The November/December 2006 issue of the AARP magazine carried an interesting story on pandemic flu. The expert virologist who authored the article painted a grim picture of the future of the coming pandemic and gave one view of how to prepare.
Let’s set the record straight.
Almost all of our predictive models for pandemic flu are based on 1917/1918 Spanish flu (which actually originated in Kansas); the 1957/1958 pandemic and the 1968/1969 pandemic. The 1918 Spanish flu is known in virology circles as H1:N1. Genetic reconstruction has allowed us to isolate this virus from pathologic specimens collected in 1917 and 1918 and stored by the U.S. military and other organizations. This means that we can now study the actual virus H1:N1 aka the Spanish flu and compare it to the current pandemic risk H5:N1 aka Avian flu. What makes avian flu more likely to be a pandemic?
As we all know now from the media, influenza virus mutates over time. Small mutations are known as antigenic drift while large mutations are known and antigenic shift. These drifts and shifts slowly change the virus from something that the human immune system can recognize and therefore protect against to something that is novel or new to the human population – a pandemic. In short it is something that the human immune system has never seen before.
In 1918 the H1:N1 strain was seen. Like all of pandemics before, it struck with a predictable infection rate (attack rate); approximately 1 in 3. Of these 1 in 3 on average in the population half would become seriously ill. Half of those would develop severe lung disease and half of those with the severe lung disease would ultimately die.
The picture changes significantly, however when you look at the infection by age group. H1:N1 caused virtually no more deaths in those over age 65 than the average flu. In fact in 1918 you were no more likely to die of the pandemic if you were over age 65 than you had been in 1915 or than you would be in 1920.
So what does that mean for the coming Avian flu (H5:N1)? Pandemics are very consistent. They act virtually the same every time they occur as long as they are a novel avian virus. H5:N1 has not been different to date. It is expected to cause no greater number of deaths in those greater than age 65 than the flu did last year in 2005 or the year before in 2004.
Yes, there will be an increase in the number of people who become ill across the age spectrum from birth to those over 100.
Yes, there will be a total increase in the number of people who die. Unfortunately the vast majority of those will be between the ages and 15 and 40. This was the age group that showed the greatest increase in death rate in 1918, in 1958 and 1969.
AARP magazine is to be tremendously complimented in their January/February edition they published an exquisite interview with Anthony Fause, a noted expert in infectious disease and pandemic preparedness. That interview asked insightful questions and gave good, logical answers. Unfortunately the same cannot be said of the recommendations made in the November/December edition.
The article in the November/December edition recommended stockpiling food and other supplies in anticipation of infrastructure collapse and supply chain failure. This advice ignores the lessons learned from history. In 1918, as with all other pandemics, 100 percent of the population was exposed despite social isolation efforts. In 1918, one third of the working population was out of work and yet food was still delivered. Farms still produced. Society did not collapse. There is no reason for panic.
Stockpiling medication is also a formula for disaster and disappointment. The current strain of H5:N1 is already showing resistance to Tamaflu, requiring far higher than usual and longer than usual doses to be effective. Tamaflu’s shelf life is also far shorter than the window of likely infection from the pandemic (as late as 2012). This means that you may purchase Tamaflu and have it expire before the disease attacks.
Finally, previous pandemics have come in multiple waves over an 18 month period. In most cases the disease appears first as a low level infection in the population, followed by a large flood of influenza and then an aftershock of disease. You simply cannot stock enough Tamaflu for all three events. You cannot prevent yourself from being exposed during those three events. And you cannot stock 18 months of food and water to safeguard yourself and your family during that event.
So what can you do?
Bring pressure to bear on the healthcare community to better prepare for surge capacity.
There are fewer than 1,000,000 hospital beds in the United States and in an average cold and flu season fewer than 40,000 hospital beds are empty. The federal government recommends between 150,000 and 190,000 available hospital beds even during the peak of an average cold and flu season. The United States is woefully short of hopsital beds and it falls to private hospital corporations to provide that surge capacity.
The New England Journal of Medicine in 2004 an article by Dr. Michael Osterholm they found there are 105,000 ventilators in the United States. Eighteen percent of those are either broken, in repair or in cleaning at any given moment. Sixty-seven of those are in chronic use for ventilator dependent patients outside of the hospital. This leaves 16,000 ventilators available nationwide.
If we break down the expected number of illnesses just in those over age 65, those 16,000 ventilators will all be in use. What happens to those between age 15 and 40, the children and grandchildren of those who read the AARP magazine?
The healthcare community must step up to the plate rather than pedaling panic in the pages of the AARP magazine. The juxtaposition of the Avian flu article in the November/December issue and the far more insightful and useful interview in the January/February issue show the division within the house of medicine. The AARP magazine has the largest circulation and readership in the English-speaking world. Which side of that division will its members come down upon – Panic or preparedness?
It was once said of the generation that now reads the AARP magazine that they are the “Great Generation”.
The Great Generation earned this title because of their self-sacrifice during World War II. They guided a great nation through an industrial revolution and a technological revolution that became an economic revolution that swept the planet. Many have tried to discount the Great Generation because they are now the “Geriatric Generation.” I believe the Great Generation will lead us again not into panic but into a new era of preparedness.
Griffin Works offers Pawsitive Interactions with Service Dogs During Response Operations©, an audience-customized training that breaks down barriers by offering hands-on handling training and demonstrations with working service dogs for fire departments, EMS agencies, and public safety organizations.
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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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.
We partner with public and private organizations, sharing resources and fostering partnerships to improve disaster preparedness, response, and recovery, and mitigation.
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.