It’s just dawned on me there’s an area where I might be able to make a little difference.
My great-grand-father founded a medical magazine which still exists today. It’s a major “Specialists to GPs” information weekly in French-speaking Switzerland. They publish pretty much on theoretical and ethical questions too, the lot with a good sense of humour. The Group itself is a specialized medical publishing media. I inherited the shares and I am invited, as each year, to the Annual General Assembly and Dinner this next Thursday. I shall be meeting the medical Who’s Who of Geneva, all doctors, in activity or retired, as well as some board members and the Editor-in-Chief. I shall be one of the very few without such high degrees. In other words, I’m the baby in the cradle… These are forward-thinking people capable of original thinking. I have their respect through the blood line and through my past behaviour in this group. And they are capable of shaking a few trees too in this community.
I, on the other hand, find it difficult to express myself spontaneously on a subject that I don’t know all the ins and outs. It’s ok for me to write, because I can think things over. This time, though, I’d like to make chit-chat at cocktails, and after, at the dinner table with one doctor on either side of me, and steering the conversation on avian influenza.
I realize this is short notice to ask for help, but honest, my upper floor light bulb only lit at 500 watts a few moments ago.
Would you help me sharpen my mind in the next few days with submitting me through a “Question and Answer” session here, so I’m more confortable on Thursday evening? I.e. test my knowledge and correct me.
For example, tell me:
Q “but it’s only a bird illness for poor farmers at the other end of the planet”
A What do I reply? Yes, this is true, but the WHO has said that these poor farmers have been found to be the victim of limited human-to-human transmission. So what if after a family visit, one’s farmer’s cousin boards the plane to Amsterdam? After all, flu is asymptomatic for a few days.
Is this the right answer?
Q “Ah, it’s not a problem, the government has made a plan. We have thought about triage so that we don’t mix the flu patients with the others”
A “Shall I quote some of the stories I made up for Katherine on this thread?”
I’d like to have them ask themselves deep questions, have them think about my “innocent” remarks all night long… And I need you to put me in a Q+A session, where I practice short, punchy responses. So would you draft some test for me, please?
Many thanks.
“but it’s only a bird illness for poor farmers at the other end of the planet
Au contraire; it is in an unprecedented number of mammal species as well; some of which usually do not even contract seasonal influenza. Also it has gotten places that are totally unable to monitor for human cases, such as parts of Africa.
“We have thought about triage so that we don’t mix the flu patients with the others” - “Tant pis” that influenza is contagious before people begin to feel ill; impossible to know who is contagious, unlike SARS and fever monitoring.
I like to say (and I believe it is true) any of those past human-to human clusters could have been the start of pandemic; they only know it wasn’t after the fact, and sometimes two or three weeks have passed by the time we hear of the (untested) index case…
Communities will need to prepare to cope anyway; pandemic cannot be prevented, and vaccine will not be ready in time; supply chain disruptions will occur anyway and need to be prepared against, as they alone will cause mortality surges…
Good luck!
crfullmoon – at 08:00 - Thanks. Good points, I’m going to work on this right now. 1. Finding and remembering the mammals - cats, pigs, bats, tigers, etc. And yes, they either don’t event contract seasonal influenza, but if they contract H5N1 they are not necessarily sick (ducks for example).
Africa, impossibility of accurate testing/reporting. Yes.
Influenza contagious before symptoms - your remark is so true. That means that they, the doctors, will be exposed to it before they know it - front line. They’re risking their lives and that of their families before they will even have a chance to know they are infected. Counter-argument: how come Indonesian HCWs did not get sick then? Ah, because it’s only a genetic susceptibility. Grrr. How does one answer this?
Communities will need to be prepared - I guess this is going to be very fuzzy in their minds. So, example: no more truckdrivers to bring medicines into the hospital as many will be sick themselves. Counter-answer: we’ll ask the Army. Ah but the Army is likely to be short-staffed too. So do we have to contemplate a draft? Yeah?
Frenchi-Girl
How come Indonesian HCW did not get sick?
Because the virus wasn’t easily transmissible at the time? But if and when it becomes a pandemic strain, HCW surely wil get sick, in fact that’ll be a major sign that a pandemic is in effect. right?
Army — will be asked to do a whole lot more stuff as well right — delivering food, guarding pharmacetuicals, enforcing quarantine….everyone will want the army to be helping out.
FrenchieGirl – at 06:58
Q - It hasn’t gone pandemic yet after several years, what makes you think it will now?
Q - There is always some disease out there waiting to kill us all, at least according to the media, how is this disease any different?
Q - But what can I do about it? If it happens it happens.
Q - Wouldn’t the WHO let us know a pandemic was approaching by by raising the Pandemic Level from a 3 to a 4?
I’m sure there are more, but this should get you started. Good luck.
Okieman - Thanks. That’s a real good list of questions. Gimme a few minutes… (scratching my head).
Rather than trying to remember answers to specific questions, which will be very difficult, it may be easier to prepare a list of points that you want to use, so that when a question comes up, you have a selection to choose from. That’s what people do for TV or radio interviews, decide what you are going to say, then steer every question onto one of your pre-determined responses. Also, try to include one authoritative statistic in every response.
Here are some that I can think of. It’s better to pick a few that you can remember and elaborate on, than too many and not be able to expand on them.
Q - It hasn’t gone pandemic yet after several years, what makes you think it will now?
Q - There is always some disease out there waiting to kill us all, at least according to the media, how is this disease any different?
Q - But what can I do about it? If it happens it happens.
Q - Wouldn’t the WHO let us know a pandemic was approaching by by raising the Pandemic Level from a 3 to a 4?
Okieman, Q1.
Anon_22 and all. Many thanks. I’ll try and do that too. Boy, your list is good too!
Still I am going to plod through each item above, and thank you too anonymous and crfullmoon. Unless I write them, it’s not going to stick in my memory…
When speaking informally to medical and science types, I always just say “I don’t want to talk about the bird flu. Let’s talk about the implications of pandmeic influenza..” and that has always changed the conversation in another direction as, in their minds, they really are two completely different things.
Pixie – at 09:08 Thanks. In French, it’s “grippe aviaire” - avian flu, or a “pandémie grippale” - flu pandemic. Influenza is word rarely spoken, it’s written. I am not sure they are viewed as two entirely different things, but I’ll see.
Okieman - Q - There is always some disease out there waiting to kill us all, at least according to the media, how is this disease any different?
Anonymous - Q - There is always some disease out there waiting to kill us all, at least according to the media, how is this disease any different? Influenza A is the only one which goes pandemic
Well, what about polio, TB, plague, small pox, measles, HIV?
We have medicine and vaccination for polio, TB, plague, small pox, measles. Somewhat useful medicines for HIV. Other illnesses like Ebola or Marburg kill so fast that the virus cannot go very far and does not hike on birds.
As yet we have no effective medicine or vaccination for avian influenza. The virus not only hikes on birds, but also in other mammals (list courtesy of FluWikians and Monotreme)
But what can I do about it? If it happens it happens
keep a deep pantry, so you can try and avoid infection, or at least cope better during supply chain disruptions of normal food, medicine, and emergency care (If it happens, you and yours will suffer through the consequences, however swift or slow they may be. Some governments have already said it will be too many people to provide for everyone; you’re on your own.)
Good line, Pixie; “I don’t want to talk about the bird flu. Let’s talk about the implications of pandemic influenza” or, A Pandemic Influenza Year…
Wouldn’t the WHO let us know a pandemic was approaching by raising the Pandemic Level from a 3 to a 4?
No, they said will act on a potential phase 4 situation before taking time to decide to raise the phase alert; decided the economic and political short-term impact should be avoided, but, many places still have their action levels tied to this system (that used to still say, Nov. 2005; they finally dropped the date part?!) By the original definitions, before they were re-written, we may have been at Phase 4 some time ago.
Jan 2006 …A WHO decision to change the phase of pandemic alert will be made separately from the decision to initiate a rapid response or rapid containment effort. “Since a change in phase is expected to trigger a number of potentially cascading actions by countries, possibly including travel restrictions and border closures, such a decision will be highly visible and is expected to have significant political, social and economic implications”…
Anon_22 - I like your list too, but I’m also seeing myself being dragged in that sort of conversation, and cutting this short is not going to be easy:
- The fatality stands at 60%, and the WHO has formally recognised that it may not drop in a pandemic
The WHO is very much in the dark (the magazine said as much last year). It’s just in poor farmers who sleep and kiss their chickens. These statistics on small numbers are not statistically significant. We don’t know the amount of mild/asymptomatic cases to make proper calculations. But fatality at 60% in a poor country which is not well equipped like the West does not necessarily equate to this figure in Switzerland. We have such good structures and medicines. (My own doctor said: well, why should we be concerned here since France has said there would only be 170,000 dead, that’s a little more than one patient per doctor).
1. The UN urged the WHO to go to level 4 months ago, and they refused.
2. H5N1 is closely related to H1N1 from the 1918 pandemic. They both cause cytokine storm which is extemely difficult to treat, and is quite lethal.
“Closely related” is not the best way to put it. Others can find a better explanation.
How about killing a similar demographic; young, healthy, productive ages?
FrenchieGirl’s doctor wants to risk his loved ones’ lives that some bureaucrat (who didn’t want to bear bad news to the boss)’s spreadsheet is a guarantee of future results??
The fine print says, “Can FluSurge and FluAid be used to accurately estimate the impact of H5N1?”
Estimates from FluSurge are really illustrations: for a given scenario; therefore, accuracy cannot be guaranteed. FluSurge should be used as a starting point for planning. Given the large number of unknowns for a possible pandemic, any plan has to be flexible
The WHO recently says, it could go pandemic with it’s current fatality rate; even a 2% fatality rate would kill people under 20 in one wave as many as what all other causes combined now take two decades to kill.
The point that the number of influenza cases can double every 2 to 3 days, and action needs to be pre-arranged now before all involved start being impacted … but …but….
(need to go have a cup of tea and a lie-down) Good luck, FG, bless you for trying…
Wear something stunning, look great and good luck. Just beware of a glazed look and someone offering to go get you a drink.
Ex. A time honored way to end a conversation.
I think One method of communication with physicians is too ask them questions. You can combine anon_22′s techinque with that… Such as…
Your question:
Q “Ah, it’s not a problem, the government has made a plan. We have thought about triage so that we don’t mix the flu patients with the others”.
Ah Ha! and what is YOUR role in this government plan? Have you and the other physicians decided the triage criteria for your patients to be admitted to the hospital or to be sent home….? Do you have an office plan to be able to separate your flu patients from your other patients?
uhhhh…. just thought of something. Were you wanting the conversation to be social? or were you using this function to create awareness within this group of physicians?
That would make a difference…
The Swiss are historically far more self-reliant and prepared for emergencies than any other European country. They founded a Federal Republic long before the United States emulated them, and have maintained their independence without foreign occupation even by the Nazis. I strongly suspect that if you frame the panflu threat as a serious threat to their way of life it will be taken seriously.
When speaking informally to medical and science types, I always just say “I don’t want to talk about the bird flu. Let’s talk about the implications of pandmeic influenza..” and that has always changed the conversation in another direction as, in their minds, they really are two completely different things.
The quote of the day, I think.
The ‘bird’ flu has met 2 of the 3 criteria for a pandemic influenza virus.(criteria=1.novel flu virus 2. causes disease in humans 3. effective transmission human to human)
It is continuouslly working on conquering criteria #3. The more cases in birds and/or humans, the more chances/opportunities it has to complete step #3.
When it has completed step #3, it will not mail us a warning card. The pandemic will begin. We are being warned now-by observing its’ actions, by the government and public health.
How much advance warning do you need?
Switzerland is the country with all the civil defense shelters and fake concrete old barns that are really artillery (I saw it on a PBS travel program). It might be a matter of pride that they not let themselves be steamrollered by a pandemic. They could lead the way in being prudent.
Also, with Western Europe being very conscious of their declining population, Europeans (and all of us, really) might want to pay attention to a virus that would kill mostly 20 to 40 year olds.
Is your aim to alert them to the probability of a pandemic or to the societal crises that follow? I hope that some of them read science fiction because being prepared goes beyond the medical issues. Imagining the consequences of a pandemic might be the hardest part.
The places that I lived had storage facilities in the basement for tenents, they could also be used for bunkers. Some people kept things like apples in their storage areas. I think the Swiss would be very receptive to prepping. They are prudent people.
Hello all and my thanks to you all. I was very busy last night and today and I still have a few hours of hard work (real work at work) to do, so I’ll come back here and continue my exercises tonight.
Meanwhile, just a little answer to FloridaGirl, I was wanting to create awareness of potential structural medical collapse within this group of physicians, even though the context will be social. So far as I know, through the media, I understand there are only five isolation rooms underneath the main hospital in Geneva - nowhere near enough if there’s a crisis with some exotic disease, never mind bird flu… And, of course, to try to make them aware what a pandemic flu really means in human terms, I’m not sure this is well understood by doctors at large. It’s one thing to see a person die with lung cancer, and another to see youngsters die in excrutiating pains, with no medicine to help, and another to know that as a primary care giver, they will be risking their lives and that of their families. Up till now, I tend to think that avian influenza is viewed with exceeding intellectualism, not pragmatism. I want to poke at that and try and bring my little thing to knock lofty unreal ideas into a deep look at the pragmatism of bird flu. (I’m not sure I express myself well on this, will try better this evening). These physicians are deciders in hospitals, and for those who aren’t, they are either coordinators of the deciders’ actions, or writers on medical ethics. They also have extensive links with the medical community at large in Switzerland. And friends’ networks. They are, most of them, independent thinkers who do not hesitate to criticize publicly what they deem wrong. They don’t risk their jobs speaking aloud. The magazine is “the” magazine with an official voice here.
More tonight.
good luck!
Yes, good luck. I firmly believe the Swiss will get it right. Of all the countries, I think they are best equiped, if nothing else ,by having every male serve in their military.
Will you have some kind of hand-outs ready in case some show interest immediately? (List of websites, for example, or names of books about 1918 pandemic.)
(For those playing along at home, the Pandemic Awareness cards are useful. )
Reporting back from the dinner, with a little delay, sorry.
I was able to chat of the subject with two people, but not much.
One was saying “people ought to be told the truth” and we got interrupted… Then, after a while, he was proceeding to tell me that Switzerland was well prepared, it had 25 million of treatments. And I punched in the stomach… Hmm how will you get the treatments from Bern to Geneva if the truck drivers are sick? Dawn came on him then. And then, “with a doubling rate every 2 days, how will you cope when you have a thousand people at the hospital door? What about your family, knowing that at the moment, it’s young people who die? And got interrupted again. But I think he started to put it together throughout dinner, he kept looking at me with questioning eyebrows (not attraction, you jokers!). So they know the medical side of BF, but had not really wondered about the medicine supplies side, nor about the effect of contagion on their loved ones.
As for the other, I quickly proposed to have a weekly column “BF news”, he was not averse to the idea, but says he’s the only one to stir things up. He was also of the opinion that transparency would not be helped with the new appointment at WHO. He asked me if I thought a pandemic would happen, and I said I was convinced of it. He knew all about the latest news, including those that don’t make the MSM, so I wonder if he’s a lurker here or the other boards.
I managed to attract the attention of a TV presenter of a medical show, on another subject. Hoping she’ll contact me on that other subject, and then I can “campaign ahead with BF”
I chatted a little here and there at cocktails, not much. I was, thanks to FW, one of the “knowledgeable” outsiders and I was able to slip a few sentences along Anon_22′s lines. I almost took my BF file with me, and I regret now not having done so. I am wondering whether to initiate more contacts with the said two people. I might. They are open to ideas.
So I set out an immense task for myself, and only managed 10%. Yet I was happy that this little bit was well accepted. There’s obviously some awareness, even if not enough.
Thank you! Every 10% is a good seed.
Seems like it is hard to connect the dots; so the people who know about H5N1 and want the public told the truth, don’t know where the other like-minded souls are nor how many they are if all together…
Influenza A is the only one which goes pandemic
Well, what about polio, TB, plague, small pox, measles, HIV?
** somehow different. Depends how exactly you define pandemic.
Flu-A infects 20% of world-population in 1–2 years
almost regularly several times per century.
how will you get the treatments from Bern to Geneva if the truck drivers are sick
**get another one. Not all will be sick at the same time.Give him protective cloths
Going steadily. Got… something…
the WHO estimates that 40% of people won’t come to work, but that is for all countries and all industries within a short time, what will happen to our supplies?
Where does WHO give that figure?
I can’t find WHO saying it; others certainly have.
where and based on what? our “pandemic wave in a spreadsheet” wikipage, together with the forum thread about “how long will people be ill” and the “case for closing schools early” may all add up to 40%, but people would like to see the figure near an authoritie’s name
Not what you’re looking for, but CIDRAP Nov 29, 2005 …”The Minnesota Chamber of Commerce hosted today’s event. It included a keynote speech by Michael Osterholm, PhD, MPH, director of the University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP), publisher of this Web site, as well as a forum featuring business representatives who are working on pandemic preparedness.
Osterholm warned that a pandemic will leave no part of the world untouched. “ Please understand that this is not an optional planning activity,” he said.”…
“ The private sector accounts for about 85% of critical infrastructure in the United States, said Wayne Brown, in store/business incident management for Wells Fargo and Co. bank.”…
…”An unexpected theme emerged from both groups: the need to put aside competition during a pandemic”…
CIDRAP again; “APHA projects big decline in public health workforce Sept 1, 2006 (CIDRAP News) – The nation’s largest public health organization sounded an alarm this week about the public health workforce, citing a current shortage and projecting that the profession could lose up to half of its workers over the next few years.”…The report says the number of public health workers decreased from 220 per 100,000 Americans in 1980 to 158 per 100,000 in 2000.
“Our emerging public health workforce crisis comes at a time when Americans are facing a host of risks to their health and safety, from bioterrorism to pandemic influenza and environmental disasters,” said Georges C. Benjamin, MD, executive director of the APHA. “At the same time, we risk losing ground on responding to ongoing health problems such as obesity, heart disease and cancer.”
Federal funding to recruit and train public health workers must increase dramatically, and states should evaluate their public health workforce needs and establish development and training programs, Benjamin said. “Medical devices and disease tracking instruments are ineffectual without adequately educated and trained workers,” he said.
The APHA says that in the next few years, state and federal public health agencies could lose up to half of their workers to retirement, the private sector, and other opportunities. A study from the Association of State and Territorial Health Officials and the Council of State Governments found that the average age of state public health workers is 47 years, 7 years older than the national average for all occupations. Current vacancy rates are as high as 20% in some agencies, and annual turnover rates have reached 14% in some parts of the country.
The most severe shortages were found in epidemiology, nursing, laboratory science, and environmental health, the APHA says.”…
lugon, see the CIDRAP business index page, this CIDRAP summary:
and here.
See also here
All references were found here on the Business Continuity page. I did not check all the references.