As a result of taking on too many commitments and therefore having to deliver on them, I’ve this week had to force myself to articulate What Do I Really Think. I realize that there are 3 strands that have been forming in my mind over the past months, and they are now getting a bit clearer. I haven’t quite reached where all this is going to go, and I don’t have time at the moment to write a full account, but I just want to share briefly what I am thinking (and also in answer to lugon, who keeps asking “but what are you actually thinking?” :-) Thank you, for pushing…)
As I look at the big picture of pandemic flu mitigation/preparedness, at the policy level, some changes in thinking are needed, if the world is to have any chance of escaping catastrophe. These are major changes, deserving of the phrase ‘Paradigm Shift’. And these are intentionally not American-centric, even though they also apply to America, so please assist me by conducting discussions at the wider level, of all countries. Let me know what you guys think.
1) Civic preparedness to increase community resilience, with full citizen participation, should form one major strand of public policy, publicly stated,
This first one I already wrote about, on the global pandemic awareness thread. Leaders need to state, explicitly, that even a mild or moderate pandemic in the modern highly globalized and interdependent world may inflict such severe to catastrophic damage to the fabric of society, that this must be treated as a matter of urgent national security importance. That the nature of the threat requires a bottom-up approach in defending the country against it, in the form of community preparedness with full citizen participation. That citizens who are partners and stakeholders will be far more likely to be assets and allies than liabilities. That the process of educating, supporting, and training citizens to do that is one major policy role that governments will undertake without delay.
2) In support of ‘supportive treatment’: the role of immune modulators must be raised to the same importance as antivirals and vaccines
Currently whenever pandemic flu is talked about, we are told first about antivirals, then about vaccines, and after that, a distant third, would be social distancing measures and other supportive treatements. The term supportive in therapeutics is never quite defined properly, but generally implies something that a) does not treat the root cause of the problem, and therefore b) is not likely to do much more than make the patient more comfortable.
To the extent that influenza is a virus infection, then antivirals are deemed the therapeutic interventions, ie intended to cure the patient. However, since we know that some kind of immune dysfunction, possibly involving upregulation of the cytokine pathways, so called ‘cytokine storm’, is the major mechanism for fatalities in the current H5N1 infections especially, I would argue then that a) the disease is as much caused by the host response as the virus infection itself, therefore b) any chemical substance that may have an effect on dampening this host response deserves the same level of importance (in terms of funding for research etc) as antivirals and vaccines.
I am, of course, specifically thinking of data showing a potentially beneficial role of statins, and how there is an urgent need for studies to verify whether such a benefit does exist, and how best to utilize it. But the paradigm shift includes other immune modulators too.
Scientists and those who make funding decisions should start to conceptualize treatment differently, and go beyond antivirals and vaccines. Immune modulators such as statins may have a vital role to play, and deserve to be considered as the third leg for pharmaceutical intervention in pandemic flu.
3) Count hands, not beds
I have read many estimates of clinical infection rates, how many people needing hospitalization, how many ventilators needed etc. But the fact is, even a mild to moderate pandemic is likely to overwhelm our formal healthcare facilities, even assuming 0% HCW absenteeism, which of course is a fairy tale. BTW for some strange reason, estimates of general absenteeism in non-health workforces is generally about 40%, but no one appears to be willing to hazard a guess, or to factor into any plans, the far higher absenteeism likely for HCWs.
For most cities in most countries, current HCW workforce is fully utilized on a good day, and seriously stretched with any major incident. What is the point of opening up community centers or hotels to ‘admit’ patients, ie add lots more beds, when the number of HCW will be reduced and therefore insufficient even to service the normal number of beds? Poorly staffed facilities in a epidemic situation will rapidly become multipliers of disease, creating more outbreaks rather than mitigating them.
So what is needed is not more beds or ventilators, but more carers. An extended mass casualty situation will force societies to accept, however unwillingly, a much lowered standard of care. This much lowered standard, in the context of influenza, will mostly take the form of basic nursing, hygiene, hydration, nutrition, symptomatic relieve, and emotional support.
This form of care, is something that most adults of average intelligence and a bit of training, can perform. What is needed is a massive publicity campaign for people to “get properly trained to care for the sick at home”, and simple say 5-evening courses in a standardised format that can be delivered in communities, in schools, even online.
We need to make the phrase ‘home-caring’ as trendy and politically correct as home-schooling or going green.
Hear, hear!
(And it needs to start happening Now. Not: still planning conferences to *discuss* public participation in pandemic planning processes…Didn’t Dr.Nabarro say, we are past the time for tabletop exercises already??)
1) Civic preparedness to increase community resilience, with full citizen participation, should form one major strand of public policy, publicly stated,
2) In support of ‘supportive treatment’: the role of immune modulators must be raised to the same importance as antivirals and vaccines
3) Count hands, not beds
Great. (I’d only add what Dr.Osterholm pointed out ages ago; it is about more than that the virus can kill; the disruption of food/ imported medicines/ and current medical care/utilities by itself will cause deaths. That needs to be in people’s mindsets and community problem-solving actions now, since it is a local-level responsibility.)
(Hm, and maybe “We need to make the phrase ‘home-caring’” And, *caring for your own dead* “as trendy and politically correct as home-schooling or going green” Could some religious communities, that already try to bury their dead promptly, help others that relied on the funeral industry -which would be overwhelmed- get plans in place now that are better and less traumatizing to the public than current official plans, which are not made for double-digit mortality rates and collateral deaths from disruptions?)
Unfortunately, most are not there yet, for eg #3 —folks are still hand wriging over the potential medical liabilities with just in time training to handle surge. They are of course assuming there will be anyone left to sue. Yet our greatest pool of volunteers and ‘hands’ will come from what I call the ‘newly survived’.
I believe your above stated goals are excellent! However, I feel they will be in-effective if we are unable to overcome the 4 stages of denial that everyone is in.
1. Disbelief / discredit the messenger. 2. A pandemic cannot happen and won’t ever happen. 3. Even if a pandemic does occur, it won’t affect us. 4. There is nothing we can do about it.
I’ve recently had conversations with our City Government. they are not willing to adapt their city emergency preparedness plan and include a specific plan for a pandemic. Eventhough the State and County Governments and Health Departments have been distributing information encouraging them to do so. Their response is “A pandemic won’t ever happen”, we’ll spend our resources on something that will. Such as an earthquake.
So, I asked them, When was the last time an earthquake occurred here? 4,000 to 6,000 years ago? Have any of you ever been in an earthquake?
When was the last time a pandemic occurred in the U.S.? 1968 - 34,000 U.S. deaths and 700,000 deaths worldwide; 1957 −70,000 U.S. deaths and 1–2 million deaths worldwide; 1918 - 657,000 U.S. deaths and 50 million deaths worldwide. I then asked them when was the last time that anyone in the room had the flu? Most said last year. Then why are you prepareing for an earthquake when the probibility of a pandemic is much more likely? (No answer)
Little Kahuna,
These changes are decisions that need to be made at the very top. Local officials do not have enough clout to see them through.
great anon_22
workin on #1
Assuming that the ‘very top’ are aware of the magnitude of the situation, can anyone think of a reason why they are reluctant to adequately communicate the message to the masses?
Anon_22, very well put. I know you are stretched very thin, but if you have a chance, I and others would value your thoughts on the potential efficacy of vitamin D as a cytokine inhibitor over on that thread.
Thank you, anon_22.
The whole concept of “paradigm shift” is what we need. Let’s keep in mind that when Thomas Kuhn introduced the concept of paradigm shift, he suggested paradigms change only when those “infected by the old meme” die, not because they change their minds.
So maybe we need to look into a “higher level meme”, one that we share, or a whole set of things that we do share, so that we can change the small things (the action pieces you suggest, and maybe others) without challenging the big things (the beliefs we all have and none of us wants to see challenged). A few examples: if someone’s outlook is “national security”, then pandemic preparedness is part of that; if someone else’s outlook is “caring for the poor”, then pandemic preparedness is part of that; if some people need “a common enemy”, then this is it; and if you need “a source of inspiration for grassroot activity, real fast now”, then this is it. Look at how you see life … done? Pandemic preparedness is part of that.
Maybe this sounds too new-agey, but we do have a serious and specific problem in getting as close as possible to people’s “motor neurons”; you know, the neurons that actually move muscles. :-/
And for those of us who want to move our muscles in some specific direction, let’s follow Goju and do #1. And if we can’t do that just yet, then maybe we can help with #3?
Heres a couple of thoughts from one on the home frount:
First of all I agree TOTALLY with everything anon_22 has said. Given that,I know that many are reluctant to address avian-flu, however-everything anon_22 said CAN BE USED FOR ANY TYPE OF DISASTER! How many lives could have been saved if people had prepared even a little for KAtrina?-or smaller scale, if ordinary folks have some basic first aid training, know how to shut off their electric breakers, gas lines etc, have food stored so they don’t go out in the ice storm for milk and end up-side down in a ditch. If you mention having supplies stored in case of a power-failure people think your some kind of survivalist nut. They have all kinds of drug awarness/peer pressure/dangers of teen sex programs in the schools-why not a basic preps class- a how to take care of yourself in an emergency. I fully realize that for some teens, an “emergency” means you’ve run out of lip gloss, but there are many many responsable teens engaged in all sorts of community/enviromental programs-think how many eco-vegitarian teens are running around out there. The trick would be to make it cool.
Second point-Could not supportive treatment also include basic things such as STOP SMOKING NOW!!!!LOSE EXCESS WIEGHT???? GET BLOOD SUGAR/CHOLESTERAL LEVELS WHERE THEY NEED TO BE? I’m thinking of what ordinary people could do to help.
Third point-hands not beds. I nursed my mil through ALS (Lou Gehrigs disease) at home-no I didn’t have any training, just winging it mostly. I would have dearly loved to have had some evening classes on ANY kind of at-home care, but espeically for terminal care. Having done this, if my family does come down with flu, I plan on nursing them at home. But, I will also say, that having done this, I am gratefull for any scrap of info I can get on nursing care because its brutal. Most people have no idea how difficult it is to care for a seriously ill patient 24/7 at home. And I feel lucky that I had hospice which won’t be available in a flu outbreak, and a very sympathtic coronor who walked me through all the steps of an at home death and what to do- and that won’t be available either.
Just thinking of all this makes me queasy and sad. We have no idea what we are up against.
GREEN MOM: sorry to hear about your time and loss of MIL. You said: and a very sympathtic coronor who walked me through all the steps of an at home death and what to do- What steps? I’m guessing we all might need to know that.
While this is an issue mostly in the U.S., I’ll say it again - something needs to be done to protect the extra “hands” from being sued by the sick or families of the sick for something they do in good faith that isn’t quite right medically.
Mari, we might want to keep things separate - training and sueing-protection. There must be ways to avoid letting the second get in the way of the first. After all, people learn to do first-aid all the time, no?
Most states have “Good Samaritan” laws to protect people who render emergency aid. Coloado’s is worded thusly:’‘ “13–21–108. Persons rendering emergency assistance exempt from liability. (1) Any person licensed as a physician and surgeon under the laws of the state of Colorado, or any other person, who in good faith renders emergency care or emergency assistance to a person not presently his patient without compensation at the place of an emergency or accident, including a health care institution as defined in section 13–64–202 (3), shall not be liable for any civil damages for acts or omissions made in good faith as a result of the rendering of such emergency care or emergency assistance during the emergency, unless the acts or omissions were grossly negligent or willful and wanton.”
Now, we just have to make sure that the “helping hands” kind of care we are discussing here is determined to be “emergency care or emergency assistance.”
Enza,
funding seems to be an issue. the PH office i’m familiar with has had donated materials to be mailed-out to the entire county on the table now for several months, tho only recently received the (Homeland Security) funding to do so.
i think later this fall however, we may be seeing some public info commercials on tv? at least in this state.
Green Mom – at 09:39 - I plan on nursing them at home. But, I will also say, that having done this, I am gratefull for any scrap of info I can get on nursing care because its brutal. Most people have no idea how difficult it is to care for a seriously ill patient 24/7 at home.
Though I agree with you entirely, people are just not ready to hear/read such things; the few times when I tried to deal with the subject, directly or indirectly, the thread either collapsed for lack of sufficient interest, or the topic was set aside, or somehow I did not get through.
Even the idea that one would need several sets of sheets to change the bed of a patient several times a day does not strike home. That means prepping by buying sheets, planning big infectious laundry baskets, cooking and feeding appropriate food/drinks, cleaning vomit, wiping cough spurts, emptying urine and matters, cutting nails or hair, shaving, comforting (with/without PPE), calculating medicine dosage, writing patient charts, measuring fever, counting loss of fluids, DIY-ing equipment such as bibs for drinking, bells for calling, shifting pillows, moving blankets, etc.; the lot possibly without continuous energy/heating/gas/water, and having to deal with the healthy ones as well, without (as much as possible) putting them at risk.
One of the problems is the very name of bird flu. It evokes flu, maybe bad flu, but few of us have enough imagination to envision that this bird flu is something more like a combination of pneumonia/diarrhoea/hemorragic fever than “normal flu”. And that this is even more difficult to care for than cancer or other chronic wasting diseases, because of the danger of contagion to the carer and others. Illnesses like Ebola, Marburg, SARS, Dengue, Yellow Fever, Typhoid, Rabies, Tetanus, AIDS, are illnesses for which our today’s experience is “isolation” or “hospital special ward” or “ICU”; they are not illnesses that are easy to imagine having to deal with at home with no support from the outside.
People nowadays think of “clean” hospital care, white sinks, white sheets, metal beds, and let nurses look after the more personal aspects of it. The younger generations have no idea what it is to be seriously ill at home, agonizing and dying at home. The most care at home they know about are illnesses like a nasty cold or bronchitis, or a broken leg, or gastro-enteritis. Anything that spurts much natural secretions is taboo. Touching, seeing naked people is taboo also. So is, too, the very personal care and devotion you give a patient. Taboo is death and wasting to death. Taboo is the manner of dying.
How many of us will, willingy, given the choice, take care of very sick loved ones at home? Suppose we do accept, that acceptance will be tied with the proviso that a doctor, a nurse, morphia and antalgics will be available at the whim of a telephone call, and that if it gets too difficult, we could count on hospice care. Even if we really want to and are not afraid to care for a very ill person at home, many of us abdicate in front of the power of the knowledge of the medical profession. We tell ourselves we cannot do it, we are not capable of doing it, we would not dare do it.
People don’t want to know, even for more trivial illnesses. It’s only when they are confronted with such situations that they show some want for learning how to turn a patient, how to change sheets without breaking your own back, etc.
I think I’ve more or less given up on that subject.
FrenchieGirl – at 11:56
While I’ve prepped for this eventuality I did try and pull together … using anon_22′s and other’s previous information … a working protocol for treating flu patience at home, particularly making a point of what was different for kids. I only got so far with it because frankly I don’t have enough clinical knowledge and doubly frankly it was overwhelming. It seemed like after a certain point all you could do was try and keep them comfortable.
I put it here on the wiki but I think it got moved around. I think it is here now.
People are more than welcome to add to it and then use it as a tool for dessiminating information on possible scenarios that they will face at home, regardless of geography.
Do you think anon_22 – at 01:41 that this shift at the policy level will ever occur given the world, political and economic issues currently in play? I agree with you, but I don’t see it happening because no one wants to take responsibility of putting time, money and energy into something that may not occur for years if at all (thoughts of many TPTB, not mine). I know you are busy, but when you have the chance, I’d like to know where your thoughts are going with this … Thanks for sharing!
Thank you Kathy in FL - Thank you. I had read it in its time.
I was more looking at the practical ways of treating the patient at home. I’m sure there are plenty of nursing books, electronic or paper, around. But there’s nothing like describing point-by-point the carer’s day at home with an ill-patient. You see, we prep, we gather food, oral rehydrating solutions, medicines, how to do the laundry. These pieces of puzzle, I see nowhere assembled in a coherent fashion, like a novel if you will. Day 1, morning, hubby/wife is weak, thirsty, sweating. Go make get lemon water, bring, give with a spoon, every minute or so. 20 minutes later, go get new sheets, towels, basisn with hot water, soap, put table next to bed, put basin on table, gently wipe face, use facecloth, put soap, wipe, rinse, cover, … put everything away, turn patient, roll sheets, change sheets, put soiled sheet in basin with chlorine (ah, you just forgot about the basin with chlorine, go get it). Next let patient rest. Patient moans, too hot. Uncover. Go get medicine. Patient asleep, can’t swallow. Go grind tablet, put in cup with juice, bring to patient. Patient takes one sip, vomits like a geyser all over you… etc. Then you have healthy kids, and by the time you’ve dealt with your patient, it’s time to cook for them, but also for your patient, grind the food, keep warm, go check temperature, write down, back to kitchen, kids anxious and playing hell with your crockery, etc. and caring for your patient at night too… And the laundry, and the rest…
Just to give an idea of the taboo of dealing with something as simple as women’s menstruation, there was a poster on one of the threads that said that during other centuries, women used cotton cloths which they washed. The reaction was: “yuk”. I respect this reaction, but I keep wondering how we are going to cope with someone very sick at home and the gestures to be done to make them, at least, comfortable, if this is in any way representative of the XXIst century thinking on body matters.
So about the 3rd paradigm, more hands, more trained hands. It’s not a first-aid course that’ll teach you the daily care of a person sick with bird flu (at least not the French one). It’s what I describe above that will help. First-aid will be good to know how to make splints, how to make mouth-to-mouth ressucitation, how to make a heart massage, how to turn the person on the side in the safety position, how to take a pulse and clear the airways. Beyond that, you won’t learn daily care.
If we have more hands, more trained hands, they need to be taught the basis of feeding, by spoon, by liquid, by semi-liquid, which food can be taken that way, how to make it, how not to pour too much liquid in a mouth that they don’t suffocate themselves, how to recognise when the swallowing reflex is non-existent, how to relieve mouth dryness, how to prop up a patient having difficulty breathing…
This thread is the reason I came back here this morning. It has been rolling over in my mind --- as I went to sleep, driving the kids to school, while doing chores around the house, etc. My initial response was to post, YES! But, somehow that just wasn’t enough. I wanted to explore my feelings and thoughts about why this thread struck such a chord. I wanted to read what others had to say about it, and why. Honestly, I am still “churning” over the what’s, why’s, how’s, etc. What I do know, with 100% certainity, is a total agreement with this being a paradigm shift. (Lugon, as usual, you laid it out methodically.)
Also, the 3 areas that anon_22 laid out were paramount, IMHO, to the change that must take place. At this point, I still think it comes down to empowerment of the average person. I am not sure how that works, because some people don’t want/or think they “can’t” handle this “responsibility” and it appears most authority doesn’t think “folks” can/should/whatever assume this responsibility. I just know I believe that having been told to expect to “be on own” means we “folks” need training and information. For me, that means a continual “checking” of what I am doing, what I can do better, and what avenues are there for me to explore or take.
Why authority doesn’t do more to get us in gear? Fear of panic & fear of what if it doesn’t happen. Why more information isn’t put out there? I dunno, not seeing this clearly as a “potential”… unlike anything we have (in most countries) ever dealt with.
About death, and caring for the very seriously ill. I can only speak for myself, but there is only so much I can deal with at a time. I sometimes read those threads and just have to give myself permission to deal with that later. I know it might not be a prudent thing to do, but there is just so much I can handle. I want y’all to know, that at least I am reading those threads. I just can’t deal with them yet. However, I appreciate that y’all are dealing with those topics. I would venture to say… I am not the only one “lurking” on those threads!
What I do know is that I see something on the horizon. I am not sure what to do with what I see, & I don’t exactly understand what I see. I just know something is up, something is brewing. I sometimes get tangled up in why I see this thing, and so many others don’t… including some people in authority who are putting out ambiguous warnings. I have to admit it is a very humbling experience to “see”, as well as a responsibility I have never quite had to deal with before.
My assessment is that there will be no paradigm shift before the next pandemic, regardless of how badly it is needed. It will break too many rice bowls, incovenience too many people and conflict too strongly with the present paradigms in place.
The problem is that to create a self-reliant culture we need self-reliant people, and over the last 75 years H. sap. has been organized to be *less* self-reliant, not more. See Kipling’s poem “the Gods of the copybook headings”
LMWatBullRun – at 13:18 - This is harsh, innit? I prefer Kipling’s “If” because for the 3rd paradigm, that’s what we need to learn and teach.
EnoughAlready-I think you’ll find that if you HAVE to deal with it you can-most of us can cope with far more than we think we can. Having said that, I think you are wise in trying to digest it little bits at a time-just keep in mind we may not HAVE much time. I do share your thoughts on it being a humbling experience to see this thing coming. Sometimes I say “Why me? Why not everybody else” I’m trying not to get to mystical or whatever here, but sometimes I almost feel like certain people are “chosen” to know about this. Its a weird thing.
mj Thank you for your kind words. Regarding the coronor-mostly it was just paperwork and info about whom to notify when. Since she was a hospice patient (i.e. terminal) with a do not resisitate order, and we had notified authorities inadvance, we didn’t have to do the ambulance/hospital/police investigation thing. And since here the coronor is also a funeral home director he could sign the death certificate and transport the body. Laws vary state to state and I have no idea what laws/regulations will be in play in case of a pandemic.
lugon – at 11:28 - While people will welcome information and training so that they will be able to take care of their own family members, unless certain legal protection is provided, they may be reluctant to use the training to help strangers.
Hmmm…nothing like a good paradigm shift to start the week off right…
Lord knows we DO need exactly what you suggest, anon_22, but I think I will win the lottery before we get even ONE, let alone THREE shifts before we see another pandemic. Have you EVER tried to shift a paradigm before??? You’d have an easier time eliminating the obesity pandemic…
OK…now that my cynical commentary is over…kinda…
Let me add another paradigm shift (LOL) needed: How about getting individuals to be responsible for their own welfare for a change? I understand that there is enough responsibility to go around, but I, for one, would be ecstatic just to see each person caring enough to care for themselves and/or their own families.
How do you think WE all got interested in this subject? Why are WE learning about a very unsavory topic? Why are WE looking at shifting the axis of the world to mitigate a very real threat? WHY? Because we took the initiative to learn and investigate and then take some action. Do you really think we are so unique or intelligent or perhaps so paranoid?
At the very least, we want to protect ourselves/families/community to the best of our abilities. We aren’t waiting to be “taken care of.” We are not acting like dependent children. We heard something or read something that made us THINK and that was our impetus to keep learning.
IMO, it is time for the adults of this world to start acting like they ARE grown up. I keep watching this “passive euthanasia” being committed by the majority of the population. Between the smoking, obesity, drug use, inactivity, poor nutrition, etc., it is an epidemic! Ignoring warnings that have already been issued, is just another part of this problem. People want to be forced into action. Or rewarded. Or cajoled.
People want someone to fix their problems. They do not want to be involved in the repair or the prevention. They just want to be fixed with a pill or surgery. “Push the EASY button.” Most of us live where the basics of life are readily attainable. But we are slowly killing ourselves, and wondering how it happened. Only when people take responsibility for themselves, do they change anything.
I think the first step depends on getting EACH individual to understand that they are responsible for their own life. This wiki is comprised of thousands of individuals. We each have our own contribution. Together, we can make a huge impact. But, it must all start with each individual.
anonymous @ 1236:
You have some excellent points about wanting to learn the minutae of basic bedside care. Gathering of the supplies and PPEs to care for such a patient as one with a lethal, infectious disease would be a daunting task…for anyone.
Something that came to mind for me when reading your post was…the person who cares for any ill (panflu) patient at home, ideally, should NOT be also caring for the basic family unit. I would NOT recommend being the bedside caregiver AND also caring for the rest of the family. It will be very difficult not to get infected, even if you are a HCW.
I know this will have to be a “fluid” situation in which plans will change, but I do not plan on sitting in the sickroom unless absolutely necessary. And I am sure that will happen sooner than later. That’s another sad commentary to think about.
FrenchieGirl please don’t give up. I am sorry if you have pointed it out before but are there publications that you believe would be helpful to educate willing hands?
Anon22 that goes for you too, any suggested reference sources for home care guides? LMonty posted an interesting note about supplementing Statins with COQ10. “I have a big beef with statins. They disable a biocehmical production system (HMG3 Co-reductase) in the body…But, that production system also creates a couple of other important molecules- one of which is CoEnzyme Q-10 (ubiquinone). CoQ 10 is an energy source for our tissues (mitochondrial ATP production requires it), and without it several bad things happen. One of which appears to be congestive heart failure.” See also http://www.coenzymeq10.it/cardiovascular/article.html
I wonder if there a link in the index to information about statins?
Kathy in Fl thanks for your write-up on treatment. I put a link to it in the index.
oops the anonymous at 12:36 was me, FrenchieGirl!
Fredness, I’ll try and have a look on what is available on the Internet, but I am not sure of the results, or rather, if I get too many results, how to put them together.
One of the ways to make people learn some of the basic care would be, just like sexual education, to teach it at school. In some ways to revive the old “Household” class, but this time oriented towards caring for sick people. It’s all good and well to propose having teachers teach kids to wash their hands and sneeze in a handkerchief, etc., but we can surely do better and put a little programme in caring for each age class. Many kids would show their copybooks to their parents, one could also give a free booklet to the parents at the beginning of the year (or before if pandemic happens before next school restart)
And at Universities and professional schools
Thank you all for your responses. Sorry I only have a minute, but I would like more comments on the policy suggestions and their implications, or how to make them happen, and save discussions on how to do homecare to a different thread.
Ok, anon_22 we probably do need a seperate thread for homecare. Shifting to policy-One of the things that really hit with Barry’s book was how Wilson, as president so quickly and thoughly cranked the country up for the war effort-I found it quite scary, actually, but what if some of those techniques were used for flu? What if we had 4-minent flu speeches? What if the RED CROSS cranked up to that level? Thinking about how they used PUBLIC OPINION (all men fear me)to get people to buy bonds. Of course, the LAST thing we want is to hold a Liberty Parade that probably did in the city of Philidelphia.
Wilson created the Committee on Public Information (CPI) Is that something we want to do? A FLU Czar? I really want flu news to get out but I don’t like the tactics the CPI used. Just some thoughts.
Anon_22- Ok, I have already said it won’t work because of political reasons, and since I am fully aware that this may become a discussion of forbidden type, I’m going to ask you, Anon_22, to clarify that you really want a forum discussion of the political policy behind the present paradigms?
As much as I ache to engage in this discussion, I am sure that it will inevitably devolve into a political debate. What I would suggest is that I email you privately to go into this matter OFF Forum. Is your email in your profile?
Much as I would like to be able to help out in a pandemic, I have a shameful problem - an extreme horror of bodily fluids, particularly vomit. The sight, sounds, or smell cause me to start wretching and sometimes even cause me to vomit myself.
How do I overcome this? Confronting it does not seem to improve matters.
I am very embarrassed about this.
Anon_22, “We need to make the phrase ‘home-caring’ as trendy and politically correct as home-schooling or going green.”
I also like the idea of training, made available for free in all neighborhoods. So many people are in the habit of using the emergency rooms for every little thing, because they have no confidence in their own judgement. This training could be designed with that in mind, and pandemic preparation as another good result. I think people would attend…I will.
Scouting for Girls, the first edition of the Official Handbook of the Girl Scouts, was published in 1920; I found an inexpensive reprint edition at the local bookstore.
How useful in post-pandemic 1920 to have a text teaching skills for young survivors suddenly taking care of houses, families and invalids! * cleaning a house * fighting germs * planning lunch or dinner * washing dishes * changing the sheets when a bed was occupied * feeding helpless patients * making “fireless cookers” * making “iceless refrigerators” * kindling a fire * finding edible wild plants etc.
Some information is dated (of course). But it is a glimpse of our ancestors who were coping with basic pandemic survival issues we may soon face!
Wonder what the modern scouting movement is teaching? Are there any Wikians writing Scouting literature? Anybody feel like they’ve earned all the badges for Pandemic Prep?
anon-22 at 16:17 To make the paradigm shift at the policy level will take political power and clout of numbers. When politicos begin to hear from people in numbers, they will begin to act. I don’t want to make this a political discussion, but the most important decision makers are at a high level as you suggest. Each of us, however, must begin to take the political heat that comes with being out in the open on this issue and make our case publicly to whatever politicians will or even won’t listen. I guess what I’m leading to is that we need a political lobby for the defense of mankind from Pandemic Influenza! I spend a lot of time in the political arena and there are some politicians who will listen and can be convinced to act and even lead if they know that there are a few of us behind them, defending and helping them.
The alternative is of course to work at #3 I do fear that the population in general is still at a state, as described by Jonathan Shell, many years ago in his book, Fate of the Earth, where he described the reluctance of mankind to deal with nuclear issues because ultimately we would be talking about mankind’s possible extinction. The discussion of a pandemic of the worst case scenerio has the same chilling effect on people as most of us know from trying to talk to friends and even relatives!
Sorry, I do apologize for being brief. I’m running late! Please do start threads on home care if you want, and there are older threads that you can continue. It’s just that right now I don’t have time to look for them.
LMWatBullRun – at 17:01
Well, policy debates have to get political sometimes, and if it is relevant to the issues discussed, then it is better to have them on this open forum. Let’s just try to stay on the issues rather than be partisan, if that is at all possible.
I personally believe these objectives are moderate and achievable. It will probably take a lot of effort from lots of people, but let’s at least have a debate as to whether these are good suggestions, bearing in mind limited resources, ie money or political capital spent on anything usually means something else has to give.
Don’t lets go into “they won’t” too soon. Lets at least think about this. :-)
The mechanics of paradigm shifts have been studied for years in organisational behaviour classes.
What normally happens is a “freeze”, “Unfreeze” and then “Refreeze” process.
What we are seeing now is the normal “Freeze” state of affairs. Change is not possible at present, Pandemics are just too hard to think about and anyone who does is simply branded “Alarmist”.
At some stage we will “unfreeze”, probably when efficient HtoH is demonstrated and the H2H first clusters appear [b]on a scale that canot be ignored by the public or the press[/b]. At this point, general community attitudes and government policy will “Unfreeze” and all of Anon_22′s excellent prescriptions can be implemented with no resistance whatsoever.
Of course afterwards, once the pandemic is over, everything freezes again.
Walrus-
the problem with the mechanism you describe is that it will be too late to be of any use. Those who survive will have the needed meme indelibly imprinted in their psyche. Those who don’t won’t need it. in either case we will not have to concern ourselves with it. What Anon_22 is trying to do is to create the needed changes BEFORE the pandemic does it for us.
Anon_22-
OK. Will think about how to present what I perceive as the minimum needed changes as non-confrontationally as possible. I do think that you underestimate the scope of the needed reforms; you cannot force self-reliance on people. That is an ability that must be self-taught.
I did not intend to restrict you to caregiving resources based on Google. For your previous posts I understand you have experience in this field. Were there any books that helped you or was it primarily learning by doing? The latter would be difficult in this situation.
I plan to buy the Mayo Family Health Guide and either of the books available at Caregiving at Home or Comfort of Home: An Illustrated Step-by-Step Guide for Caregivers (available in Spanish). Of course my favorite guide is Infection Control for Viral Haemorrhagic Fevers by the WHO and CDC. Not much on hand holding but a very good start. This could easily be adapted for pandemic education. (available in French and Portuguese).
My city recently sent disaster preparedness information to all residents. It was not pandemic specific. I did notice a Ready.gov billboard on my commute home. I hope that establishing the concepts of preparedness and self reliance as a common need will result in action taken by a greater percentage of the public. Progress is slow even within my home. We do what we can until the problem cannot be avoided, then we will face it ready or not. It is hard to give this boundaries. We can’t afford all the preps we want. Who knows all the things we need to learn? I have stayed in denial about the thought of collapse. You can’t prepare for chaos very effectively. It is easier to focus on the flu.
Has anyone heard of the 100th Monkey Effect? “The Hundredth Monkey Effect is the name for a supposed phenomenon in which a particular learned behaviour spread instantaneously from one group of animals, once a critical number was reached, to all related animals in the region or perhaps throughout the world.” While the premise of the phenomenon is debated it also refers to a paradigm shift (or simply learned behavior through observation and the transfer of knowledge).
Annon_22 - In support of #1, that “leaders need to state, explicitly” the kind of damage that can result from a modern pandemic, I beleive they have begun to move that way in recent days by being careful to call it not a “bird flu,” but what it is. Here is a very recent quote from Nabarro:
SINGAPORE, Sept. 17 (Xinhua) — The World Bank and the United Nations officials warned the possible occurrence of pandemic of avian influenza here on Sunday.
“There will be a world animal and human influenza pandemic one day, but we don’t know when,” said David Nabarro, Senior United Nations System Coordinator for Avian and Human Influenza, at a press conference held here.
http://news.xinhuanet.com/english/2006-09/17/content_5101115.htm
Making the move towards calling it a “world animal and human influenza pandemic” consistently, rather than “bird flu,” changes the paradigm greatly. I’ve seen TPTB move steadily towards this nomenclature lately. This may go a long way towards notifying the public that no, this is not just a “bird flu,” but something that needs to lead to civic preparedness for humans, and other animals too. Re-naming a thing is often a big first step in changing how we even begin to think about it. I am glad to see TPTB are beginning to use more specific language, which will hopefully lead to them being “explicit,” as you have well said, about the next steps that need to happen next as well.
Anon_22 No. 3 “This form of care, is something that most adults of average intelligence and a bit of training, can perform. What is needed is a massive publicity campaign for people to “get properly trained to care for the sick at home”, and simple say 5-evening courses in a standardised format that can be delivered in communities, in schools, even online.”
This training would not be first-aid, rather it seems to be the skills needed by Nurse’s Assistants who are trained by local hospitals, clinics and nursing homes. They learn how to change sheets with the patient still in the bed and feed and bathe frail/sick people, and take vitals. Perhaps this could be expanded and paid for with grants for low income people. The materials and syllibus’ are already in place, as well as people who know how to teach these skills. I think that if TPTB started setting up classes on how to take care of the sick and dying during a pandemic, people would start noticing THAT and may be scared into action. I now believe that most people are not going to do anything until they get scared REALLY SCARED!
Sorry, that was me at 18:28
Green Mom – at 13:40
I know you are right, about it all. And… I know I have to toughen up and deal with a lot. Right now, today… I am being a wiennie… & I know it. I know time may be much shorter than any of us can imagine. I keep telling myself all of these things… and that this may be my last time, for a long time, to get to be a wiennie. Just don’t let myself get stuck here too long… is what I’m telling myself. Thanks, GM!
Slate Magazine (online at slate.com under survivalist) has an interesting article entitled: How To Survive the Avian Flu, Smallpox, or Plague. The article talks about paradigm shift like this:
Sorry… but I am terrible with linking. There are also links to fluwikie.
anon_22 – at 16:17
This may or may not be one direction home health care education can be encouraged.
The world population, at least in first world countries, is aging. Unless the “aging” population wants to find itself warehoused someplace at a certain point in their lives, then people need to start returning to the idea of multi-generational households or at least in the idea that home health care is a more financially sound investment than institutional warehousing of the elderly.
I’m not sure how it went in other countries, but it was once upon a time quite common for people that were too old or physically or mentally feeble to care for themselves to be sent to asylums. These asylums were also used to warehouse people who didn’t fit the definition of “normal” for any given generation … mentally ill or mentally challenged, addicts, or for behavior that was outside the “norm” of any given era. Then, in the 70′s and 80′s this population was basically booted out of the state facilities because it was determined to be an inhumane treatment. It was a huge population dumped back out into the “public” … and the consequences of this we are stilling dealing with today.
It might be that showing people that a certain amount of this is already needed that you could then feed into the idea that more of it will be needed in the future for sure … and that in cases of extreme emergency, such as with pandemic, the training would be even more valuable at the beauracratic level as well as the personal level.
When I spoke to the Red Cross about volunteering, they told me that the disaster planning courses had been curtailed because of lack of attendance. These classes had covered multiple areas of potential disasters, including hurricanes, bioterrorism, pandemics, etc.
They said only a couple people ever showed up, and we live in a hurricane zone.
Enough Already: I agree with Green Mom. I also think we will rise to meet whatever we must. I think it is a survival instinct. Just by reading this forum gives your mind a chance to begin to assimilate and role play.
If this panflu occurs, we ALL will have no choice but to use our resources wisely. Anyone who denies fear about facing a pandemic is a fool and I wouldn’t want to be working with them.
Fear is what happens when you face a reality. ANXIETY is a different beast…it is only a potential. It may never happen. I will work to diminish my anxiety (not smart enough, strong enough, brave enough???) by planning to face my fear (I’ve never seen a pandemic, never worked a pandemic).
I remember the first time I stepped into a patient’s room. I was terrified. The patient was a little old lady in her 80s. Now what on earth was I afraid of? She was frail and had fractured her hip. I was afraid of my inadequacies. Not of her. I didn’t know that then. But I learned. And so will you.
We have a saying about anesthesia…They define it as “hours of boredom punctuated by moments of terror.” And that about sums it up. EVERYone (who cares) feels the stress of being good enough to meet the challenge. The trick is to not let that stress immobilize you.