This is my summary of the October 23rd Disaster Roundtable which I attended along with Anon 22 and DRD 191.
The following link has all the reports on it from the speakers. I will highlight only a few here. http://dels.nas.edu/dr/f18.shtml
Session 1: A. What Would a Modern Day Flu Pandemic Look Like? Eric Toner, Center for Biosecurity, University of Pittsburg Medical Center.
I missed part of this session but here are the figures from the Health and Human Services for a moderate and a severe pandemic. This presentation gives you a sense of what HHS is thinking.
The scenarios pretty much follow the thinking on this forum. Lots of death, overwhelmed hospitals, no vaccines, few anti-virals, limited useful non-medical interventions and limited medical ones. Goes to Leavitt`s oft quoted statement about any unprepared community thinking the Federal Government will rescue them will be tragically wrong.
B. National Plans for Confronting a Pandemic Flu, Bruce Gellin, National Vaccine Program Office, Department of Health and Human Services
Again no sugar coating here. Same numbers as above and recognition that worse could happen. Main points that I got out of it. Tamiflu is not in short supply – something that Roche sent out a press release on not too long ago and forget a vaccine. Pretty much all the points that have been discussed on Flu Wikie (such as extending a vaccine with an adjunct, pre-vaccination to create some immunity, changing methodology for vaccine creation (non egg-based), expand current production) were discussed and there was no silver bullet.
There was a discussion on changing priorities for access to vaccinations from normal flu – vaccinate high risk person to pandemic flu – vaccinate essential workers working in essential infrastructure and vaccinate high risk populations after.
In one slide we saw the underlying assumptions of the Federal Pandemic Planning: the concerning part is as the speaker pointed out “the determination to use all instruments of national power”. That language is specifically chosen. Probably includes martial law being enforced and suspension of civil liberties.
The goal of all of this is not to stop a pandemic but rather to blunt the peak of the pandemic and reduce its peak severity.
Finally, there was my favorite slide talking about how this Pandemic has become a plandemic!
C. Local Expectations and Readiness for Pandemic Flu, Joshua Sharfstein, Commissioner of Health, Department of Health, Baltimore
He noted that at the local level dealing with health issues in a major cities is basically a crisis a day and that it is even harder to sustain interest in planning at the local level than at the national level. In addition, cities have to plan to numerous ambitious goals for various levels of disasters from being able to evacuate a city in 24 hours, to being able to supply antibiotics to all in case of an Anthrax attach to pandemic flu. Also the work must be done through numerous local groups many of whom have lawyers. The danger is bouncing between fear and being overwhelmed. He noted that the money from the Federal Government for Pandemic Flu basically just offset cuts on his staff and did not represent an increase. Main point: its really hard at the local level.
Session II. Why Government and Health Professional Cannot Go It Alone in a Large-Scale Health Crisis.
A. Public Resistance or Cooperation? A Tale of Smallpox in Two Cities, Judith W. Leavitt, School of Medicine, University of Wisconsin, Madison
I really recommend that everyone take a look at this presentation. To me this was one of the most important presentations given. This is a comparison between two different Directors of Public Health in major cities in the US dealing with public health outbreaks. One uses a heavy handed approach and ends up with distrust, non-compliance, and riots and the other seeks open communication, creation of trust in all populations in the city, and consistent actions and communications and ends up with one of the lowest death rates of all cities. To me this one points out the need to have a set of ethical considerations be the basis of pandemic planning. We need the decision makers who will have to make hard decisions in crisis moments to heed a set of ethics that we generally all agree with. Without trust you can not ask for nor will you receive cooperation. Thus we need to know that communication will be complete and open. That all populations will be fairly dealt with and none will have differentiated treatment. We need a signed statement of ethics from our Mayors, Our Directors of Public Health, etc.
B. Street Science: Why Public Health Professionals Need the Public, Jason Corburn, Columbia Unversity
Another excellent presentation however the link does not open. Basically, pointed out that we are pigeon-holing populations when we bring in expert scientists who prescribe to people rather than listen to people about what is happening to them. We are missing the street wisdom and therefore missing the ability to gain compliance and empower populations. Street Wisdom understands that everyone has some expertise to lend to an understanding of how things work in their communities and without this understanding and buyin from the community compliance is not forthcoming.
C. Who Will Tell the People? Pandemic Risk Communication in the Internet Age Susan Chu, Flu Wiki
Great presentation by a well-know Fluwikian – although I may be a bit biased here! Who will tell the people — why Flu Wiki of course!
Session III. When Does Citizen Engagement Work Best? Lessons Learned from Research and Experience.
There were three presentations. Basically, I thought these were off the mark. Two of them talked about large efforts to pull in stakeholders from around the country into giving input for various health policy decisions. The efforts were ungainly and expensive. The last one was less than understandable. Basically, there seemed to be a real lack of awareness about the seriousness of the situation and no feeling of a short time line. These presentation seemed to be more about planning for planning and policy making sake.
Finally, Session IV Roundtable Panel Discussion – How Can Some Citizens Help When Hospitals Must Turn Some People Away in a Pandemic? On the panel were: Gabor Kelen, Deparment of Emergency Medicine, John Hopkins University; Randy Rowel, School of Public Health and Policy, Morgan State University; Darlene Sparks, Washington, Disease Prevention Education, American Red Cross; and Susan Messina, Citizen-Activist
The main idea here was to try to come up with a dialogue between different stake holders on this topic. I don`t think the roundtable worked too well as the guests were way too timid about understanding and thinking about a real pandemic situation. Only two examples: when asked by the moderator what his emergency room would do with an influx of pandemic flu patients, Mr. Kelen simply said he would close the emergency room to flu patients and force them to go somewhere else unspecified. He also had no alternative help for them. (Ok so all you folks living in Baltimore who thought you could go to John Hopkins – forget it!) So then the moderator turns to the citizen activist and says Well as a mother of small kids how would you feel about that? She then goes off on some well you have to realize the problems the community is facing tangent. Clueless. I learned more from the people who got up to ask questions: One point being that the D-Mort Team – volunteer morticians who work on disasters have only 10 trucks and would be unable to respond since they would be dealing with local disasters. Also that there are only 400 medical examers in the US and they would have to sign the death certificates of people not buried in mass graves and they would be overwhelmed too.
Overall, an interesting day but the main points I took away where:
Too many plans no real action.
The plan has become the point.
Not enough gut level feeling at the intermediate policy level about how quickly this could really become a crisis.
We are not really talking about education or awareness. We need to start thinking and working for a cultural change — which is much harder. We need our doctors to talk about this with their patients (and that does not necessarily mean Tamiflu). The stigma of talking about this is worse than the beginning of the AIDs epidemic. If your doctor does not take this seriously why should you?
We need a culture of community resilence which would value being prepared and which is re-enforced in many ways whether social, professional, religious, or whatever. Creating cultural change to value preparedness not just for a pandemic but for other things is very hard.
I asked the room how many people there had actually tried to get a group together to talk about Pandemic Flu? About a 5th of the people in the room had. These were public health professionals and they hadn`t even been trying to organize a response although many are called upon to do just that in their jobs. Frightening.
To best sum it up: Our guy from John Hopkins pointed out that although he knows the dangers and believes them, he himself is not prepared and his sole prep is having some water in his basement. One plea I made was that those of us of the engaged public on the ground needed their help to make an impact on our local communities. While this health profession community may have heard me in theory – they didn`t understand nor hear me in the reality. Secretary Leavitt`s statement still unfortunately rings true even in the preparation stage. We are SOL for outside help and your local community is where the rubber will hit the road.
This is an excellent report Senegal and very thought provoking.
Sounds a bit like a dog going round and round chasing its own tail. These folks that have the power to bring about change are caught in the vortex of theory vs. reality.
Senegal - Fantastic report - thank you for covering the meeting so well.
What impacts me the most is the plandemic. At the NYC conference I attended, the same emphasis was given… whatever plan you have… do it now. tweek it as you go… but the time for making the plans is over.
Scary when you think about what they are saying.
I missed this thread completely. The slides that I used are available from the ftp. The intellectual basis behind the Flu Wiki idea, including ‘The Wisdom of Crowds’, requirements for a successful forum, and the possible use of Wiki’s for local and special niche groups for pandemic are explored. Also some fun stuff about ‘anti-BS factor’.
Also, I had a run-in with the person representing the Canadian Health Agency, who thinks that I am less than totally objective when I suggested that a sense of urgency might be appropriate, since I ‘live and breathe this’ whereas they ‘have plenty of other disasters to worry about’.
Since when does paying special attention to one issue make one less qualified to talk about that one issue?
And since when does risk assessment include giving equal attention to all risks irrespective of the likelihood or impact of said risks?
Anyhow, it wasn’t the best conference that I’ve been to, notwithstanding the fact that I did get to speak in it.
Oh, one more thing. It scares me even now to tell you this but a couple of the speakers who will remain unnamed were completely unaware of how many people have been infected by the H5N1 virus and how many have died.
They were talking about this in the most theoretical way. So they were shocked when I told them at the break about 67% CFR.
And I was shocked that they didn’t know….
(“Mr. Kelen simply said he would close the emergency room to flu patients” -how will he tell who is contagious and not looking sick yet? WHO/Hu/ChinesePanFlu won’t stay out of the hospitals long, with no way to tell who’s been exposed.
“a couple of the speakers who will remain unnamed were completely unaware of how many people have been infected by the H5N1 virus and how many have died.”
“What happens? Nothing. Not even ice cream. The gods look down and laugh.” (Groucho Marx)
I was pretty happy that Anon 22 was at the conference and her talk was great. Yes I blanced at the level of discussion on some of the topics which was so theory driven and without an understanding of the reality. Some of the other talks were right to the point. It was a very uneven conference but the information on using social wisdom and the points about trust and open communication hit home with me.
Im surprised at the john hopkins info. I participated in the clinical trial for the vaccine there and got to ask many questions to people that dident look at me like I was crazy. That was a rare change at the time. I was told that the hospital put one person in charge and they had this grandiose plan of setting up massive tents all around the hospital to triage and treat patients. Maybe that plan has been tossed especially in light of when I asked the nurses if it was 1918 or worse would they really come to work and most responded that they would suddenly be experiencing “car trouble.” (with such “excellent” planning could you blame them) Maybe the new plan really is to lock down the hospital and let God sort em out.
Oh, that would be quite lovely, to be ill with H5N1 and be housed in a tent. Are they going to heat the tents in winter, or air condition them in the heat of summer? Barring that, what is the air circulation like inside one of these tents?
I would think people would prefer treatment in a tent in whatever conditions it provided as opposed to nothing at all.
Actually in 1918 those that were housed in tents and were slightly hypothermic did better than those in the hospital.
Folks, being sick in a tent might be a survival string but it won’t be comfortable. First you don’t have anything remotely resembling a bed mattress. Flying and crawling critters, lack of privacy, no bathroom at the beside, no sink ,no showers, etc. An extreme hardship especially if you hang off the stretcher because one size doesn’t fit all or if you’re a woman.
I think this quote applies nicely…”post traumatic means you survived!”
Too True — Annoyed Max at 15:28. Perhaps he said this as part of the roundtable discussion and that was a “role” given to him however it was hard to tell - he seemed serious about it. If I was near John Hopkins and was considering it as my local care center I would certainly find out what their real plan is.