Dr Tom Inglesby, from the University Pittsburgh Center for Biosecurity, has kindly agreed to meet with myself for an interview for FluWiki. The following are excerpts from his biography, the full text of which can be accessed here
Dr. Inglesby is Chief Operating Officer and Deputy Director of the Center for Biosecurity of the University of Pittsburgh Medical Center (UPMC) and Associate Professor of Medicine and Public Health at the University of Pittsburgh Schools of Medicine and Public Health.
Dr. Inglesby is the author of a number of widely cited publications on anthrax, smallpox, plague, and biosecurity issues related to medicine and hospital preparedness, public health, science, pandemic planning, and national security. He is a principal editor of the JAMA book entitled Bioterrorism: Guidelines for Medical and Public Health Management. Dr. Inglesby is Coeditor-in-Chief of the peer-reviewed journal Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science
Dr. Inglesby was a principal designer, author, and controller of the highly recognized Atlantic Storm exercise of 2005 and of the Dark Winter smallpox exercise of 2001.
Dr. Inglesby has served in advisory and consultative capacities for government, scientific organizations, and academia on issues related to biosecurity–providing briefings for officials in the Administration and Congressional members and staff; serving on a task force of the Defense Science Board of the DoD and a committee of the National Research Council of the National Academies of Sciences; and participating in an advisory capacity to CDC, NIH, HHS, DHS, the Defense Advanced Research Projects Agency (DARPA), and the Defense Intelligence Agency (DIA).
Some of Dr Inglesby’s recent work include
Systemic Collapse: Medical Care in the Aftermath of Hurricane Katrina
Comments from the Center for Biosecurity of UPMC on Proposed Revisions to Federal Quarantine Rules
Hospital Preparedness for Pandemic Influenza
Other related resources from the Center:
Protecting the Homeland: Fighting Pandemic Flu From the Front Lines by Tara O’Toole, MD, MPH, Director, Center for Biosecurity of UPMC
Getting Medicine to Millions: New Strategies for Mass Distribution Lien O, Maldin B, Franco C, Gronvall GK.
Please post questions that you would like me to ask. Again, I will most likely consolidate them in order to cover as many topics of interest as possible.
For the doctor, and actually everyone you do interview:
Are you personally prepping for it? How long are you prepping for? How long do you personally think you have to prep?
After the infrastructure falls apart, what cascading health issues will occur, and how can we prepare for them now? (Or is this too basic a question - something that fluwikians have already addressed?)
Nothing is too basic. In fact, sometimes basic questions are the most important ones.
Einstein once said, when asked how come he achieved so much, (I’m paraphrasing) “I have always asked very simplistic questions, the kind of questions that children asked, and get told by grown-ups to shut up about. Well, I guess I just kept this child-like behavior, and that led me to some very important discoveries.”
should we treat the sick at home or should we prepare some districts in each town, where (only) the sick and suspected will be put in a pandemic ?
Thanks anon-22. (And I meant health issues other than H5N1 - although perhaps with all of its varietal forms, avain flu transformations should not be taken off the mindset either.)
anon_22:
Dr. Inglesby and Tara O’toole are good people and serious about bioterror and related issues. This should be very informative for the readers! Thanks!
If we SIP, what will we eat and drink and how will we get it? Are you aware of any government efforts to supply people at their doorstep?
What plans exist for a small hospital (City of 30K)to prepare for a probable BF pandemic?
Given the world’s limited capacity to produce a vaccine once a pandemic strain has been identified, how long to you think it will be before the Average American can obtain a shot?
Given the stability of the H5N1 virus in the environment, what steps will you take to make sure you can drink you tap water or if there is no tap water, what are your plans for drinking water?
Here are the links to Atlantic Storm and Dark Winter, which, if read in the context of the World Economic Forum (Davos) pandemic simulation document, will give everyone a tremenous amount of insight into the issues around mass casulty mitigation and triage, decision making at the highest levels, international co-operation (or lack thereof) in the face of catastrophe, and much more. I would strongly encourage everyone to read these and the above links, which will allow us to cover specific issues in depth as well as broad paradigm considerations.
“Dr. Inglesby and Tara O’toole are good people”
I agree. :-)
Do you feel that SIP-for a significant percentage of the population-is realistic in the America of 2006? If so, what sequelae of SIP’ing related to the current “J.I.T.” business systems do you anticipate?
Is it worth it to significantly reducing the workforce by encouraging people to SIP?
Please ask the doctor this —
Are there ANY circumstances under which you could imagine the healthcare system as we know it could collapse during a pandemic so that people have no reasonable expectation to get in to see a doctor? If so, would you think that it would be reasonable for individuals to maintain a certain level of prescription medication at home to have on hand just in case — for example, some antibiotics for children who frequently get ear infections or strep throat (because parents know the symptoms of ear infections or strep throat in their kid) or antiviral medication (for a circumstance when 3 people in the house are deathly sick with the flu and the only person available to take care of the others in the family is now coming down with a headache)?
This seems kind of reasonable to me, although people always say that it is dangerous to trust mere mortals with antibiotics or antivirals. However, is anyone thinking beyond what we want to happen right now (i.e., see a doctor, get a prescription only if you are sick, buy the medicine, take the medicine) to what we might hope could happen in the case of a pandemic — i.e., get sick, try to diagnose yourself, try to see or call any doctor if you can, if no healthcare is available then go ahead and take the medicine as previously discussed with your family doctor.
Why don’t doctors and the FDA take the lead in this thing? Why do they force us to tell fibs in order to get some medications to have on hand for an emergency? We don’t want to ask doctors to do anything that will get them in trouble, but no one seems to want to help regular people prepare to take care of themselves and their family. Why is this?
You can ask if there is any protection for HCW’s that make triage decisions during a pandemic. ie What is they are sued for taking someone with little chance of recovery, off a respirator, so they can use it on someone they believe could survive with it.
Can you ask “Once a biological or other hazard is released and widely dispersed in the environment, what steps can an individual or family take in order to clean up and maintain a safe shelter/living area?
What supplies would he recommend a family unit or small business keep on hand to deal with it? Bleach? Alcohol? Peroxide? Detergent? Duct tape and plastic sheeting?
Recommendations for family PPE?
And what does he think that the chances are for a “biological or other hazard” to be released and widely dispersed in our environment after the infrastructure falls apart? What types of “hazards” does he forsee? and by whom - or is that irrelevent?
Oremus – at 12:49 I think in the US there are provisions on paper to have hcws under the govt umbrella safe from being sued for working during a disaster; changing “standards of care” and “legal protections” in plans somewhere, already.
(What will actually happen on site, or,when people can’t find any help for loved ones, well, that’s another situation.)
My question would be…we are well aware that healthcare systems will collapse in a pandemic. We will be on our own to treat our children if they become infected…
…Given the just in time delivery systems and lack of raw materials for pharmaceuticals in proximity of manufacturing plants…where are we going to get supplies of antibiotics, oral electrolyte powders, anti-fever medications and prednisolone after the pandemic has begun and how am I going to get advice from healthcare professionals such as nurses, doctors, pharmacists…
It appears apparent that the requirment for pharmaceuticals will be many multiples of supplies avaliable on Sept 6, 2006.
What have you concluded about these issues?
The reason for this question…is that I think we could possibly live with intermittant supplies of electricity water etc. but the real ‘civilization buster’ is intermittant or nonexistant supplies of pharmaceuticals that will save lives from secondary infections and improve the quality of life for all.
Vaccines and antivirals at this point are untested and cannot make the same claim… they are pretty much unknowns, variables to be considered like any other variable in a pandemic. .
anonymous at 10:56
Many threads and many discussions have been concerned with your question. The one thing most folks who post here seem to agree on is that the health care system, which is on the cusp of disaster at any given day in normal times, will immediately break down in a Pandemic situation. There are not enough hospitals or Emergency room beds available at the best of times. Add a couple of hundred extra patients a day to your hospital of choice and it is a recipe for disaster! And that does not even take into consideration that you might not want to be in a hospital during a time of Pandemic. Do what you have to do for yourself and family. Hopefully you will have a sympathetic doctor, I did not, even though he agrees with the above. Read Dr. Woodsons book regarding medications needed and get whatever you can however you can. Most are available on the Web, but be careful. Good Luck..
stilearning at 14:07 - you asked before I could type it out. That’s my concern. Would our enemies take advantage of a Pandemic?
What other viruses are on the horizon that could pose a danger?
NauticalMan – at 15:51
I realize it is an issue well-discussed on the Wiki. I would like to hear what an influential doctor who (as an advisor to governments and whatever all was in that resume above) is in a position to affect policy has to say about the issue. I’d like to hear someone in his position actually say—
“Yes, the healthcare system will collapse if the pandemic kicks off. You won’t be able to see a doctor or get any medicines that you might need for your family. But rules is rules. It would be very irresponsible for any doctor to prescribe medication in advance for something that you don’t currently have. The best policy will be for you to just sit tight and hope for the best. If a kid in your family should need an antibiotic for an ear infection during a pandemic, I imagine someone somewhere will have a plan for getting you the antibiotic. I would imagine that you could drag the tyke down to the emergency triage center where all the hacking flu patients will be congregating. The lines will be long, but eventually you will be seen. It might take 58 hours or longer (since obviously the breathing problems will come first). Then of course if there are antibiotics remaining at the pharmacies, you’ll be good to go. K?”
I’d like the doctor to actually hear how bizarre this sounds when he says it out loud. Then maybe—just maybe—he would help think of a better plan.
anonymous
I think you will wait a long time for any doctor, at least one in any position of authority, to come out and admit this, because the answer will of course be that we need to do a lot more than we have, and that means more money, for hospitals, front line health care workers and so on. Given the present state of expenditures, on tax cuts, Iraq and on and on, there is no one in this Administration or Congress who would be willing or more likely, able, to do this. Maybe, just maybe, that will start to change in the upcoming election or in the Presidential election in two years, but given that we have the best Congress that money (read:special interests) can buy, it is doubtful that even a change from Republican to Democrat will make a lot of difference unfortunately. As was said on another thread here today, “Hope is not a plan” There have been people who have come out and tried to tell the truth, Osterholm? at Health and Human Services on the CFR, he had to retract that later, Army Chief of Staff General Shineski? on what it would take to occupy Iraq after the battle was won, he was retired. This is not a government where facts and truth are particularly admired at the highest levels. Mods, forgive my somewhat political rant, but the whole situation is very aggravating to this old timer.
Is he a member of the American Medical Association or other professional group? Is there any chance of physicians’ groups making public statements which could describe the possible dire straits we’d be in if TSHTF? Or their journals publishing advice for doctors to give every patient who visits them? Even suggesting that patients wash hands frequently and visit the government pandemic sites, just to put the subject out there.
(Is there anything that can be done to remove the blinders so many people have on? I feel a rant coming on.)
NauticalMan – at 17:19
But I don’t think there IS enough money…or enough HCWs…to handle this thing. Sure they can do more, but there is no conceivable way to fix this problem with money. No matter how big they build the hospitals, they will never be big enough for this. No matter how many ventilators they buy, they can’t afford enough. The system is just going to CRASH if this thing happens. Why can’t they just face up to that and try to think creatively about how to do the best we can? Why can’t they just come out and tell us that we will need to be able to fend for (and doctor) ourselves and then allow us to prepare to do just that — instead of insisting that we can’t be trusted to hold onto the medication until we really really need to take it. At the very least, why don’t they make plans to set up a emergency hotline system where we can talk to LPNs or PAs over the phone, give symptoms, and have them call the prescription into a mail-order pharmacy warehouse for us. Maybe plans are being made along these lines, but I haven’t heard about it. And right now is the time for them to tell us what their plans are so we have a little confidence that there will in fact be a way to get some medicine. The time to communicate their plan to the general public is before not AFTER TSHTF. If there is no plan, then for God’s sake why don’t they try to help those of us who want to prepare for our families?
crfullmoon – at 14:23 I, too, have heard this is in the works. But, I have not seen it.
anonymous – at 18:56 First let me say that there are many people thinking and doing…. At least where I live. It is not talked about too much, but groups of doctors are looking at studies and criteria and trying to make plans.
My County is working on steps to create ATS, Phone banks manned by trained personnel, and nurses and docs, faster safer triage methods, establishing and testing resources regionally, hospital preparedness, and more.
You are not hearing things because it is so hugh, that plans are just beginning in most places. The scope of what needs to be acomplished can be overwhelming. especially for a County that only has one hospital, and lots of wide open space. Our resources are very limited, but heart and soul is being put into the efforts.
That said… I feel the same frustration you do. It is difficult to have been watching this unfold for a year to 2 years, making plans, and still not feel even close to being ready.
The worst part is knowing… that no matter how much you are prepared… it will never be enough. We will still be struggeling with fear, shortages, (of everything), pain and suffering, loss of friends and family…. And we, the HCW’s, will be the focus of so many to be the “ones” to solve their deliema or “save” their love ones… and we will be suffering, too.
But, do not for a minute think that there ARE Not people working on it. There are… just maybe, too few, with too few resources, and maybe too little time.
(This is not written to sound harsh… but my frustration is showing.)
Do you feel that the current level of risk communication of the effects of a pandemic has been effective in this country?
What would you like to hear people being told about this possible pandemic?
Do you have suggestions for developing pandemic awareness in a way that will encourage more people to begin preparing for a SIP situation of a longer time span?
ATTENTION
I just realized I missed posting this link, which is the most important one. Apologies!
another biosecurity link?????? ewe…… your US smallpox simulation exercise from 2001 (prior to 9/11) kept me awake all night …….ok…….better informed than not. Thanks, annon_22
ask about the schools pandemic plans - I reword it…
The schools plans are to alert the health dept when they see 10% of students out from illness. This will ensure the spread of the virus throught every town in America… and a sure death sentence to many of the young.
Ask him what he would recomend as a School pandemic plan that would work given the political and economic fallout of closing schools either too early or as a false alarm.
(FloridaGirl at 19:22 I found something for MA, http://www.mass.gov/dph/bioterrorism/advisorygrps/index.htm Seee the Summary for “Liability Protections for Massachusetts Employees and Volunteers” )
Looking forward to the interview from Dr. Tom Inglesby. (I like all Science Teacher’s questions at 19:38 !)
Is H5N1 the end result of a botched experiment?
or planned biowarfare……..and just made to look like the end result of a botched experiment?
or biowar plans ….with the plans escaping a bit prematurely?
and back to more related questions from our treasuredgal’s first question: What is his best guestimate of when the pandemic begins? Will the approximately 18 months duration of the 1918 pandemic be repeated given our speed traveled globe? What percent of the world’s population will be culled by H5N1 - does he believe that the mutations will have increased or decreased CFR?
Ask him to speak about anything he has been thinking about which you have not put in your questions to him. This is one smart guy.
oh - another pet peeve - How long will it take after the start of the pandemic to get the water and electric back up and functioning?
Just how seriously is the govt working on maintaining the infrastructure?
P.S. (I promise to shut up for a while (maybe) to listen to your questions now.)
The many links that anon_22 has provided to illustrate this good doc’s teams’ work are ALL very worth taking the time to read. The information which anon_22 has provided through these links are issues I never would have thought to study. The work presented is another sort of prep - imperative information.
The US healthcare system is fragmented and currently stressed. We have both for-profit and not-for-profit facilities. In the face of a panflu:
1. Who pays/finances for the care for the expected massive surge of patients? Is there a plan in place to federalize this care (creation of a single party payor)? Can the US afford to absorb the costs of this care?
2. Where do the needed extra HCWs come from, to replace those sick and dead, as well as to care for the expected surge in numbers?
3. Will organizations like the Red Cross, Salvation Army, etc. be coordinated to avoid duplication of efforts and instead complement each other? Are they part of the plan?
4. Are there concrete, measurable plans to keep the communication lines open, essential supply chains running, essential services running?
I totally echoe what Tom DVM – at 15:05 said:
“…Given the just in time delivery systems and lack of raw materials for pharmaceuticals in proximity of manufacturing plants…where are we going to get supplies of antibiotics, oral electrolyte powders, anti-fever medications and prednisolone after the pandemic has begun and how am I going to get advice from healthcare professionals such as nurses, doctors, pharmacists…”
Having stooped to purchasing fish antibiotics (Amoxicillin) for my very large family, I don’t mind telling you I am more than agitated that I can’t acquire such a basic, modern day necessary treatment any other way. Equally concerning is the availability (or lack of) of suppositories for diarrhea and vomitting. I am seething that I am told I will be “on my own” when a pandemic hits… yet I can’t secure very basic things to even hopefully combat this thing. Stuffing cans of tuna under my bed is NOT an acceptable “directive.” What I need, really NEED, is what is offered (& paid for largely by US tax money) to 3rd world countries: ORS packets, solar disinfecting and sanitization apparatus, trained health care providers on some basic level (especially for the most vulnerable of our population), teaching and training information relating to such a catastrophe as a pandemic, etc. Additionally, I am concerned about social upheaval and civil unrest.
Realistically, what can an average citizen do at home, in the event of no medical services, to clinically manage the primary and secondary morbidity factors associated with this strain of influenza? If clinical management should be focused on preventing the intense cytokine response, how is a typical citizen suppose to do this with OTC products?
If I pull my kids out of school because of obvious health risks, what are the ramifications going to be concerning truancy fines and violations? I for one do not intend on waiting until 10% of a school or district is bellied-up with this stuff to shelter my children… it would be too late. With an incubation period of even 10 days, the seriousness of potential risks are beyond comprehension with this influenza strain. What is the government planning to do about this, in terms of protecting citizens from unwise protocol?
EnoughAlready – at 03:45, it might be worth contacting homeschooling organizations in your state to find out how to line any paperwork up now, ahead of time. In too many places, officials aren’t up to preparing local families (who deserve a head’s-up) before pandemic breaks out.
Ask the government your questions regarding their pandemic plans, too, with follow-up questions if/when what they say is illogical…
crfullmoon – at 12:19
I’ve thought about that. But, I am also thinking about my grandchildren. Contacting school district and county health department is on my list! Thanks.
Question: What recommendations would be given to a type one, insulin dependent diabetic for prepping for emergency situations during a pandemic?
For the Dr.: Do you think, given what you now know and the current situation, that we can escape a pandemic with this particular virus?
Three questions:
Ah, well.