another Y2K - nothing to worry about.

He says, "H5N1 is going nowhere fast, much to the chagrin of the fear mongering crowd. The situation has remained unchanged over the past 4 years and there is ZERO evidence that it's evolving into a human pandemic virus."

And, finally, a highly respected writer, Jody Lanard, reminds us how a message of "don't panic" is interpreted. From Dr. Lanard:

On telling people to stay calm:
Here is an excerpt from Appendix 5, "The Problem with Saying 'Don't Panic'," which I wrote as part of the draft background document for WHO's Outbreak Communication Guidelines in 2004:
Officials clearly have the fear or belief -- the mental model -- that panic is imminent. Instead of diagnosing, validating, and addressing the public's actual level of anxiety, officials repeatedly warn them not to panic.
To the public, "There is no need to panic" implies at least four things:
1. "The officials think or know that people are close to panicking. Things must be pretty bad." This increases public alarm.
2. "The officials think we're about to panic. How insulting." This decreases respect for officials.
3. "The officials are close to panicking themselves." This increases public alarm.
4. "Sometimes there must indeed be a need to panic."
Very hard lessons to teach officials.

An amazing response and recovery

If you've been following the news from Alamosa, Colorado, they are making significant progress on cleaning the water system. Somehow - and we may never know exactly how - the water distribution in this San Luis Valley town was contaminated with salmonella.

The water emergency has had an enormous impact on this small community. Nearly 10,000 people are served by the municipal water system in and around Alamosa. As a result of the response needs, the city welcomed 749 volunteers from all over the state, and many from out of state as well.

Some of the volunteers trudged through town, door to door, talking to people about how to stay safe or leaving notices on doors. Others from far more complex water districts around Colorado used their expertise to flush the water system with a very strong concentration of chlorine. And still more made sure that everyone could understand the safety instructions - no matter what language worked best.

The people who live in Alamosa have not been able to turn on the water without thinking about their health for two weeks now. It has been a huge inconvenience to buy or pick up drinking water, and many even visited a very gracious hotel on its own water system to take a shower for a few days. Through it all, the residents have been optimistic and patient.

If you have ever thought about helping out in an emergency such as this, consider the public health and medical volunteer system today. It includes Medical Reserve Corps units all over the state, staffed by medical volunteers who are willing to step up during an emergency. But your skills might be useful even if you aren't a health professional. The Colorado Volunteer Mobilizer (CVM) is a way to register as a volunteer before something urgent occurs, and to get the training you might need before helping out.

Visit http://www.cdphe.state.co.us/epr/volunteer.html today for more information about the Colorado Volunteer Mobilizer.

The "new" gold

I know that they tell you to have some cash in your emergency kit "just in case," but I think Westerners know what is even more important - water.

You couldn't go anywhere a couple of summers ago when drought was all over the news here in Colorado.

This time, there is a salmonella outbreak in the San Luis Valley city of Alamosa. Best evidence so far shows a problem with a municipal water system.

Everyone is scrambling to get bottled water to them. The traffic on those two-lane roads is sure to be heavy with many semis pulling in to town.

When they get enough bottled water, city officials will shut down the water system completely by flushing it out and using chemicals, which generally isn't needed in that part of the state.

When the clean-out begins, the advisory will be, "Do not use tap water for any purpose except flushing the toilet."

Think about that - the logistics of feeding and caring for a family seem overwhelming in this situation. People are being advised to use paper plates and disposable utensils. They have to buy ice. Some restaurants are closing, just to be sure. Others may close, when they discover how impossible it will be to operate safely under these conditions.

So if this doesn't make you go out and buy some more water "just in case," nothing will.

There's more information online at www.cdphe.state.co.us/epr/alamosa.html.

The coming pandemic and antivirals (again)

The anti-viral controversy has raised its head yet again.

Today, the Rocky Mountain News published an opinion piece from two members of an organization called the Colorado Coalition for Pandemic Preparedness. Read it for yourself at http://www.rockymountainnews.com/news/2008/mar/10/speakout-is-colorado-prepared-for-a-flu-pandemic/.

The writers think that Colorado has "been slow to react to the Health and Human Services request to secure our own antiviral stockpile that we can immediately access in a flu pandemic."

While I appreciate the efforts to bring pandemic flu and public health preparedness back to our consciousness, on this point, they are just plain wrong.

As soon as the feds made their "generous" offer to the states to pay one-quarter of the cost of a state stockpile of Tamiflu, the Colorado Department of Public Health and Environment gathered its resident experts to consider the options. Then, as now, there were two possibilities:

1. Colorado could buy extra antivirals at a cost of about $7 million. We also would have to figure out how to store them properly, an additional ongoing cost for refrigerated storage. It would mean eliminating staff and several programs devoted to public health preparedness for all-hazards situations -- whether flu, blizzard, tornado, plane crash, bioterrorism or explosion. And it would mean a reduction in funding to local public health departments all over the state. And, since the feds won't extend the shelf life for the state stockpiles (only their own), we'd have to throw it out and buy more in five years.

2. Colorado could focus its efforts on the "other tools in our toolbox" to combat a pandemic, since we have no idea whether a pandemic virus would respond to Tamiflu or other available antivirals.

When we last visited this topic (see December 19, at http://breadybhealthybinformed.blogspot.com/2007/12/to-tamiflu-or-not-to-tamiflu.html), I posted 10 reasons for Colorado to abstain from purchasing extra antiviral medication. And I still stand by those 10 reasons... and we could keep adding to the list.

No one can just dismiss the writers' concerns for themselves and other first responders and medical professionals. They are our heroes time and time again.

But Colorado is providing for the people on the front lines of pandemic flu. In fact, the Governor's Expert Emergency Epidemic Response Committee heard from a medical ethics expert before taking pen to paper (or fingers to keyboards) and creating a list of priorities for medication and vaccinations in an epidemic. And with our allocation from the Department of Health and Human Services, Colorado would have plenty of meds for firefighters and nurses called to those front lines.

So, what do you think? Have you changed your mind as a result of this opinion column? Do you think Colorado is on the right track for public health preparedness?

Ready or not?

See Channel 7 here in Denver for information on the campaign resulting from a partnership between the Colorado Department of Public Health and Environment and Wal-Mart/Sam's Club stores beginning next week.
http://www.thedenverchannel.com/news/15348315/detail.html

In this editorial, our director of public health preparedness and response issues a challenge to everyone.

It's not so much a "be prepared or be scared" warning, but he offers some useful info on being ready for anything.

Most relevant to me? How about:
"Spread out the cost by buying a few items each time you shop."
"Work... with neighbors or friends to develop and store items together."

How about you?

What is the best piece of advice you have received about preparing for any emergency? Let us know.