I am a physician (to remain anon in this post). I work in a specialty department in a large hospital organization (that is I am not your family Doc and not generally exposed to secretions). This week I saw a patient for an “injury”. The injury occured in China while he was on “vacation”. Patient roomed with his wife who was coughing up a storm! No one on the staff had questioned he or the wife on what kind of travel…..have you been on farms?…..had contact with poultry?….
I am really getting fed up with TPTB at my institution. We per say have guidelines on respiratory sx for patients but they are not rigidly followed. We have crap PPE for providers and we do not have a culture of questioning patients about travel, current illness etc. We routinely room patients with family members/kids/multiple kids several of whome are sick and exposing everyone else……
Will I serve or SIP….the answer is obvious.
I should have also included the fact that the patient and his wife were Chinese. Thus they were not typical tourists and obviously probably did visit local family etc. and could have potentially many opportunities to be exposed beyond the usual traveller.
It’s bad enough that the general public shrugs the whole thing off as some sort of crazy survivalist dogma/cult, but the realization that the major players in the medical field are so ill informed is downright scary.
I will say that my granddaughter’s pediatrician told my husband (when he asked him outright what he thought of the bird flu) that he doesn’t underestimate the potential danger, and that we are not nuts to prep. He has already stockpiled 3 months worth of supplies and his wife and children will SIP at the first hint of trouble. It was quite a relief to hear that some docs are on their toes, but my guess is that if he hadn’t been asked outright, he would not have mentioned it.
My guess is that the confirmation of the first case is what it will take to get the undivided attention of the TPTB in the medical profession. It’s very frustrating.
People can’t handle the truth.
That’s the fact. And its a hard truth to handle…
We could be facing:
50% attack rate and 50% CFR = 1.5 billion dead
Can’t put it any simpler than that. If TPTB would say this, would people start to prep? You bet! Instead TPTB say 1918 is the worst case scenario. Would that it were only so.
anon: very scary thread. Makes me think of your question to Serve or SIP: Not trying to be an alarmist, and I am sure she just had a cold, but it may be too late for that decision. If not this time, then maybe the next time. If not you then some other doctor is some other city. If you are at ground zero when it happens then you are the ‘trip wire’ for the rest of the country. Let’s face it, people who say they are waiting for word of health care providers getting sick or small clusters growing are assuming (or hoping) that they are reading it on wiki or MSM. It’s entirely different if you are IN one of those clusters. I hope that hospitals get their act together better than what you related above. MANY lives are depending on the ability and professionalism of the HCWs to ask the right questions, wear the PPE and identify early. Trip wires don’t work when the hazard’s already inside the boundary… Good luck and thank you for this post.
Anon who started the thread:
As a Critical Care Nurse I have to say if you don’t inquire about these things who will? Doctors can effectively change practice-please choose to discuss it with the Inf Disease doc in your house. I’ve tried and basically failed. Ditto on isolation and visitors and PPE. What is your plan if any?
anon - at 21:45
May I ask what would make you or your fellow healthcare providers begin to assume a possible H5N1 infection based soley on, say, the travel patterns of an individual presenting with flu-like symptoms?
What would it take for you to remove the “have you had any contact with chickens” qualifying question from the “identifying potential H5N1 patients” equation entirely?
The reason I ask this is that many of us here feel that there is a danger the beginning of the pandemic may be missed because everyone will be looking for a link to chickens when, if the virus changes to pandemic form, the chickens will be out of the equation and left in the dust, and human-to-human will be the name of the game. If we are always using the chicken qualifier, how will we be able to detect the human-to-human transmission of cases, which is the real danger?
Thanks in advance for any input.
Can you throw a snot wringing fit? (or borrow a surgeon to do so : ) There’s nothing so incandescent as anger inspired by injustice and it sure sounds like injustice is being done to you and your fellow HCW
Olymom: He/She is a surgeon or a orthopedic doc more than likely.
ColdClimatePrepper – at 23:07
“People can’t handle the truth.”
Stop treating people like children and maybe they’ll stop acting like children.
It’s system wide. At a recent, pre-hospital emergency medical services conference, info about H5N1 pandemic flu was given to paramedics and EMTs…
“Flu symptoms may be more severe than seasonal flu.”
If someone gets the virus they must take Tamiflu for 7 weeks.
And my favorite… “How do I protect myself? Try to stay at least 3 feet away from anyone who is coughing or sneezing.”
There was no sense of urgency… could have been a talk about toenail fungus.
We’re in it deep.
To Dr. Anon
I know of what you speak. Hosp. admin here is in deep denial as well. However, I would suggest you gather a good sized group of like minded MDs, sit admin down and state your demands.
Anon at 00:51:
And my favorite… “How do I protect myself? Try to stay at least 3 feet away from anyone who is coughing or sneezing.”
Deja vu just happened. Except we had to wait for the administrator to finishing yawning before giving an answer. HCW’s will be down to flipping coins to get to see who has the bad luck of intubating someone. This is widespread and systemic throughout the health care system. The entire point is to keep the HCW in the mindset to put duty over saving your own hide or family. There are a few of us here and there who talk about it when alone, but my entire ICU discussess it and we debate what we will do. We don’t share this with management because it’s pointless. They are choosing this path of less resistance for them and acute anxiety for us. So when the time comes and they expect and want discussion—we will be talked out. Informal poll at my hosp had a 49% rate of single parents or primary custodial parents. They have slowly admitted to their co-workers it could be too big a sacrifice for them. Everything hinges on the CFR and triage coordination IMHO.
Somehow this doesn’t frighten me. I doubt I will be able to get into a hospital for treatment anyway. I’m a nobody. I hope the health care workers do protect themselves, we’ll need them on the other side of the pandemic. If you guys all die because Tamiflu doesn’t work or whatever, then we are done for.
Then we have the emergency management director for a health system on the west coast who said -
“For example, health workers would have to improvise in a true pandemic. If we had to, we’d think about Home Depot — they carry masks and gloves,” he said. “There’s a lot of things you can do. We’d have to work together like we never have before.”
I don’t think this is what Home Depot’s “You can do it. We can help” means.
I agree with “Nobody for this post - @ 1:54.” I will be very upset (sad) if I can’t get my kids or myself into a hospital; however, going into a hospital won’t necessarily change the outcome for us. It would just put others at risk. And we do need to keep HCWs for “after.” And we also need them to keep the research scientists, who can possibly find a vaccine, healthy. Like I said, I will be very upset, but it’s a sad fact (I think).
If it’s a severe pandemic, I would not expect or even attempt to obtain hospital treatment. The idea of joining rioting hordes, sick child in arms, trying to get help from exhausted, overwhelmed HCWs stops me in my tracks, and as mentioned above, probably would not change the outcome. I can imagine the care my child would get under those conditions would be far inferior to what I could provide at home, even if (or especially if) it is just pallative care.
If my GP asked me what I would expect from her, I would tell her her duty of care to her small children superceeds her duty of care to her patients; phone consults would be great, however. I am stocking up on antibiotics (and dosing info), necessary medicines and OTC medicines the best I can.
Anon at 1:56
Tell the Director not to worry, if his/her Home Depot theory doesn’t work I’m sure “there is a Visine for that!” :)
LMFAO at “there’s a Visine for that”
I had a chance to bring up the pandemic with a nurse who is working at my local hospital,and I asked if they are planning for it.She said yes they were it was part of their all hazards plan.When asked if they were stockpiling food and PPE she said no they will get it when it comes up.I pray I can be strong if we get flu and not go running to the hospital.I cant imagine taking my 7 year old there and then not being able to stay with her.Having her laid out in a nasty hallway.Probably not able to even get info on her condition.No I am with northstar,If there is a pandemic the hospital is the last place I want my kids unless we are like the first sick people.
Hospitals will need to shut down in a moderate to severe pandemic. I’ve said this before. As we type, there is a nursing shortage and a bed shortage. No flu. Just normal stuff. Normal stuff will still be going on when or if we have a pandemic. Hospitals will not be able to stay open.
DR. Anon,
I have a relative that is scheduled to travel to Hong Kong this week for 5 days. What specific recommendations should they observe?
Many Thanks,
Argyll.
“When asked if they were stockpiling food and PPE she said no they will get it when it comes up” Words (polite ones anyway) fail me - how can any one lack the common sense to think that through?
This whole thing is driving. me. crazy.
Anon docs and hcws; get your financial affairs in order and stop biting your tongues; what’s the worst that could happen? They fire you before pandemic breaks out? (Maybe survivors can go back to very old-style; putting physicians on the family payroll and just not paying them when people are sick, post-pandemic…)
Yes crfullmoon, It is driving me crazy too.In fact it made me toss my cookies,my post anon @ 10:06
Thanks all of you for your comments, especially those in Healthcare. I have tried “pitching an email fit” at my institution without any luck. I think Administration just plain does’nt get it. Bird Flu is not on their radar as they struggle to count their beans everyday and make their institutional goals set by the ever higher PTB. When it comes down to it I don’t think that most of Admin. feels a sense of fear…it’s like they simply have no sense of biology or respect for the Virus…guess that’s why they’re administrators!
Infectious disease at my facility also is not too excited about bird flu it seems. They probably do know that we have no surge capacity and are basically *&%$ed anyway.
For you travellers I would say protect yourself! Practice good hand washing #1. I recently flew and I did wear a mask. Don’t care how stupid I looked. I had 3 nasty repiratory bugs last flu season and I attribute 2 of them to airline travel. People were coughing on the plane. Studies show the air in airplanes is ok but that it is the people within 3 rows of you that will make you sick through large droplet spread. Put your mask on as you are boarding….not while you are going through security! LOL
anon for this thread too – at 00:51
Tamiflu for “7 weeks”?
Was that a typo?
Malachi – at 11:12, can you hear my insides? They’re about loud enough. Either the coffeshop sold some bad coffeecake, or discussing some things with some totally cluless individuals this morning, who should know better by now, is about to make me sick, too. They keep thinking the local health dept will surely suddenly start to do the right thing, that it is only a health dept. responsibility, and, just another interesting issue (not as personally interesting as what’s already on their organization’s agenda, of course) when they don’t get that the “health dept” and the entire political system decided to (Or, they’re just fatally incompetent. Whatever.) let the public proverbially drink the pandemic koolaid.
Let the hospital administrators go down with the ship; maybe you can have in-services now, and teach them how to administer triage; didn’t someone find some rough pandemic influenza triage guidelines already??
I think it is a national security issue to have trained experienced health care providers post-pandemic for the Recovery period, even if our imported medical essentials chain is broken; they can still help, if they are alive and functioning. Not dead or burnt out.
As I have stated on other forums, my evaluation is that there will be no effective health care system left after a severe pandemic, and few HCW, either. I expect that we will lose a disproportionate number of HCWs nd support staff during a pandemic, and I am planning for that eventuality. Worse, we may lose the medical training facilities, too.
I’m also a critical care nurse and have stated on other threads how I’ve been banging my head against the wall with my hospital for >2 years to absolutely NO avail, we have had no plans, no meetings, no PPE’s stockpiled, almost half of the nurses in ICU are prepping at home, and that’s where we will be!,,,,along with the other half when they realize we are not crazy after all (only they will be without food) I’ve had 2 of my bosses who are not preparing say “I’ll be at your house 1st thing” and I have told them politely “no you won’t”.
None of us (medical professionals) really want to admit our biggest flaw. Preparation has to come from the bottom up. When I say from the bottom up, I do not mean this to sound derogatory at all!!!! When a patient comes into a hospital it is not the MD or nurse that sees them first, it is either a nurses aid, orderly or a clerk. Involvement, information and preparation of our lowest skilled coworkers is our first defense—wheather we want to admit it or not!!!!
THINK ABOUT IT!!!!!
When I hear hcw”s talking about how unprepared and oblivious their hospitals are it really shoots up my ppof(personal pissed off factor),as hippie moms are told by health depts that hospitals are prepared,have 3 days of food and water,Sorry but you really have no need for antibiotics since you aren’t sick.MI put out an all hazard emergency booklet that stated “antivirals will be available to high risk individuals” and gave us directions on how to know when it will be our time to go to the mass vaccination point.I could rant,but will just say,God(or whatever higher power)bless us all.
Anonymous at 00:35
No insult was intended to anyone. I clearly did not explain properly what I meant.
I’m just commenting on how difficult it is to wrap one’s mind around these numbers. Most people, myself included, have a hard time thinking of this sort of catastrophe. It boggles the mind and can lead to a variety of reactions, from denial to preparing frantically. TPTB are just human beings too, prone to the range of reactions, and vulnerable to the difficulty in facing these numbers. I believe it takes time to absorb the possibilities, and begin to act in productive ways. I’m hoping we are starting to see those actions happening, though I’m not confident the world will be very well prepared if it happens soon.
Its just a comment on human nature. If there is a pandemic, I believe it will become the norm to be preppers and to imagine the consequences of plagues. But it might take seeing it happen, for many people to really “get it,” unfortunately.
I watched the India situation because of what happened to the health care industry there. They were swamped with patients, hcw’s were dying, and this went on for a few weeks. They seem to be recovering at this point, but does anyone have any first hand experience or statistics to show what it did (or will do) to them in the long run?
You’r right the possibility of 75 million dead in the US is mind boggeling!!!!
I have no intention of depending on our health care system during a pandemic. Grace RN said a while back (and this is not a direct quote, so if I don’t get it exactly right, Grace please forgive me) that old fashioned home nursing will be what is needed. I just hope and pray that if my family gets sick, I can stay well long enough to provide that level of care. I have sat by sick children many a long night giving them spoonfuls of Gatorade to keep them hydrated and that is what I envision if they contract H5N1 or whatever the next pandemic is - there aren’t going to be enough of anything at a hospital during a pandemic - we’re just going to have to do the best we can at home. JMHO, of course:-)
That was supposed to be a :-) at the end!
WIT: I hope it’s as simple as good old fashioned home nursing. But with the lack of mild cases as evidence, I’m not hopeful. What I’ve been reading from the doctors that treated the patients in the “hospital” was they couldn’t control the temperature, the drop in blood preassure, the inability to breathe, or the ARDS that developed in their patients. They gave the meds, they intubated and put them on ventilators, and the course of the disease was changed enough for survival for some, but rehabilitation is taking these same patients who survived months to recover. They had to tube feed them. You can’t do this level of intervention at home. Maybe if you’re a doctor nurse team with a ventilator, medicines and all the equipment at your disposal.
Realistically there is no chance if the CFR doesn’t drop in the home setting. That’s why discussion threads changed so much to isolate and SIP as long as you can because everyone is hoping for a CFR drop, so home nursing may help. Try to monitor the CFR as the disease breaks out(if it does). I don’t mean to be cruel or cold here, just realistic, the best hope is SIP and as I said before-if I had kids I would lock them in their rooms. They might hate you, but they might not get infected either.
The reason TOMDVM called H5N1 a freak of nature is because freaks aren’t the normal, they’re the abnormal. Woodson’s care plan is all based on the fact that the CFR drops, otherwise you’re standing a death watch.
When I started this thread I did mean it to be a bit of a rant on hospital administrators who just don’t get it and basically will “get back to you in a few months on that” if at all. I am going to take control of my practice at the grassroots and steal masks or whatever from around the hospital and demand that the staff that support me,…. mask my patients with respiratory sx and I will mask myself no matter what the social stigma.
I agree with Leo7. I posted months ago that I dealt with a loved one with Legionaires pneumonia in an ICU. It takes INTENSE, minute management of ventilators when someone is this sick and she did not even technically have ARDS and had a disease that should respond to antibiotics. It still took 3–4 days on a vent to clear and since she was herself a nurse she had the best cardiologists and bypass surgeons “looking over the shoulders” of the internists, RN’s and respiratory therapists and tweaking things. The harsh reality is that you as G.Q public could not even imagine this level of care in a non-pandemic setting.
Home care will be valuable for those who do not go into cytokine storm/ARDS type body shutdown. Darwin did not say it would be easy
Anon:
Recently, when AF was mentioned to my Nurse Manager at lunch one day, she said our Chief Nursing Officer was also concerned about Bird Flu. The woman had a net positioned above her office, which was in a portable building, so that birds could not come in contact with it. We’re screwed at my hospital.
My partner is a school teacher at a private school with a considerable chinese overseas enrolment - Rich Chinese send their kids overseas for schooling. One of the characteristics of kids is that you don’t always get the truth, the whole truth, and nothing but the truth, from them all the time. One of the characteristics of the Chinese culture is a propensity to say “Yes” never to say no, and preferably say what they think a person would like to hear.
This makes life quite interesting for my partner, like the fifteen year old kid who buys a turbocharged Subaru Impreza WRX, somehow gets it into her driveway, and blandly tells her he has a licence to drive in China (oh sure!).
However, on a more serious note, this very nearly caused a tragedy when we had the SARS epidemic. A schoolgirl told her guardian hear and her parents she was going interstate to see friends during school holidays. She didn’t - she went to see her boyfriend in Hong Kong at the height of the epidemic. We only found out afterwards when she told a girlfriend who immediately reported her.
While the Australian pandemic plan calls for temperature monitoring and screening of passengers when we hit phase four, my partner is going to have the school either pull their passports or tell them that if they go overseas during the pandemic, they are not to bother coming back.
I gather that when A phase four is declared the government here is going to advise people to postpone all non essential travel as well as start their preps.
Walrus, that doesn`t sound like a simply “rich Chinese” problem, that sounds like a typical teenager problem, with a bit more free cash,that is.;-)
hmm..remember when some one posts anon…there are no credential checks….”buyer beware”
I would suggest looking at syntax and reconsider stated credentials.
I resigned my position as the Infection Control Position at my hospital because I could not get Administration to buy into pandemic preparedness. We were too busy spending money on art, new furniture, and sod for landscaping and there were no funds to properly purchase PPE, additional supplies, etc.
I laid awake at night worrying how I was going to get things in order and protect staff, educate everyone, develop plans, execute plans, etc. and be the sole champion of this project without the support of an administrator who thought it was just a lot of hype. After nearly 20 years fulltime employment there, I woke up one day and decided I could not be soley responsible for the health and welfare for an entire community healthcare facility should a pandemic occur and that was exactly what I was being held accountable for so I wrote my resignation, worked my notice, took two months off to rest, play, finish my personal preps and get a job in a facility that is preparing (I worked with their IC staff on a regional pandemic task force) and does have administrative support.
Had I stayed where I was, if I survived the pandemic, I would have driven myself nuts worrying about the ones who didn’t and thinking of perhaps what I could have maybe done differently to get TPTB to get on board. To date, they still aren’t and I resigned over 3 months ago.
Should read Infection Control Professional - not position. Tired eyes. Sorry. :>0
Are we there yet - 11:51
Tamiflu for “7 weeks”? Was that a typo?
No, unfortunately.
She might have been confused with using Tamiflu for prophylatic effect. I read an article months ago that stated prophylatic use of Tamiflu by healthcare workers would require enough meds for 7 weeks. Obviously that’s not correct it would need to be taken as long as there is exposure. I hope that thought isn’t widespread.
But looking on the bright side, she did get the name of the medication right.
ICP:
Wow, the commitment to follow through on your convictions is admirable. I don’t know too many people who would do that. I know you worked hard to make that position. In the end, when stress is keeping you awake like that you need to act, and you did. You’re more healthy for your patients and your family now. I can say from various experiences that some hospitals are more toxic than others, especially with this.
I went to weekend duty in order to fit school into my life—it was a commitment to my personal happiness and a signal not to dwell to much on what I can’t change, although I still try. I don’t have as much “free money” for fun things, but I’m happier with making that decision. It all comes down to what you can live with.
anon – at 21:45 “Will I serve or SIP….the answer is obvious.”
Hopefully not too late when you decide to SIP
ICP, now if there were only journalists anymore; who wanted to write about ethics of local pandemic (un)preparedness…
All the best to you all…
oops that was me -silly library computer…
Relative I talked to yesterday said his wife, a nurse who works for a large suburban regional hospital, has been informed that if TSHTF all workers and their family members will be supplied with Tamiflu. After trying for a year to get him to take it seriously and being told they would come stay with me (jokingly),(no way I told him), they have now started to prep.. Do not know what other plans the the hospital may have in place, but will try to find out.
I hope they did the math - and, looked to see that the tamiflu is in the cupboard, and not on backorder -
Do they say they plan to have mountains of it; to use prophylactically for months, or, are they going to give it to staff when they get sick and need to be on a vent?? Are they realistic about the doses required and that pandemic may be resistant when it gets here? How much PPE and food and security for the hospital staff is ready now?
Ask the hospital how they will expedite pronouncing death, make legal death certificates, and bury id’ bodies without letting work pile up - are they talking to lawmakers to make pandemic exceptions for who can do paperwork?, brainstorming with the local funeral directors and cemetery trustees and faith communities? Have they seen the links on the Mass Fatality Plans threads? (Or on the main wiki index; under Deceased persons, or Mortuary)
Thanks for the kind words.
I am using what knowledge I have to offer to my community to help teach on all levels about pandemic prep and encourage folks to prepare to SIP and be less dependent upon hospital-based healthcare. I approach it from the “hospitals will be overwhelmed and this is what you need to be prepared to do at home” standpoint, so I do not reveal the truth about the system failure (I also live in the same community)in hopes that someone at the hospital will wake up and get it together in time. I just fear that it isn’t going to happen.
I am very satisfied with my new position and had several offers at different facilities and feel I chose wisely and carefully. It was never about money, hours, benefits, etc. It was simply, where can I contribute something that will benefit others the most?