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Antiviral Stockpiles and Prophylaxis

by | Nov 24, 2007

An organizational decision to stockpile antiviral medication and then acquiring anti-virals is the simplest part of a plan.  The protocol associated with securing, transporting, screening and eventually dispensing the antivirals is another matter altogether. I wonder if you would be so kind as to comment on some of the antiviral initiatives that you are seeing and give your personal opinion on the use of antivirals as prophylaxis.

 

There are several issues to consider when dealing with antivirals and pandemic flu. The first deals with the dose, regimen and efficacy of antiviral treatments for pandemic flu. Experience with antiviral regimens against H5:N1 influenza in South East Asia has shown that even with the best healthcare professionals in attendance and the greatest minds guiding care, the usual dose of antiviral medication must be doubled and that the length of time required for treatment is twice as long. Further, the past several months has demonstrated a disturbing trend towards the need for the use of both drugs at this four fold increased regimen. This set of facts alone means that a company planning to stockpile must now plan on four times as much of each drug for each person to be treated. 

 

The second issue deals with obtaining sufficient quantities of both drugs to provide effective treatment. Based on standard doses, experts and governments agree there are insufficient supplies of antivirals available to treat just those in healthcare critical infrastructure and national critical infrastructure roles. The four-fold increase in dose and the need for duel drug therapy effectively reduces supplied eight-fold. 

 

The third issue deals with the ineffectiveness of prophylaxis and the risk of creating resistance to the few drugs we have now. While drug prophylaxis has a certain theoretical appeal, it has not been shown to be effective for influenza. Worse, constant exposure of the disease to low doses of the antivirals increases the likelihood of mutation resulting in resistance to the antiviral drugs. Finally, any drug used for prophylaxis is taken out of the total supply, thus reducing the amount of drug available for treatment. Given that at worst, only one in three people exposed to the disease actually falls ill, giving prophylaxis to everyone means using three times more drug than needed, or running out of drug three times sooner.

 

The fourth issue deals with the ethics of superseding national needs regarding critical healthcare infrastructure support and national critical infrastructure support. Given a limited worldwide supply of antivirals, such redirection of drug means that some segment of critical infrastructure will be denied treatment.

 

In short, the decision to stockpile medications is ill-conceived, impractical and quite possibly unethical. Prophylaxis is perhaps the only decision that would be worse.

 

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Part of the National Domestic Preparedness Consortium and home to the National Emergency Response and Recovery Training Center, TEEX has been leading homeland security training since 1998. The major TEEX programs include fire and rescue, infrastructure and safety, law enforcement, economic and workforce development, and homeland security. As a member of The Texas A&M University System, TEEX is unique in its ability to access a broad range of emerging research and technical expertise. Beginning with course design and development all the way through hands-on instruction and national certification testing, TEEX delivers comprehensive training through both classroom and hands-on instruction and as online courses.

The National Child Traumatic Stress Network (NCTSN) was created by Congress in 2000 as part of the Children’s Health Act to raise the standard of care and increase access to services for children and families who experience or witness traumatic events. This unique network of child-serving professionals, caregivers and young adults, researchers, and national partners is committed to changing the course of children’s lives by improving their care and moving scientific gains quickly into practice across the U.S. The NCTSN is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) and coordinated by the UCLA-Duke University National Center for Child Traumatic Stress (NCCTS). 

The Emergency Management Institute (EMI) is part of the Department of Homeland Security’s Federal Emergency Management Agency (FEMA). The EMI provides national leadership in developing and delivering training to ensure that individuals and groups having key emergency management responsibilities possess the requisite skills to effectively perform their jobs.

The High Alert Institute maintains a list of reviewed courses provided by governments, universities and professional organizations. This list is geared towards the non-emergency management person who participates in disaster planning, preparedness, response, recovery or mitigation as part of their job responsibilities.

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Koi need forever homes, too! For pond enthusiasts, freshwater exotic and ornamental fish may not be available through pet stores or rescues in their area. The High Alert Institute Aquatic Pet Shelter Rehoming Program will be happy to assist you in stocking your new pond or adding a new finned friend to your school. Coming soon – when you adopt a Koi from the High Alert Institute Aquatic Pet Shelter Rehoming Program, we can arrange for delivery to your door anywhere in the continental United States.

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Dumping of freshwater non-native species and exotic aquatic pets into wild habitats is a man-made disaster that is truly preventable. The Institute’s Aquatic Pet Welfare Partnership works to raise awareness and reduce the impact on healthy ecosystems through education, as well as rescue and rehoming. Joined by champions of animal welfare and environmental stewardship, this  association of aquatic pet rescue operations and aquatic pet shelters across the United States aims to save our finned friends and preserve our waterways together.

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Disasters are defined as situations in which needs exceed or overwhelm available resources. Some disasters affect an entire community, while other disasters impact individuals and families. Crises of physical or psychological health can be very personal disasters.
The therapeutic value of pets during illness, trauma, and recovery is well established. And Koi fish may be well suited for people who are not able to provide verbal pet commands or physically care for pets like dogs and cats. Koi ponds are also a source of beauty and peace, providing an ideal setting for quiet reflection or meditation.
We are working to partner with pond installers and aquatic pet rescues/shelters to offer free or reduced-cost ponds with rehomed Koi fish to people seeking this type of pet therapy.

Disasters disrupt life and impact our sense of personal, family, and community safety. Survivors and responders alike often are not aware of the emotional, psychological or spiritual challenges that they may face from disaster onset through recovery. With two decades of experience training responders and communities to prepare for the behavioral health aspects of disasters, we will continue to provide education and a curated list of resources to groups or individuals.

Non-medical factors that impact overall health are termed Social Determinants of Health or SDoH. Noise pollution, poor air quality, and poor water quality are three environmental factors known to have a strong link to overall health. And the same environmental factors that impact humans impact their pets and other animals in their care. We continue to assist in advocacy, education, and technology development to mitigate the impact of SDoH on humans and animals alike.

Our efforts in shelter and rescue are the main focus of our environmental stewardship, reducing the environmental impact of non-native aquatic animals being dumped into public waterways. The High Alert Institute also assists innovators with the design, development, and evaluation of green and renewable energy technologies. Reducing the carbon footprint associated with disaster preparedness, response, and recovery furthers our continued mission to mitigate risk and improve resilience.

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The High Alert Institute team has over a century of combined research experience in medical, nursing, behavioral health, and disaster sciences. Our team provides support to researchers and technology developers through comprehensive literature searches and reviews, as well as failure mode database searches and adjudicated reviews.

When disaster strikes, most aquatic pet owners have limited options to secure the safety of their pets. Sheltering in place may not be possible if there is no power to provide aeration and “pet-friendly” shelters do not include ponds or aquariums. Our goal is to provide an option for aquatic pet owners in need of rescue and shelter for their finned friends.

Our goal is to share our two decades of disaster readiness experience with animal welfare organizations, shelters, caretakers, and pet owners, as they implement contingency  plans for natural and manmade disasters.

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