Continued from here
Please continue, Doctor…
The Doctor – at 00:01
The Fluwiki is a wonderful place to take the pulse of the pandemic awakened and awakening worldwide. An open forum like this one, even when discussants are following the rules can be pretty loose. There is a pretty good likelihood that H5N1 will become pandemic this winter. This comes from someone who predicted it would happen last winter, so caveat emptor. None-the-less if you have studied the issue carefully and think there is a good chance that humankind is on the cusp of its next bout with pandemic influenza, NOW IS THE TIME TO GET READY.
What I am saying is quit gapping and start acting. The advice available on this site and others is all you need to get started. It is my opinion that we are clearly already well into WHO Pandemic Altert Phase 4 despite the WHO’s refusal to raise the level. My thinking is that as the virus approaches pandemic status, it will spend less time in each phase. This idea stems from the notion that as the virus spreads geographically and among species its total biomass is increasing exponentially. The increase in members of the H5N1 community increases the likelihood that it will achieve pandemic status by means of mutation, reassortment or recombination.
So, NOW IS THE TIME TO GET READY. We won’t be absolutely certain until late in the game. By that time, there will be a rush to prepare and the availability of plentiful and inexpensive supplies will be a thing of the past. The approach I advocate is to establish a Pandemic Survival Plan for your family. The plan should be structured with logical triggers that are predetermined. The pandemic triggers I use are tied to the behavior of the virus. As it advances, I advance my plan. This way, I can approach preparation in a rational way that avoids wasteful spending.
Grattan Woodson, MD, FACP
anon_22 – at 20:27
The Doctor – at 22:36
It is easy for me to identify with many of the comments made by the members of this community. Coming to terms with an event like pandemic influenza requires a great deal of thought and can be gut wrenching. It requires quite a bit of unconscious psychological processing too. I spent a lot of time playing a series of “what ifs”. This game involves imagining “if this happens the result is likely to be that”.
The journey can get pretty dark as is reflected by many comments I have read on this and other threads. As one moves along the darkness passes. At some point, the time for psychological processing will end. You emerge into the light with a better understanding of what is happening, what to do about it and when to do it. Your head is clear and you are not afraid. For the fortunate, a quite confidence develops that you will survive the pandemic. There is a certainty that you have the knowledge and resolve to help your family and friends do the same. While you remain pandemic-aware, you will no longer be pandemic-obsessed.
Thank you for that wonderful piece of writing. Even more enlightening and positive than Peter Sandman’s ‘adjustment reaction’ discourse.
May I add that those who are willing to play the what-if’s to their natural conclusions will suffer the most darkness but gain the most light at the end?
Green Mom and the FW Community
The truth is I have reaped great riches from my books. Untold fortunes! The pleasure I get when I hear that someone has come to understand the risk we face from pandemic influenza after reading my scribble is nothing short of awesome. To hear that some folks are actually acting on their newfound knowledge to prepare for the pandemic and protect their family and friends gives me a sense of immeasurable joy. So, while not exactly contradicting your kind comment about my profiting from the commercial sale of my books, I do wish to set the record straight.
Grattan Woodson, MD FACP
I want to first thank everyone, for their compassion toward my pointed question. It’s not often one can pose a question such as mine in a forum such as this and not get run out of town! :-)
It speaks volumes about the vast majority of the people who frequent this forum. This is truly a unique group.
Second, I think in our circle of acquaintances outside this forum, we are largely experts in this very specific field. There are plenty of folks here, who have no particular virology or epidemiology expertise. However I think that generally everyone here is “smarter than the average bear” and through research here and elsewhere, have become to some extent, experts on H5N1.
All I ask, is that you indulge me once in awhile and consider that not only is there hope of survival in the event of an H5N1 pandemic, but that we might dodge this particular bullet altogether.
Again, thank you for you courteous replies and kind remarks.
The good Doctor has my deepest respect.
The point I am trying to make in this thread is that a pandemic is coming and could be as soon as this winter. H5N1 looks like the likely candidate and its evolutionary path is most closely associated with H1N1, the cause of the 1918 Spanish Flu. A severe pandemic is likely to temporarily cripple our economic infrastructure leading to varying degrees of civil disorder. Preparing to be self sufficient for at least 3 months is a prudent course. The best way to ensure the safety of your family is to gather together with others into small groups of folks who agree to provide each other with mutual support and protection. Your group should select a location to ride out the pandemic and stock it with everything your vision of the possible consequences of the above could bring forth.
The members of the Fluwikie community are cursed and blessed at once. The curse is in having the foresight to realize the danger of the approaching pandemic. The blessing is paradoxically the same. By seeing the risk rather than remaining ignorant or in denial, you have been given the opportunity to do something to improve the chances that you and your family and friends will survive the coming long emergency compared with those without your vision. The vision is a curse if you don’t act on it and the events come to pass as foreseen. It is a blessing if you act upon it in a rational way taking prudent steps to protect your loved ones by making reasonable preparations for the pandemic.
This is not a coin toss, tails I prepare, heads I don’t. In my view, the dye is cast. A pandemic is coming and soon. There are lots of reasonable questions that can’t be answered like this winter or next, moderate or severe, will civil order collapse or not? These are the real unknowns.
Influenza pandemics are a sure thing. Like the sun rising. They are irregularly regular events rather than being predictable. My training in biology and confidence in the inherent wisdom of nature suggests strongly that there is a higher purpose underlying events like pandemics. We, the potential victims of pandemic influenza are probably to close to the event to be able to see any possible benefit from something that has the potential to harvest 300 million human souls in a single swipe of the grime reaper’s scythe.
None-the-less, it is highly probable that this is humankind’s near-term destiny. Living through a pandemic will be pretty terrible, no doubt about it. But as stated earlier in this thread, even with this worst-case death number I can project, the chances of survival for the average earthling under these conditions is 95%. By preparing rationally for the pandemic you improve your families chances of survival but also improve their chances of surviving well. The unprepared will be cast into an 18 month long horror that will extract a price worse than death from not a few. Preparation is not just about living though the long emergency, it is also about living safely through a chaotic time.
These words are not intended to frighten or terrify. They are a warning and a reminder. GET READY. DON’T DELAY. Only a fool would continue to hesitate given what is clearly apparent to those with who have become pandemic aware. The timing of the pandemic is not predictable. Getting ready takes time and money but is not a bank breaker. If you are one who has been cursed with this blessing, the time for procrastination is over.
Grattan Woodson, MD, FACP
The Doctor – at 23:15
Well said, and thank you for your candor and encouragement. An additional thank you for the “Preparing for the Coming Influenza Pandemic”, which I printed out almost two years ago. Immediately upon holding that stapled stack of papers in my hand, I knew I’d sleep better at night.
Prior to reading your material, I had become aware of the remote possibility of a pandemic, but had no idea of the depth of the consequences it could bring. I also feared greatly for my husband and two small boys, but after reading how to properly nurse a flu victim at home, and other preparation advice, I felt a significant sense of relief. I realize that one will never know the outcome, personal and panoramic, to such a dreaded threat, but I feel like your advice and teaching is a weapon to put in my arsenal, so to speak. A sincere “thanks, again”. Niah :-)
Dr. Woodson,
Among the very first things I read on Flu Wikie were the articles by you and Will Stewart. I found them deeply disturbing, yet highly motivational. Subsequently, I began to assemble notes on several pandemic preparation topics. These included food, water, heat, light, cooking, etc. Much of this information came from the Flu Wikie Discussion Forum. Eventually, I assembled my notes into a 17 page essay entitled “Becoming Self-Sufficient for Six Months”. Over a period of several weeks, I have gone from door to door in my neighborhood, distributing copies of this essay and trying to encourage people to prepare. I have also provided it to my friends, relatives, and colleagues.
AS you pointed out, only a fool would continue to hesitate. Well, I guess I know more than my fair share of fools. Incredibly, most of the people with whom I have discussed the pandemic believe that they will be given plenty of advance notice by the media, sort of like tracking a hurricane. They fail to realize that the flu will travel at the speed of public transportation and by the time the media pronounce a pandemic, it will be too late to prepare. Prepping takes time, and time is something they can not afford to waste.
Although I can not help imagining that dozens of my friends, relatives, colleagues, and neighbors will fare quite badly in the pandemic, there is nothing more I can do for them. They have been informed and they have been warned, yet they have deliberately chosen not to prepare for their own survival.
In the brief amount of time I have left before all hell breaks loose, I have shifted my focus almost entirely to my teenage children. They are sure to face at least two pandemics in their lifetimes, so I am doing what I can to assure their survival, even if it happens to be under 19th century conditions.
Thank you for your contributions, Dr. Woodson. I look forward to reading your new book.
Dr. Dave - have you posted your essay on the Wiki yet? I’d like to download a copy. If it’s not posted, you can email it to inkysmailbox at yahoo dot com. Thank you!
Dr. Woodson,
Can you please elaborate on the 8% CFR you believe will be?
Have you done a calculation on collateral deaths based on various CFRs?
Have you done a comparison on CRF with and without prepping?
Thanks for your time and attention. I think what you have done is miraclulous. There truely are angels here on this earth. Your online book was one of the first I read last June after I discovered the Qinghai incident and it was a major turning point for me in understanding the coming threat.
As you said - I am not sure if i should thank you for it… or hate you for it! LOL.
GoJo,
My best estimate of the CFR for a severe pandemic in the US and EU is 8% with a very rough range of 6% to 10%. See the thread below for more on models.
http://www.fluwikie2.com/pmwiki.php?n=Forum.CFREstimatesAnyGood
I wrote my results down and published them on the www.BirdFluManual.com website where it can be downloaded. The article is called Estimates of Illness and Death During the Pandemic. It discusses the model, the adjustments made in it and why. When you read the article, keep this post in mind; models are just fancy guesswork.
http://www.birdflumanual.com/articles/illnessAndDeath.asp
I have not adjusted the model for those who prepare compared with those who don’t. Intuitively however, one would think that being prepared would confer a survival advantage.
One of the most important reasons to prepare in my opinion though is to do what you can to reduce the effects pandemic influenza could have on those who survive. It will be quit hard living during pandemic times but what could be worse is the accompanying potential for civil disorder, food shortages, a breakdown in the power grid, and loss of access to potable water.
I have made my primary role ante-pandemic to help people prepare to take care of their family and friends at home with mild to severe flu. Preparing for this takes very little time and is relatively inexpensive. In my mind, one of the really big unanswered question is how many people will die as a result in a temporary breakdown of civil order and our economic system. This is the big question mark. Preparing for this risk is very expensive and time consuming and requires careful planning and execution, as many of you already know.
The 8% CFR applies solely to medical deaths due directly or indirectly to influenza.
Another big item not adjusted for in anyone’s published models, including mine is the crowding out effect. When flu patients occupy all the hospital beds, what will happen to all the people who have everyday heart attacks, strokes, serious accidents, and infections? Where will they be treated and what will happen to them? Where will the babies be delivered and by who? We don’t know the answers to these questions but can guess that it will be pretty terrible.
Of course hospitals that have made a plan all propose canceling all elective procedures. This will free up some beds. The problem is that the examples I list don’t come under the heading “elective”. They are not something that someone schedules except possibly in the case of some pregnancies. In any event, many of the patients with non-influenza emergencies that are effectively treated today in a modern hospital are likely to find themselves crowded out of the hospital and on their own. The outcomes won’t be good and the CFR from these normal run-of-the-mill emergencies can only soar.
Grattan Woodson, MD, FACP
I can think of one more big question mark: where do the hospitals plan to get blood for emergency surgeries in a flu pandemic? Who is going to go out and donate, and perhaps more importantly, how will the blood be screened for the bird flu virus?
Dejure:
This is a world where most people know their cholesterol level but not their blood type. That said, if lab workers are absent it’s possible some tests might not be available but this is worst case scenario. In PF event that is worst case or close to it, I would assume the doctors will be praying for 0 neg blood to be on the safe side. However, I think less than 6% of US population has this blood type. So, it will be a sorry day if you don’t already know your bloodtype and power is out at the hospital or the lab workers Sip, or the Red Cross is unable to collect donations.
As for testing blood for H5N1 this may be a problem as well. I think they are losing the ability to test for it in the face of co-viral conditions, like HIV or Hep C or West Nile etc. Almost everything I’ve stated won’t occur if the grid stays up, if O neg donors fall over themselves to donate more blood than usual, and Lab workers don’t SIP in greater numbers than other HCWs. Bottom line: Know your blood type and who in your own family can donate to you. Better safe than sorry.
I should probably make an effort to find out my blood type. The dog tags I wore for 6 years in the Army said O neg, but the time I gave blood to the Red Cross, my card came back saying O pos.
Yes, AVanarts:
I’ve heard many O positives call themselves the universal donors. That title belongs solely to the O negatives. You can buy lab kits for home testing now days.
Dr. Woodson,
I read the info… and I still don’t understand why a CFR of 60% - 80% would come down to 8%.
Taken on its own, the paper makes perfect sense… but put under the light of the current situation, why do you believe 8% is valid?
GoJo, I make the case in the Bird Flu Manual that the actual CFR for H5N1 is probably much less than the 50% we see now. The reason is undercounting of cases. This happens because in Asia they only test people admitting to the hospital so mild or moderate cases are missed entirely. There is also evidence that China has had thousands of cases and hundreds of deaths due to H5N1 that they have systematically suppressed information about. You can read more about this in an article I published on the www.birdflumanual.com website called Bird Flu Hanky Panky in Asia. Here is the link:
http://www.birdflumanual.com/articles/birdFluHankyPanky.asp
My work suggests that a better estimate of the CFR for H5N1 infections in humans to date is in the low 20% range. What’s more, it is my opinion, that the CFR will fall further once H5N1 adapts better to humans. This has always been the case with flu pandemics. If not, they would wipe out the human species. No species could survive a 50% population reduction every 100 years of so. It would lead to their extinction. Since we are not extinct, then we can conclude that it is not in the nature of influenza to behave in this way. Furthermore, if it did, it would wipe out one of its primary host species. This would threaten its survival. This argument runs the risk of anthropomorphizing these evolutionary events due to my limited understand. Suffice it to say that when H5N1 completes its evolutionary journey, my best guess is that it will have a much lower CFR than it does now and nothing like the 50% figure.
Grattan Woodson, MD, FACP
“just fancy guesswork” was the phrase he used.
The model is trivial really, population * attack rate = cases, cases * CFR = deaths, choose any number between 0 and 100% for attack rate and CFR. The result is a surface with between 0 and 6.6 billion deaths; choose any point you like.
OK - I read that report and still don’t see why the CFR would drop. It is about 80% in indonesia.
I have read reports that when they looked for H5N1 antibodies in the general population they didnt find any… hence no or very few mild infections.
There have been plagues in the past that wiped out large portions of the population and Humans carried on.
I have yet to see any scientific data that shows why the CFR would drop. The only reason I can see for “saying” it will drop is to sooth the soul and avoid panic (which i think will happen no mater what the CFR is when TPTB announce IT has begun).
I’ve only been following since Qinghai and i am not a medical professional nor a scientific researcher but i do know proof when i see it, and i haven’t seen it yet.
Goju – at 02:11
I copy/pasted this from the paper, page 13:
“Analysis of the data in the table above reveals that there were 1164 cases of influenza with 310 deaths in China in 2005 through November 12, 2005. This translates into a case fatality rate of 27%; a statistic that is substantially lower than the widely reported 50% plus rates published from form the cases of hospitalized patients in Southeast Asia and Indonesia. The Chinese epidemiologic methods and tactics while heavy-handed, appear to be more effective at identifying less severe cases of bird flu infections than is the case in the other countries. Even if the 212 cases and 39 deaths from Sichuan attributed to Swine Streptococcus are added to the above chart, it has no material effect on the case fatality rate.”
It appears from context from the rest of the report that this data, 1,164 cases, with 310 deaths, is likely to be accurate, and reflects a CFR of about 27%. The disparate CFRs (25% for China, 50+% for Indonesia) is partially due to poor surveillance and testing in Indonesia. There are probably a lot of unconfirmed cases of H5N1 in Indonesia for one reason or another. This skews the CFR to a higher number than it probably is.
So the CFR is probably not 50–80% in Indonesia. It is probably about the same as in China.
However I am sure that there are quite a few unreported deaths from H5N1 in the villages with quiet private burials in Indonesia. The stigma of having a BF victim in your home means the loss of livelyhood from forced culling and becoming an outcast to many.
We have seen this time and again.
I can only go by lab WHO confirmed cases and deaths at this point and the numbers just don’t look good.
Besides, I take info from China lightly based on past performance.
I believe we are looking at a high CFR with no scientific proof that it will come down. Any atempt to give us lower numbers without scientific basis is just soothing ointment on a very bad cut.
De jure – at 17:09, only a very tiny percentage of those eligible to donate give blood now, as it is (and the list of what are restrictions for health risks seems to get longer and longer).
Whether the CFR turns out to be 76%, 35%, 27%, 8% or even 2%, a pandemic will be a terrible event that disrupts everything. Many will die, and those who remain will have to rebuild, though they are mightily burdened with grief. We won’t know exactly what we’ll be facing until it happens, and we’ll just have to do the best we can. At current levels of preparedness or, more accurately, lack thereof, the CFR incurred by those who catch the flu will be only half the answer to the question of life and death. The flu itself will be a disaster; the collateral loss of life will be a tragedy in the classical sense, that which we have partially brought on ourselves by means of certain failures in judgment and actions not taken in time. I hope H5N1 gives us a window of opportunity to rectify what we can, but we would be foolish to act as if we can count on time.
My point? Speculating about CFR, while reasonable and important, is a matter of lesser urgency than addressing those factors we can control. So I guess I’d better hop into the shower and then pop over to Lowes for the last of the wood I need for raised beds, to Wal-Mart for beans to finish filling that 5-gallon bucket, to the library to drop some flu flyers, and then home again to start drafting a letter to the governor and other appropriate public servants regarding the need for pandemic preparedness public service announcements.
Wouldn’t a pandemic strain with a high CFR (high as in 50% or more) be a whole lot more visible to the outside world that one with a lowere CFR?
I mean, if a large outbreak of “dengue” occurs in some area, and it appears to have a 3% CFR, people may look at it and WONDER, Hmmmm… could it be H5N1? I dunno, what do you think? And perhaps cases of H5N1 would be lixed up a regular outbreak of dengue.
Thus the H5N1 H2H strain would be able to spread fairly quickly no?
But if a pandemic strain of H5N1 breaks out that kills half of those who are infected, it would be pretty unmistakeable, wouldn’t it? And tough decisions which need to be made quickly that have exconomic remifications (shut down airports, close borders, close schools) would be a whole lot easier to make when faced with the unmistakable (50% cases dying — you don’t need to wait for confirmation — if it isn’t H5N1 we aren’t waiting to find out what it IS) than when faced with the uncertain.
to a degree.. any report indicating a CFR likely to be less than 50% or more likely less than 77% is suspect. at least in regards to what the data on the ground in Indonesia is telling us. Speculation about China is exactly that. Speculation. It’s value as a data to base your judgement on might be considered “fantasy”
there is that point.. “I can survive an 8% CFR but not anything over that figure” that too is a fantasy as IMO 8% CFR is highly unlikely
so we play the “end of the world game” newbies will be aghast and react accordingly. if intelligent and inquisitive they will follow the data to the same conclusions and join in the game.
meanwhile with the stage set but quiet in terms of immediate danger.. the crowd drifts about aimlessly. will it won’t will it won’t it. did I waste money on that solar panel.. am I a dupe for believing in this.. (smiles) does it really matter with a reality check and the “actual” CFR (at the moment)
Kudos: to the good Doctor for his well written material
moeb. Good to see you back.
On the Fence but leaning…has been acting a little weird lately…I though you maybe took a break from flu wiki…AND POSSESSED HIM/HER…
…anyway, welcome back, it ain’t the same without you.
Right InKy you are…
CFR does not mater. Pandemic will.
I too am off to buy more salt, sugar and put up flyers in the CVS and Library. Then spend precious time with my family.
I have been toying with the idea of starting “toughening up” sessions with my kids. Too soft around the edges they are… even with Goju the task master at the helm.
Hello everyone!
It appears to me that TPTB are not taking collatteral deaths into account when estimating the CFR. There could easily be more deaths from secondary causes than from AI. If the situation is looked at realistically, the CFR is currently unrealistic. Deaths from civil unrest alone could easily surpass the deaths caused by AI. People will do anything to survive! Nonpreppers will kill for food and preppers will kill to protect their families and preps.
Who will control the military? All of the military personal are not informed or prepared. What is to keep this faction from going renegade?
To even consider a CFR at this time is a fantasy. All of the factual numbers are not being taken into account. gina
I’m with y’ll in that speculating is not going to do much good-its allright for those 2 am can’t sleep sessions- Lord knows I’ve certainly contributed there, but in the light of day there’s work to be done! Ta-da charge! :-)
InKY-regarding raised beds-have you looked into planting in tires? They are free and easy(ier) to handle. I started a “tire garden” in the spring and I LOVE it, the stuff I planted in the tires did better than the raised beds. Drawback-they aint pretty. I also have a cast-metal(iron?) bathtub in my back yard, that I filled with soil and compost and I get an amazing amount of greens from that! It was salvaged from somebodies bathroom re-model-not at all easy to move, but its been fantastic! Of course its not going to make the cover of House Beautiful, but I spray-painted the underside with this cool textured spray paint, and planted lots of drapey nastursiums.
On thurs. last, I atarted my written pandemic plan, what we will do when-Im waiting for my Flu book to arrive, but in the meantime, Im sketching out some ideas, making lists etc. Funds are a little tight in light of this last prep-surge, so I bought the flu book on-line and ordered the cook books I wanted through inter library loan. If I really want them, I can allways order them later.
Goju-on “tough kids” -on thursday I sat down with my kids 12 and 15 and talked to them as much as I could without scaring 12 year old daughter (Had seperate talk with older son privatly)mostly in terms of being without power for an extended period of time. We did a drill yesterday with no power. we homeschool, so just did lessons at kitchen table with a rechargable lantern-cold breakfast, cold lunch-getting them to think about meals and snacks without power. Had a killer chess match throwdown! They are both working on shopping/to-do lists. We are working on making LOTS o’ granola-everyone likes it, its healthy, cheaper than bought cold cereal, stores well and kids are learning to either mix up powdered milk, or eat it dry-huband prefers it dry, rather like musli. Also making lots of homemade hot cocoa/Russian tea/ hot lemonaide mixes, plus of course coffee and teas. A tip I learned on Outward Bound-a good hot drink will get you throught a lot. I have a Coleman propane Campstove,and plenty o’propane so We’ll be able to heat water for drinks/soup.
I was encouraged to see the “Killer Flu” issue of National Geographic very prominatly displayed at my local doc’s office. The reading material in this office tends to be “Progressive Farmer/Womens Day/Guideposts/ so very encouraged to see this! Noticed all my pan-flu flyers gone! I left some more-I go in every other week for allergy shots. Going to major medical center this week-Vanderbilt, will leave lots o’flers there plus a release of Barry’s book. Also planning to do a last big-city shopping trip- after this I probably wont be traveling to any big cities for quite a while. I’m making that list and checking it twice!
Leo7 – at 18:22 While I agree that it is important to know your blood type, (I’m A-, H is A+, D1 is A-, D2 is A+), I think it is unrealistic to think that a family member will be able to donate blood to another in an emergency. It takes so long to process the blood. D2 had 2 blood transfusions at 3wks old, and there was not time to process hubby’s blood for her. As it was, we had to wait several hours for her to be typed, the donor blood to arrive, and the red blood cells separated from the plasma or whatever. I’m sure somebody else who is knowlegeable in this area could lend some insight.
Dr. Woodson - today I took my 2 teenaged boys to a local flu clinic. The nurse practitioner refused to give them pneumovax. When I asked for a reason, she replied “they’re too young. I’m just not comfortable with it”. I pointed out the fact that they meet criteria (showed her cdc recs) - corticosteroid use r/t asthma and she responded “I’m just not comfortable with it”. I got a bit testy at this point (Irish lineage!) and asked her to at least make an evidence-based refusal because we did not go to the clinic for her comfort and would appreciate at least hearing a clinically informed refusal. Obviously, I got no-where. They have a physical with their PCP next month and I’d like to do better there. I feel, especially after reading Barry’s Great Influenza, that pneumovax could be very helpful in event of pandemic and I could use your help (and the help of others here on the wiki) in refining my approach to get the kids this protection. Thank you, and thanks to everyone who can help me out here!
Lisa -
Call around to different clinics/pharmacies where they are giving the pneumovax. There are different guidelines that are followed at different places. Just ask their age and disease guidelines.
I got my son (at age 16) got a pneumovax, without any problems, about a year ago at a local pharmacy. Try pharmacies that are not chains, and maybe even in a neighborhood that is “higher class.” Sometimes the pharmacies located where there are rather rich clients cater to them. I am not saying that is right, but something I think I may have observed.
I’d like to second Lisa’s concern- Ive been given MAJOR run around with the pneumovax for my kids. They are 12 and 15. I can sort of (maybe, kind of if I really try) see refusal for the 12 year old, (on the thin/lightweight side for her age) but I don’t at all get the fifteen year old male, whose bigger than me, (I got a vax, no prob) with a history of asthma/ bronchitis.
Finally they said they would give the kids shots but wanted them to come on seperate visits in case of reaction. Ok, I can see that-though I really suspect they want to charge for two seperate office visits. Anyway got the flu shots. Went back a few days later They claim they don’t know what I’m talking about, they don’t DONT HAVE ANY VAX????? NOBODY HAS ASKED FOR ANY????? Come on!
Lisa in SM
Try your town health department, that’s where DW and I got ours, price was $5!
The Doctor
Ordered your new book last night, along with more fuel for the butane stove, Aladdin oil for my lamp, an indoor wood rack for my woodstove, and finally a bread machine. Have broken through the temporary procrastination barrier! Also inquired about more Tamiflu. Know you had said before that it was probable based on the latest info that it was prudent to extend treatment from 2 x 5 days to 2 x 7–10 days. Have also read other threads that say double the dose for double the days, ie, 4 a day times 10 days or 4 packages per. Could you comment on that please? What is your latest recommendation in that area. Thanks very much.
JV - Thanks for response. What I dealt with today was a provider who refused to follow the guidelines sitting on the table in front of her! Guess I’m still exacerbated at her grossly unprofessional approach. I will try other clinics, if I can get the boys to go again! Older one was embarrassed by my arguing with the NP, though younger one quite impressed…Oh dear! I would like to be able to just get it from their doc if I could. They will go for their physicals without a problem. If I run into a situation like this again I’ll probably become apoplectic.
Uhmmmm - NauticalMan? Ahhh, we don’t have a health department. I can use the county one though, I suppose. But I could run into this again? That’s what it sounds like, given Green Mom’s experience. Need some technique here, as telling someone she doesn’t know her ass from elbow (all done in clinical terms you understand) has proven to not be helpful!
Lisa -
If you call for their guidelines before you go, there should be no problem. Tell your boys that they meet the guidelines where you are going!
Green Mom - I’m sorry that you know how I feel. I’m sorry that I know how you feel! This is maddening! What are you going to do?
JV - OK. I will. Thanks. Irish pigheaded anger lessening now, can listen to reason!
I’ve been told over and over that you can only get the pneumovax shot twice in your lifetime. Is this true? I got mine a few months ago now I’m trying to get the kids theirs.
My doctor advised if you get pneumovax after 65 then you only get one shot, if you get shot before age 65 then you need another one five years later.
KimT -
The guidelines for Pneumovax are here: http://tinyurl.com/em6dy
Scroll down to page 4, and look under “Revaccination.” At this time, those are the recommendations. They have been changed over the years, so in 5 or so more years, they may be changed again.
Lisa and Green Mom
Hello. I took my 6 1/2 year old to her pediatrician last year and asked for the pneumovax (PCV23) that her father and I had just had. I took all the CDC information, but what worked was my “travel to an asian country in the next year” lie.
The grocery store flu/pnuemonia shot clinics would not give my daughter either immunizations. The pediatricians’ office needed a lie. But travel medicine clinics are an alternative. And if the pediatrician had refused, I would have made a trip to travel medicine clinic even if it meant a day trip. http://tinyurl.com/yehry4
I wish you both success at getting the pneumonia immunization for your children.
Cheers.
KimT - 3 is maximum. Active high amount antibodies for 5 years and still effective at 10 years for many people. My oldest asked today. I told him he’ll be covered till mid20s, then he can wait a decade or so and get another, but he probably won’t need to for 2 or 3 decades more. My concern is the next few, maybe 10, years. I want them covered if pandemic occurs. It will be too late after it starts to get pneumovax. Health care chaos will likely prevent it. Preaching to the choir I know. Wish clinicians would see the sense in doing this now though, but most have no idea of what ‘then’ we are preparing for. Anyway, here’s a link for pneumovax for you!
The need for subsequent doses of pneumococcal vaccine is unclear and will be assessed when additional data become available. Because data are insufficient concerning the safety of pneumococcal vaccine when administered three or more times, revaccination following a second dose is not routinely recommended. http://tinyurl.com/yhj3uq
StinkinRose - I can’t write your screen name without smiling - you are the second person to mention travel clinics to me. I will pursue that option if necessary. Love a back-up plan - and the one you’ve provided is a lot safer than the clandestine burglary fantasy that’s been flitting around my tired brain!
LSM- I have a couple of ideas in mind-one is to try the health dept. I don’t have a clue where a “travel Medicine clinic” would be- I’ll investigate that. I’ll be in Nashville later this week thats a possibility. the third option? Well, the ever so helpful folks at the docs office suggested that I call “later in the year” to find out when they “recieve this seasons pnuemo-vax” Ive decided it is later in the year, (ok, six days later but it IS later) and so I will call monday morning, and monday at noon, and Monday before they close, and tuesday morning, and tuesday at noon…….
Green Mom - thanks for making me laugh! Persistence. You’re right. And I think I’ll tell boys doc they have trip to Asia scheduled with the ex, just to cover my bases. The only thing that muddies that plan is I’d have to prep them to lie, and I honestly don’t know if older one could. (unfortunately I do know younger one can, quite well too!).
enjoying the pneumo conversation. i had a little trouble getting this for myself, but did. my daughter, who will be 5 in January, has been refused on the basis that she received the pneumococcal earlier on.
i’d been under the impression these vaccinations protected against different forms of pneumonia, and perhaps that the pneumococcal may wear-off in early childhood. ?
i wish someone could clarify so i could either continue to pursue this for her or get over it.
Posie -
If she’s already had it she probably doesn’t need another (unless splenectomy/chemotherapy/and a few other exceptions). Read this: Data from one epidemiologic study have suggested that vaccination may provide protection for at least 9 years after receipt of the initial dosehttp://tinyurl.com/y8nlzp,
and ask a couple of the docs here just in case.
Hurricane Alley RN – at 13:18
Re: “It appears to me that TPTB are not taking collatteral deaths into account when estimating the CFR. There could easily be more deaths from secondary causes than from AI.”
As usual very well said.
That’s why I think the stats from 1918 were almost worthless in calculating a correct CFR; I doubt we can do it in 2006. The domino effect WILL be horrific and there will be scenarios we can’t even think of now. It has the potential to move us into 1850′s era healthcare within the first 2 weeks-nothing high tech, even relatively low tech will be gone. The ‘medically frail’-even me-I have high blood pressure and Type 2 diabetes-could easily multiply by 10 or more the true number of deaths.
I work on a Bone Marrow Transplant Unit now- talk about the medically frail! I can’t think about panflu when I’m at work anymore, or I’d cry everytime I look at these patients.
That’s why when I do speak to people, especially local government people who blow this off, my stress factor goes thru the roof. (All the better reason for me to practise the non-pharmacutical means to control my chronic diseases more!)
Doctor- thank you again. Thank you for the having the GUTS to do this.
Lisa in Southern Maine – at 18:46 And I think I’ll tell boys doc they have trip to Asia scheduled with the ex, just to cover my bases. The only thing that muddies that plan is I’d have to prep them to lie,- It’s not a lie. I used to work for Uncle Sam, and we learned overseas to be creative in wording. There is always the chance that the opportunity would arise for a trip and you are simply being prudent in being prepared. There would be so many things to be done, that this is just one to get out of the way. “In case you ever have a chance to travel with your dad, or we decide as a family to travel.. we should get as much done as possible now. Get shots, passports, etc. which will always be useful. Especially so close to Canada - passports soon to be required. While your at it, check out the travel clinic site, nice listing of suggested shots. Go for it.
For those who are trying to get vaccines for their children. If a nurse refuses, please try not to get angry with them. A nurse has the right to refuse. It could be the differecne of life and death and a law suit against them. The people here may not think this way, but some people do. gina
Hi Gina - I actually wasn’t angry about her refusal. I was perturbed at fact that she could/would give no clinical reasoning for it. Not evidenced-based at all and very unacceptable for graduate-level practice. Nursing has struggled so hard for professional status it actually hurt me to see a peer, especially one with advanced education, behave in such an unprofessional way. If she had been asked to perform a duty beyond her safe scope of practice, her actions would have been easily understood. If she felt the boys were too young and had any, absolutely any data to support that, it would have been acceptable. She disregarded practice guidelines, made a decision based on ignorance instead of knowledge. That is what riled my temper. We have struggled too long to support such uninformed practice. If I ‘am uncomfortable’ with an intervention, I will always explain why. I will present the data or lack of data. If the discomfort is due to lack of knowledge, I will clearly state that, ie “I’m not familiar enough with this subject to make an informed decision. Let me research and see what the practice guidelines are and we’ll discuss it again…”. It was her lack of professionalism that got me. We’re working too hard as a group to gain credibility as clinicians to support this kind of behavior from an NP.
mj - Thanks! A good approach. A good way to think about it.
Gina-My Mom is a nurse and so was my MIL. LAST thing I’m gonna do is sue a nurse!:−0 Thats just so asking for bad karma! I suspect in my case it is actually the office STAFF and one nurse in particular that is giving me fits. Unfortuantly, there are those who, no matter what their occupation is, are insecure or something and have a need to assert their authority-or as we say ‘round here “Lord it over others” and Im thinking thats the case here. We had to change to this office becuase of insurance, and we’ve had problems from day one, so I’m thinking this particular office is not well run.
But also, like Lisa-if I had been given a good reason-if the N.P. said “Iam uncomfortable giving this vax for whatever reason, whether I agreed with that reason or not, I’d respect that. But to be told yes you can have this and thenI go in and am told “we don’t have any, we don’t know what your talking about” makes me angry.
Yeah, Lisa, I’ve got that Irish thing too.
Time for us to go have a guiness Green Mom!
The Doctor – at 11:52 For anyone in doubt, I did indeed start this thread. I am getting a little concerned that the focus of the Discussion Forum has become a little too broad and that this runs the risk of new and even some old visitors to the site missing the forest for the trees
Cmon guys & gals, lets get back on topic please. Not trying to be crass, really.
Save a Guiness for me ladies! Am trying to get over my doctors refusals to me. Must remember, he saved my life almost 15 years ago! He’s a good guy and a good doctor, just does not get it about what could happen. No, that is wrong. He gets it, he just goes by the CDC book, without question, without thinking that his responsibilty is to his patient, not Dr. Gerberding and cohorts who have decided that the great unwashed out here should not be given Tamiflu, no matter their knowledge of the facts of inluenza pandemic nor their medical expertise, at least for a layman, gained from all our research and from the fluwiki hive..
anonymous – at 23:03
Quite right, we got a little off track, there, didn’t we!
For GoJo
I think the truth is that we cannot know what the CFR will be until the pandemic is over and we can count the bodies. I don’t think we should really worry too much about it now. If it is very high, were cooked. If it is as bad as I think, we will be burned but make it out OK. Obviously the lower it is the better.
My advice to you is to stop thinking about especially if this is preventing you from preparing for the pandemic. Either I am right about this or not. If I am wrong and the CFR is >50%, well that’s all she wrote. Welcome to the world of Mad Max. If I am right and you didn’e prep, then you and your family may pay a heavy price for your mistake.
I think you can see that given these two possible extreme outcomes, prepping makes sense. It even makes sense if the outcome is better than I think or worse than I have projected but not quit as bad as you fear.
GoJo, for some reason we humans have a long history of expecting doomsday is right around the corner. So far, it has not arrived despite been predicted throughout recorded history and probably before. The odds are really great that I am right and that you have about a 96.3% chance of surviving the pandemic. There is a long history of influenza pandemics that support this to be true. So, buck up. The world is not coming to an end but it sure as hell may get a bit dicey for a while. Forget about the CFR. While it is an important macro issue, it probably won’t enter into whether or not you and your loved ones make it or not.
GoJo, I really mean it when I say, Prepare for the Worst and Hope for the Best. This is what I am doing and I expect to live well through the pandemic. Maybe we will get a chance to meet some day. I hope so.
Good luck,
Grattan Woodson, MD
tjclaw1:
The point of knowing your blood type is in event of a trauma, no electricity for the hospital to run tests etc, in other words there is no blood processing to be done—or did you miss that point? What do you think is the purpose of blood type on dog tags? To skip the ability to process blood known as cross and type in a dire emergencey which was what I referred to. Second, if there isn’t any electricity you can’t store blood in refrigerators either. A simple transfusion person to person can be done in emergencies if blood type is known between family members.
The Doctor – at 00:41:
Don’t worry about Goju - if anyone is ready, he is. :)
However, Goju is attempting to work with local authorities in his community and the surrounding communities. Those of us who are attempting to do this are running up against one very big excuse that is inevitably offered to justify inaction: town leaders are repeatedly told by higher-ups in the state and federal government that the CFR will “most likely be only 2%”. They do not believe that this kind of CFR will lead to a breakdown of the usual supply chains and government services, and they are probably right in that instance.
The problem is that if the CFR is going to be higher, practical planning for that higher CFR event changes considerably on the municipal level.
Those of us seeking to educate our local municipalities are running up against their insistance of a 2% CFR, regardless of the lack of scientific papers supporting that claim with regard to H5N1, and regardless of the current on-the-ground evidence that we are not dealing with a flu that has a 2% CFR. When we tell them that the CFR of the flu currently circulating in Indonesia has a CFR of 76% (the one we want them to worry about reaching us here), they about fall off their chairs because nothing they are seeing from their higher-ups has readied them for a pandemic flu with more than a “devestating 1918-like” CFR of around 2%.
The odds are that a much higher CFR is in the offing with this pandemic flu. We need to be able to explain that to our local governments, and they need to be proactivly planning to prepare themselves and their communities for any of several higher CFR scenarios. Any evidence we can gather to support this effort is very helpful, and can move town leaders from inaction to action all on its own.
Nature won’t hold off on a Cat5 hurricane, or 9+ earthquake, and scale it down to fit authorities “manageable” disaster parameters… For goodness’ sake; believing their bosses’ spin, or, thinking a FluSpreadsheet is the Truth? (Even after Enron?) This isn’t a thought excercise, nor an impossibly low risk, even-lower-than-terrorism sort of thing, though some seem to be treating it like no one travels outside the country, we are too modern for depopulating plagues, ect.
(Wonder if local authorities saw ;-) that article with the Australian conference assuming a 35% fatality rate? )
Pixie, keep telling the public/parents/first responders/local politicians “that the CFR of the flu currently circulating in Indonesia has a CFR of 76%”…and, influenza is contagous before you feel sick. Maybe incentive will get to the town leaders one way or another.
Anonymous at 23:03-“Can we get back on topic please?”
Yes, but what IS the topic of this thread? I thought the topic was, plainly put, stop yapping and get prepping.
But when some Moms are trying to “problem solve” on a practical level on how to get a potentially life saving vax for thier kids-and excuse me if I have this wrong but arn’t young adults most at risk here?, we’re asked to get back on topic? Maybe Im reading this wrong, but I’m sensing a brush off here, of the same sort I have gotten from the Doc’s office. We won’t even talk about the brush off from the school system, and the community and the government and friends and family.
I apologise if I’m sounding irratable this morning, and maybe I’m reading more into this than is intended, but I am extreamly worried about this flu, I’m doing everything I can to prevent/defuse/cope/ and I’m sick of being patrionized and brushed off for my efforts.
Ok, I’m going to go now and chill and have some more coffee- I suppose its too early for a Guiness?????
Map the Sun’s always over the yardarm, somewhere. ( Sober for decades, but, still remember the good draft Guinness.)
“NOW IS THE TIME TO GET READY” Lots of ways to do that, including address site lurkers, work on our own preps, and, keep trying to get this on our communities’ and households’ radar. Sure is tiresome, and makes it harder for us, that those local officials in the know decided the course was to keep the public calm for as long as possible, instead of being transparent communicators, that would have and keep the public trust, and, have communities that were more resiliant by now.
Green Mom – at 09:22
But when some Moms are trying to “problem solve” on a practical level on how to get a potentially life saving vax for thier kids-and excuse me if I have this wrong but arn’t young adults most at risk here?, we’re asked to get back on topic? Maybe Im reading this wrong, but I’m sensing a brush off here,
Green Mom, I apologize if I implied a brush off, that was certainly not my intention. I too have a five year old child that was refused a shot (PPV23), however, just wanted to stay focused on prepping, on this thread. Maybe you should start a thread addressing this problem, I for one will certainly come looking for answers there. Enjoy your coffee friend :o)
Sorry, the anon posts at 9:39 and 23:03 was I.
Anonymous-After I posted my little tirade I thought-“Why not just start a new thread?” And then I realised-I think there is one allready. I jump in and out of here when ever I get a couple of “free” minents throughout the day and I often get the threads confused. Best of luck to you with your kid(s) and shots.
CrFullmoon- Thanks for the yardarm comment-made me laugh. Another valuable application of GPS technology……
NoFluingAround
Please contact Monotreme at monotreme2@macdotcom
NauticalMan
“The odds are that a much higher CFR is in the offing with this pandemic flu. We need to be able to explain that to our local governments, and they need to be proactivly planning to prepare themselves and their communities for any of several higher CFR scenarios. Any evidence we can gather to support this effort is very helpful, and can move town leaders from inaction to action all on its own.”
Can’t make that as a blanket statement; didn’t work in my town. DENIAL/FEAR are teamed with who’se got the $$$$ and lack of a definite ‘arrival date’.
Closed for length and continued here
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