This evening, I attended a lecture called “The Threat of Pandemic Influenza: How Can We Stop the Spread?” at Benaroya Hall in Seattle Washington. This was part of a University of Washington Global Heath Lecture series. This lecture was filmed for later broadcast (probably on the UW TV network here locally). There were many slides shown at a quick pace to go along with the discussions.
The speakers were:
Ira Longini
Professor; Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center; Professor, School of Public Health and Community Medicine, University of Washington.
Ann Kimball
Professor; Director, Asia Pacific Emerging Infectious Network, Epidemiology, Health Services; Adjunct Professor, Medicine, Biomedical Informatics.
Ira Longini started the lecture by discussing how the H5N1 virus entered a cell, and how Tamiflu worked to prevent its exit. Next he went over the last 3 pandemics:
1918, H1N1, 2% CFR, 50 million died
1957, H2N2, 0.02% CFR, 1 million died
1968, H3N2, 0.015% CFR, 1 million died
Then he showed maps of the global distribution of poultry infected with H5N1, and human cases of H5N1.
He stated that H5N1 does not spread well H2H, but in May, 2006, in North Sumatra, we saw what appeared to be a 3-generation infection. First one person was infected, who then transmitted it to 6 people, and then that infection was transmitted to one other person (8 people total in this cluster). He showed the timeline of the transmissions.
Now he said we are at Phase 3. He stated we could see 2 billion cases of H5N1 during 6–9 months of the first wave of a pandemic.
He showed time-lapse photos of the US illustrating how a pandemic would act now if it had the characteristics of the 1918 flu. The peak of infection was at 88 days as shown on a graph of cases versus time in days. This assumed no interventions.
Next there was a discussion as to how to contain a pandemic wherever it occurred in the world. He said there were 3 ways to stop it:
1. WHO has a mobile stockpile of 5 million courses of Tamiflu.
2. Quarantines
3. Poorly-matched rapid vaccination (he stated this might give a 30% protection efficiency)
He discussed R0, and the fact that for influenza, it is usually between 1 and 2.4. The 1918 virus was about 2.0. The 1968 virus was about 1.7.
Next he discussed a modeling project done with Thailand where they evaluated containing a pandemic in rural Thailand of 500,000 people. He stated that if the R0 was < 1.6, it could be contained with Target Antiviral Prophylaxis (TAP) using Tamiflu if the Tamiflu was used within 3 weeks of the start of the outbreak.
Next he showed maps of the US census tracts (65,000 +). He showed time lapse again for infections using an R0 of 1.9 with 100 mile travel restrictions (considered long range). He stated that this does nothing except to slow down the infections, but they occur just the same. Next he showed that if we had the 100 mile travel restriction PLUS a distribution of 250 million vaccinations (10 million doses/week for 25 weeks), we could decrease the cases significantly (I assume here he again means a poorly-matched vaccination). Thirdly, he stated that if we could do 60% TAP (finding and treating 60% of the cases as they occurred is what I think he meant), and we had a 20 million course stockpile, we would significantly decrease the occurrence of infections, but at day 100, we would run out of Tamiflu…and then there would be a resurgence of infections. For this strategy to work, we would need a stockpile of 186 million courses of Tamiflu (we now have 6.2 million).
He stated that if a pandemic occurs in the near future, we have no vaccine to use and not enough Tamiflu, and therefore WE WILL BE PRACTICING SOCIAL DISTANCING. He showed a poster from 1918 about some kind of closure of schools or churches etc. He discussed St Louis in the fact that they made a real decrease in the cases they had by using social distancing until they lifted those practices.
Next came a slide of what would be realistic to do to decrease the cases in a pandemic. (These slides were coming so fast, it was really hard to write it all down, and I couldn’t get all of this slide, and some of the other slides I got most of the info)
1. Try to diagnose 60% of symptomatic cases
2. Treat symptomatic cases
3. Home isolation of infected cases (voluntary)
4. Social distancing (workplace, schools etc)
5. Decrease long distance travel
Then he stated that this is what we need:
1. 250 million dose vaccine stockpile
2. Huge stockpile Tamiflu
3. School closures
4. Travel restrictions
5. Social distancing
He said that for Tamiflu stockpiles:
WHO has 5 million courses
US has 6.2 million courses, but should have 26 million by the end of 2006.
Then he said that we would REALLY like to have more courses of Tamiflu, but it is probably best not to invade Switzerland to get it! (laughter in the crowd)
Then Ann Kimball spoke.
She discussed the reasons why we are seeing more emerging diseases. She listed climate changes, increased populations, increased travel, human encroachment on animal habitats, increases contact between humans and animals. The world population is really growing and sanitation is also a large issue in many areas. Humans, swine and poultry are living in close contact. The population density of Asia is 5 times greater that that of North America. She equated the outbreaks of H5N1 in Asia with areas of high density of poultry. She stated that no one knows what the threshold of cases or deaths from H5N1 has to be for a pandemic to occur.
Then the moderator spoke and stated that what is so important with the worry of influenza infection is to 1. get the seasonal flu vaccine, 2. wash your hands, and 3. coughing etiquette.
Only a certain number of questions were taken because this was for rebroadcast. Ira Longini answered most of the questions with some additions by Ann Kimball. For the questions and answers (as with the rest of the lecture that I have discussed), I have tried to closely follow what was said, but I am sure there are some differences.
Q What would the CFR be for H5N1 if it goes pandemic?
He stated that the CFR is over 50% now, but he indicated that it would go way down if it became a pandemic. He indicated that it won’t be as high — the virulence will go way down.
Q Is Tamiflu going to be effective? There is a question of resistance.
He indicated that currently H5N1 is very sensitive to Tamiflu, and that there is no evidence that resistant strains are transmissible.
Q What is an adequate global budget?
(I really don’t know what they decided – it is never enough I guess)
Q How expensive is Tamiflu and what is the shelf-life?
It is about $60-$70 per course, and the shelf-life is about 5 years.
Q What social isolation plans are being planned?
He indicated that no mandatory isolation is envisioned, nothing Draconian.
The audience was informed that more information re pandemic influenza could be found on the DOH website: http://tinyurl.com/p2v23
What I took away from this lecture was that if H5N1 were to become a pandemic anytime in the near future, the mainstay of our ability to cope with it would be social distancing. There was no definite guideline stated as to exactly what would be done. That would be up to the federal, state, and local governments anyway, I am sure. I felt that the flavor of how the questions were answered was that the lecturers did not want to really alarm people (the CFR would be much lower, and no Draconian measures for quarantine, etc). This is just my take, because there is no way to know those facts now.
JV ~ Thank You! You took great notes and this is extremely readable for the lay person. May I make a copy of it for my hand-outs?
Thank you. I’m passing this along to the local school system.
“How Can We Stop the Spread?” They can’t.
School system seen this yet? The December 22, 2005, Gartner Fellow interview with UN’s Dr.Nabarro
…”Nabarro: Modeling the total number of deaths is a waste of time. What the absolutely key thing to have is models and simulations of the progression of the virus, as well as the way in which the virus and society will interact. We actually need those sorts of simulations very, very badly at the moment.
McGee:If it is H5N1, then will the human genome transmission take place more or less rapidly than with other influenza viruses? How do you view that spreading at this point in time?
Nabarro: The biology colleagues that I speak with tell me that if the pathogenic characteristics of H5N1 were to be taken forward as it mutates into having a human-to-human transmission capacity, then we would have a virus with high pathogenicity.
So, we really have to hope that if it’s a mutant of H5N1 that causes the next pandemic, it sheds some of the pathogenicity that this current virus has during its mutation.
McGee: I see. Assuming it is a rather deadly strain, how long would it take to reach a - I don’t even know how you’d define - a worldwide…? …
Nabarro:…”The modelers are telling us that it may be as few as 21 days from the initial appearance of a virus to it being a full-blown pandemic. That particular part of modeling is, again, hedged with uncertainties. But having that lower-end 21-day value is quite useful, because it concentrates the mind a bit.” …
McGee: “In closing, if you were on stage in the U.N. General Assembly and the world’s cameras were on you, and you had only three minutes to address the world, what would you say?
Nabarro: Well, the messages are very clear. We have an awful lot more to do with the current bird flu epidemic. It is really not under control at all, and that means we have to build up vet service quickly to get on top of it. The longer it’s there, the longer we have a virus close to humans that is capable of mutating and causing a pandemic. And the situation is very, very serious indeed.
Number two, we’ve got to be ready to contain the pandemic when it starts. And that’s done through rehearsals and other drills, clear command and control. It requires a level of planning and preparation that’s much, much greater than the majority of countries are showing so far.
Number three, the pandemic will kill when it comes. But more seriously perhaps, it will do massive economic and social damage, because our systems of trade, finance and governance are interconnected and will not survive the impact of a pandemic on workforces. We need to be able to deal with both the human consequences and the economic, social and governance consequences if we’re going to survive it.
And believe me, the pandemic could start tomorrow.
By the time the pandemic starts, preparation will be too late.
So, you should be doing this now, and that’s my message.”…
Seacoast -
Sure, you can make handouts, etc. However, I viewed this lecture as a watered-down view of what may happen. As you can see from the interview with Nabarro posted above by crfullmoon (and other discussions, interviews reported here), this UW lecture was to give the public 1. a taste of what goes on with modeling, 2. the fact we can’t really stop H5N1 if it goes pandemic, but we can modify it and 3. the fact we will be practicing social distancing.
I felt Ira Longini was careful to treat his audience in as soothing a manner as possible. He painted as mild a picture of H5N1 as possible, I believe, to a target audience. There was no alarmist attitude here.
If I was to hand out information to a group (to really let them know what was happening and get their attention), I would prefer to hand out quotes from Nabarro (as above), Osterholm, and Leavitt.
crfullmoon -
I agree. There is no way to stop this. I was disappointed with the information dispensed. I have just reported what was stated at the lecture. It is at least interesting to see how different groups continue to try to keep the public as calm as possible while still giving them some information.
I saw one of the previous lectures from this University of Washington series the other day. Thankfully they are available online. The University of Albany has some excellent material on public health also. I added them to the multimedia page along with some online courses. There is a lot of great material there. It is a good resource for teaching people.
http://www.fluwikie.com/pmwiki.php?n=Main.Multimedia
If you know of any other good courses or conferences please post them.
JV - Excellent reporting!
We need a counter to the CFR coming down Crap.
Goju, thanks. I had to write at lightening speed because they were switching the slides so fast. I knew I would never have anoither chance to write down the info from the slides. At least I wanted to get their info down correctly, whatever it might be.
I cant site a source but I have read that yes, this is true, about the CFR rate coming down but in the past it has only been a few percentage points. Its a far cry from 50% to 2% and even then 2% is wicked bad. Plus you have to remember the current number is taking into account full medical treatment including tamiflu and ventilators. What will the real number be when you cant get to a hospital and there is no more tamiflu?
The Davos meetings had bloggers making podcast, also the pan meeting was covered. It was very nice done,Probably i ipod with mic was placed near a speaker or somthing. If someone is atending a conference, please try and record it as mp3 files, and we can share it on the large file server. video would be the next big thing :)
JV, thanks for posting this.
I wish someone had asked Dr. Longini why he thinks the CFR *must* drop so low if H5N1 becomes a pandemic strain. Since he is a statistician and not a biologist, he must have gotten this information from someone else. It would be interesting to find out from whom.
My suspicion is that he gets this idea from the CDC, where they have all taken the blue pill.
Monotreme. What is the blue pill?
Monotreme -
Yes, I wanted to ask that exact question. I had written a few down as the talk went along to ask. They only took a few questions and then cut them off because of filming. I even tried to get up to Dr Longini and ask some questions afterwards, but he was surrounded by a group of people who seemed to have some connection to him, and their friends. It would have been a long wait.
I had the distinct impression, though, that Dr Longini was making sure he was not going to upset or alarm anyone. The 1918 flu was bad enough (and how bad it really became was never discussed), but he talked like he was not going to give any impression that this pandemic was going to be any worse. When discussing the CFR and social distancing possibilities, his body language, expressions, and words all appeared like a father making sure his young child was not worried about something. I honestly doubt pushing him would have given us the answers we are looking for. I truly believe that there was a decision made before the lecture to not discuss severe consequences. That is just my take on it.
I rather believe that this lecture was done to 1. show how modeling can predict the outcome of problems like a pandemic, 2. to inform the pubic a bit about what has happened with the H5N1 flu, and that a pandemic is possible 3. social distancing will be our main tool. I do not feel that the point of the lecture was to get down to the extremely disturbing facts as to how severe it could be, and I think they planned to completely stay away from that discussion…at least that is what occurred.
Tom DVM – at 20:27
What is the blue pill?
This is pop-cultural/philosopy reference. It’s from a movie called “The Matrix”, but the basic idea is broader. Would you rather live in a pleasant, but fake, world or would you prefer to know the truth, even if it’s very unpleasant? In the movie, people who prefer the first choice take the blue pill, people who take the red pill prefer the truth, no matter how unpleasant.
Most of us took the red pill.
/:0)
JV – at 21:40
You’re probably right that the message was intended to be soothing. I’d still like to know who is crafting the message and why. Dr. Longini has long-standing collaborations with the CDC, which is why I suspect they are writing his script with respect to the CFR.
Drs. Osterholm and Webster are defying the CDC by telling us the truth. It’s good to know that we have a few allies.
Monotreme. I am sure you wouldn’t want to exclude Dr. David Nabarro…the only person that I know of with the ethics to restore my badly damaged faith in the World Health Organization.
Thanks JV for all of your efforts…you are a credit to all of us.
Tom DVM – at 21:56
I am sure you wouldn’t want to exclude Dr. David Nabarro…the only person that I know of with the ethics to restore my badly damaged faith in the World Health Organization.
You’re absolutely right. I’m a big fan of Dr. Nabarro. Dr. Julie Hall of the WHO is also good.
As avian viruses take on human characteristics, they do seem to become less lethal. After all, it doesn’t make biological sense to kill all your hosts. However, it is the transition period from avian to human that is the problem.
Unfortunately, the H5N1 seems to be starting at an extremely high pathogenic level in its avian form, so the transition period is likely to be very rough until the damn thing mutates within its human hosts. Although we do not have any avian sequences or epidemeological avian history related to the 1918 virus infections, it was likely much less pathogenic to animals when it finally went effecient H2H.
Bottom line, all indications point to an ugly pandemic if High Path H5N1 takes hold.
Monotreme. They should just make him Director General and get over themselves!!
Mamabird. I believe there is no record of bird die-offs of any kind, previous to the 1918 pandemic…
…for what it’s worth which is nothing…I now believe that two avian influenza subtypes must have reassorted to produce the pandemic virus.
Tom DVM
Irrelevant to this thread: Thank you for your support in another thread that is now closed. Agreed, faith has no place in our discussions/preparations. “Mother Nature” is our mistress.
Montotreme ~ I did decide on the red pill watching ‘The Matrix’ and I equate it with being a real grown-up or thinking like a child…but there are days….
Monotreme -
I agree that someone else like the CDC may have indicated to him how to discuss severe complications.
Tom DVM -
Thanks. I really haven’t done much at all compared to what everyone else on Fluwiki is doing. I am just trying to do my part. I am going to the forum on pandemic flu here on Nov 4th put on by the Public Health Dept. I should be able to ask a lot of questions. I don’t know what answers I will get, but I also want to see what the attitude is of those in power. Do they really want to share the truth and understand what the puclic can handle or not? I think this will be pretty interesting.
Mamabird – at 22:00
As avian viruses take on human characteristics, they do seem to become less lethal. After all, it doesn’t make biological sense to kill all your hosts. However, it is the transition period from avian to human that is the problem.
Actually, the fate of the human host is irrelevant to the survival of a flu virus. Because flu viruses spread before an infected person is sick, there is no selective pressure for the virus to decrease its virulence in it’s first pass through the human population. This is very different from Ebola which is only shed when someone is in the final stages of the disease.
After a large number of humans have become infected, flu viruses come under selective pressure to evade the human immune system. During this process, the polymerase genes become suboptimal which decreases the virulence of the virus. So, H5N1 can be expected to drop it’s CFR, but only after it has infected a significant portion of the world’s population.
You know, the way they are presenting may be calculated, but from my own experience trying to get this information across to people, if you hit them with everything, all the dire information, their eyes glaze over and they stop listening or at least processing. I have been processing this for over two years and it has taken me time to adjust and then go back for more. I taped Oprah and have shown it to many people and have been surprised by some who just didn’t allow the information time to swirl around in their brains before they just forgot what they watched. If they were not the sharpest knives in the drawer, I could understand, but they are mostly bright people. This has definetly changed my approach, I don’t “go for he close”, I reopen the topic every chance I get and they are much more responsive and receptive.
JV Montreme Tom DVM and many others………..I wishI had more to contribute to this forum but outside of econ issues I don’t but I did what to thnk all of you for what you are doing to help us all save as many lives as possible and in my case it’s working thanks to your contributions……..God Bless
JV Monotreme Seacoast et al.
Is there some way we could pressure the American Medical Association and by extension the Canadian Medical Association etc. to encourage or even better direct doctors to provide prescriptions at the request of patients willing to spend the funds to stockpile broad-spectrum antibiotics and oral electrolyte powders etc.
sorry that last post was me
econ101,
Everyone contributes what they can. I’m glad you’re able to use the information you get here to help others.
Tom DVM – at 23:07
Is there some way we could pressure the American Medical Association and by extension the Canadian Medical Association etc. to encourage or even better direct doctors to provide prescriptions at the request of patients willing to spend the funds to stockpile broad-spectrum antibiotics and oral electrolyte powders etc.
I doubt the AMA have looked into this issue very carefully. They will do whatever the CDC tells them to do. That’s the problem. Unless the CDC changes their message, then most organizations will continue to plan for mild pandemic.
econ101. Thanks…but you know what…there may be something that might allow you to intuitively come up with something ground-breaking that the rest of us have totally missed…
…so please jump in anytime.
Monotreme – at 22:11
After a large number of humans have become infected, flu viruses come under selective pressure to evade the human immune system. During this process, the polymerase genes become suboptimal which decreases the virulence of the virus. So, H5N1 can be expected to drop it’s CFR, but only after it has infected a significant portion of the world’s population.
In this paragraph, if you substitute ‘Chicken’ (or ducks)for ‘humans’ this would explain why birds are now showing up with asymptomatic H5N1 infection when the CFR was near 100% for the past few years.
Is that correct?
Tom DVM -
I understand completely why antibiotics should be prescribed to have on hand before a pandemic. But there are quite a few problems having the AMA accept this:
1. Antibiotics have been used in the past by patients, and some doctors, incorrectly, and too often. Drug resistance has become a problem. Today, doctors try very hard to use them judiciously.
2. The very thought of giving every single person in the US a prescription for an antibiotic to take in case of pneumonia would make them crazy, I think. All that antibiotic out there being used properly?
3. Is there even enough antibiotic available to distribute to everyone—right now? I doubt it.
I think this is a very tough situation for the AMA to endorse. They want to control proper use of medicine, and I can understand why. I think for them to even cope with the thought of drive-through medical care on a mass basis during a pandemic to distribute medicine is a nightmare. Unfortunately, I just don’t see pre-pandemic antibiotic prescriptions being endorsed by the AMA.
I think the best way for each person to try to get antibiotics or other prescriptons before a pandemic is to take info from Webster or the other virologists into their doctor and show them that these famous virologists suggest this. Maybe they will get prescriptions, and maybe they won’t. It is a terrible, terrible situation.
FloridaGirl – at 23:35
if you substitute ‘Chicken’ (or ducks)for ‘humans’ this would explain why birds are now showing up with asymptomatic H5N1 infection when the CFR was near 100% for the past few years.
Possibly. Although some ducks were always asymptomatic and I’m not sure how many chickens are asymptomatic. An animal would have to be long-lived enough to be infected at least twice to force the virus to evade the immune system. Not sure that would apply to chickens.
JV: Nearly a year ago on a HCW thread people were arguing this same point. At that time I believed what you posted above and now I’m not so sure. I vote for packets for every citizen with antibiotics, antipyretics, and oral replacement powders to be available. Have packets put together for children based on weight. If allergic to antibiotics, provide substitutes with written guidelines for consumption. MRSA is bad, but failing to provide basic meds in an emergency would be worse. It’s doable and we’re not talking a hundred pills. We’re talking a normal dose for a respiratory condition. There are times when people must come first, not policies or guidelines.
“There are times when people must come first, not policies or guidelines.”
Leo7. Thank you. The above is clear, concise and complete…and a beautifully succinct piece of writing.
Goju; that Gartner Fellows interview has your cfr-crap-antidote. “Nabarro: The biology colleagues that I speak with tell me that if the pathogenic characteristics of H5N1 were to be taken forward as it mutates into having a human-to-human transmission capacity, then we would have a virus with high pathogenicity.”
(That, and common sense; that if the virus is contagious before people feel sick, there is no reason it can’t kill its hosts.)
We about couldn’t make a better virus transport system than the current business/vacation/illegal air- and other travel situation we now have, that we didn’t have in 1918.
Annoyed Max- Not mad yet, “even then 2% is wicked bad. Plus you have to remember the current number is taking into account full medical treatment including tamiflu and ventilators. What will the real number be when you cant get to a hospital and there is no more tamiflu?” Exactly.
JV, can you imagine if all the parked vehicles had had that “Pan Flu Flyer To Go” on their windshields after the lecture? (sigh)
JV — what if there were some intermediary step between having indiviuals having their own stash of antibiotics, and having the antibiotics not exist at all?
What if they were at least stockpiled at pharmacies, in firehouses, in town halls, whatever? Based on population density?
There has to be political will/money to get, and guard, and distribute those stocks. (“If you can get it, won’t you tell me how?”…)
Also, there may not exist enough for everyone, right?
Doesn’t mean these aren’t good ideas, (and, municipalities could have started doing this last Oct, or Dec, or April…).
Between the bureaucrats who have to hope it won’t happen or those who hope there’s nothing they could do anyway, so the status quo can go on as long as possible…
Hi everyone. Interesting discussion.
In my opinion, if the power is out, and there is no food in the grocery stores and children are sick…there isn’t an army in the world that will be able to protect those stockpiles…which means they will be destroyed in the chaos.
If the Government passes an edict to the American and Canadian Medical Assoc. etc. stating that they must provide presecriptions to those who request them for pandemic prepping…
then the Government will not have to use tax dollars to supply treatments to a significant segment of the population…communities could go together and pool there money to protect everyone…
…and this could all be done before the panic ensues so to speak.
No one losses under this scenario…and really could the MRSA problem at this point get much worse? That horse is also long out of the barn and down the road.
If we don’t get the antibiotics etc. in the hands of citizens before demand skyrockets, there will be no humans for the MRSA to replicate on…
…I understand resistance is a serious issue but I believe for many reasons including national security and viability, pandemic planning trumps it.
Thanks
Tom DVM: What about a strong push to have everyone vacinated for pneumonia BEFORE the pandemic? The vaccine is available right now and could dramatically reduce the amount of secondary infections and deaths from the flu, and reduce the need for antiobiotics after one gets the flu.
Janet That is a very good idea.
In fact, my suggestion would be for putting our limited community healthcare funding into pneumnonia vaccine and forget the seasonal influenza vaccine which in my opinion clearly doesn’t work very well at all.
As you have said…the pneumonia vaccine may decrease the requirements for antibiotics to treat secondary infections.
Janet In your post you clearly demonstrated a level of critical thinking and common sense that regulators seem incapable of…
…Please continue to provide your insight at every opportunity.
Thanks!!
Leo7 -
I believe that everyone should have antibiotics (and other prescription medication) given to them before a pandemic starts. I believe that because antibiotics will save many lives if people are cautious as to how they take them. Antibiotics must be used when appropriate. There will always be some people who are not careful with what they do, or misunderstand, etc. However, in the long run, I believe more people will be saved if they are given the chance to help themselves under these dire circumstances. We have been told we are “on our own,” so we should be given a chance to survive on our own.
What I was trying to say is that I can’t see the AMA suddenly saying that everyone should have a prescripton for an antibiotic before a pandemic. I think I know how they are thinking. But, when I weigh the consequences, I think distribution of antibiotics beforehand is the best choice for the population.
What I would urge people to do is to first try to get antibiotics from their doctors. There are other means, like pet antibiotics, which people are also using. It is terrible what we have to resort to to save ourselves. Also, if everyone can’t get his own antibiotics, there will be antibiotic sharing during a pandemic. Just like there will be food sharing. People are very resourceful, and they will do what they have to do. What I am trying to say is that I know and can see what should happen, but I don’t think the AMA will change their minds. I have not changed how I think at all.
crfullmoon -
Most people parked in the basement of Benaroya Hall. There are guards down there. I don’t think they would have allowed flyers on cars. However, I didn’t think about it!
Average Concerned Mom -
From what I have heard, antibiotics and other drugs will be stockpiled in certain locations around the country for distribution during a pandemic (to pharmacies, clinics, etc.). The problem is though, many people will be trying to SIP, or at least not want to venture out far for various reasons. I would not want to try to get to a drive-through clinic. Maybe I wouldn’t even have the gas to get there, and I wouldn’t want to get on a bus if they were running. I am concerned about distribution to the masses when they need it during a pandemic. All those who need antibiotics won’t be able to get them.
Tom DVM
“In my opinion, if the power is out, and there is no food in the grocery stores and children are sick…there isn’t an army in the world that will be able to protect those stockpiles…which means they will be destroyed in the chaos.
If we don’t get the antibiotics etc. in the hands of citizens before demand skyrockets, there will be no humans for the MRSA to replicate on…
…I understand resistance is a serious issue but I believe for many reasons including national security and viability, pandemic planning trumps it.”
I agree with what you say. Bottom line is that I just don’t think we will get this out of the government before a pandemic. I think we are already “on our own.”
Ok, so, If your a mom trying to protect her family and the #@&#*# medical establishment WONT give you a script for antibiotics, but you CAN get the pnumo-vax, then thats a proactive way to go? I worry so much about not having sufficent meds, i.e. antibiotics on hand, which I know will not do anything for flu (virus) but might help with secondary infections. So the pnumo-vax will help with the pneumonia, is there anything proactive I can do about the possibility of Bronchitis? I don’t suppose there is a “broncho-vax”?
JV. Thanks as always.
I agree that the American Medical Assoc. and the Canadian Medical Assoc. etc. won’t change their approach for the same reason the World Health Organization won’t change their approach…because they can…
…they are blinded by their own God-like image.
I don’t believe for one minute they are doing this to protect us from ourselves…I think they are doing it because they can and they enjoy control.
We have a doctor shortage in Canada but we can’t have a nurse treat us for a sore throat…they blocked mid-wives for more than twenty years including prosecuting them for practising medicine without a license.
Their power is absolute…and worst of all they know it.
Hi TomDMV
at 11:41
I agree.
just a quick note. I have to leave in 2 minutes. I would think that the pure survival instinct and desire for self-preservation would eventually override their irrational thinking and actions.
JV. Thought I would jump in here for a couple of reasons:
1) Thank you for your kind advice in reference to my ailments. Your comments were much appreciated.
2) I am going to be making some comments about the medical profession as I want them to stand up and be proactive on the issue and provide prescriptions so people can stockpile medications for their children if they can afford and choose to do it…
…at the same time I would like to be clear…
…that if every doctor in North America had half the moral ethic that you have…I not only wouldn’t have to push them but I wouldn’t have to be on flu wiki as a veterinarian, talking about human medicine…same goes for the World Health Organization and Dick Thompson.
…What you did last winter was come into the discussion at exactly the right time…the calvary arrived in the nick of time…with all guns blazing!!
You’re a pistol!! Thanks for everything…and I sure don’t want you to think that I am bunching you with the rest.
Tom and JV:
I believe we are on the same page of thought. A mainstream doctor with clout in the Heart Association, Stroke Association, or ID is going to have to be the type that speak out. The three MD’s currently speaking out publicly isn’t enough and they aren’t in the mainstream-well Webster is but he’s a researcher, but the others aren’t. Until that happens, the current practice won’t change. I get the impression the MD’s are waiting for some sort of national mandate or plan that they will be instructed to follow. The last doc I spoke to about it said current practice doesn’t change rapidly one doctor at a time. They would have to be addressed nationally by a group who understand patient treatment practices in the office environment. Hasn’t happened yet.
Back to my idea for a second —
If enough antibiotics were stockpiled in each fire department/town hall/post office/whereever — then the supply would be there ahead of time.
Security wouldn’t be an issue ahead of time; these wouldn’t be in particular demand NO pre-pandemic.
The antibiotics wouldn’t be in people’s medical cabinets NOW, so people wouldn’t be tempted to use them for a sore throat, etc. Thus leading to antibiotic resistant infections, which I understand is a huge concern to us right now.
However — at the start of a pandemic — and before everything goes haywire — these meds could be distributed along with instructions and guides to home care. They could be dropped at the front door of every house in the area, for example. Even if you dropped off only 2 courses of antibiotics and 5 people lived in the house, it sure would be better than nothing. Even better — give us a list of phone numbers we can call for advice on how to know when to use them.
Of course I think it would be even better for doctors to just write me and others like me the prescriptions I want and wouldn’t mind paying for. But if that just isn’t going to happen for whatever reason, then at least HAVE the drugs and have them in my town, and have a plan to get them out BEFORE a full-scale pandemic is in swing.
Leo 7 Thanks.
Average Concerned Mom. I agree with everything you said perusual.
The community is the key here…we have to stockpile enough medication for every single person in our community or the end result will be anarchy…our community has to know that there will be no healthcare and our community must step in and provide medical care and food where necessary…
…either we fly together or we will fall together…there is no middle ground.
Now, if we could only unlock the key to community awareness…we would be getting somewhere.
Thanks Tom.
And as I was washing the dishes, the idea came to me. Stockpiles should be held at the post offices. I know it sounds crazy, but that’s in normal times. In normal times you don’t have the post office deliver medicines, but it makes sense. They are roughly arranged according to population density, and they have the knowledge and ability and organization to deliver to every household in the country. AND they are under federal control already. And they have trailers for the mail — what’s a few more with a bunch of meds in their parking lot?
That’s how I would do it if I were queen of the country, anyhow.
Re: Stockpiling antibiotics
Problem 1:
Right now in stock there is enough antibiotics for a typical course of pneumonia as follows:
Zithromax: 12 courses Amoxicillin: 200 courses Biaxin: 100 courses Erythromycin: 3 courses Avelox: 6 courses Levaquin: 4 courses
One of 3 stors in a catch basin of 12,000
pharmacies operate on a just-in-time scenario as well, out of sheer economic need. Most stores have a minimum inventory of 1/4 million dollars (that’s the small ones).
Extrapolate that to the rest of Ontario, or Canada for that matter and it becomes clear that there aren’t enough doses to go around.
Problem 2: If stockpiling is possible, there will be limited supply to treat the diseases that need treatment with these antibiotics now (including, but not limited to pneumonia)
Problem 3: Medication “expires” where is loses 10% or more of its potency in on average 2–3 years, shorter if exposed to humidity or large temperature fluctuations.
Problem 4: People may take the medication inappropriately. e.g. you catch what you believe is pneumonia and take a few biaxin. You start to feel better, so stop taking the biaxin to “save your stash”. In the meantime, you may have created a resistant “superbug” waiting for its chance to breed.
That’s off the top of my head
It’s kind of like giving a teenage smoker a prescription for morphine because they might get lung cancer when they’re older. (all right, maybe that’s a little over the top, but makes the point just the same)
Tom DVM
Just noticed your earlier comment about the medical community in Canada, specifically about nurses being unable to treat someone with a sore throat. Here in the States, Registered Nurses are able to continue their education and can become Nurse Practioners, NPs, and if memory serves me, are able see patients, prescribe meds and the like. Do not know what their limitations are, perhaps a nurse or doc could shed some light on that.
Have heard some comment that many NPs are as good as doctors. Nothing like this there?
Average Concerned Mom – at 09:29
re:Q: “JV — what if there were some intermediary step between having indiviuals having their own stash of antibiotics, and having the antibiotics not exist at all?
What if they were at least stockpiled at pharmacies, in firehouses, in town halls, whatever? Based on population density? “
Cost, security availability and outdating. Other than meds needed for biosecurity use ie antibiotics for anthrax, no one/no agency will purchase, store, secure, rotate any antibiotics.
IMHO.
Tom DVM -
Tom, I hope you are doing a bit better, and thanks for your kind words and thinking I am a pistol! I don’t deserve it. I am only providing a small amount of information which others would find hard to sort out on their own. I wish I could do more. It grieves me so to think that so many people may suffer for lack of medicines because they will either not be prescribed beforehand, or not be available when needed.
Leo7 and Tom, yes, I think we are all on the same page. Doctors are so entrenched in following the AMA or their own specialty’s mandates. They are not easily swayed by others. We need leadership within these groups to take a stand.
Average Concerned Mom -
I have heard that antibiotics and other medicines will be stockiled in large quantities in regional areas. Distribution beyond that I don’t know about. I can see a lot of problems with distribution on a local level. Will an MD call in a prescription for evey person? No, because not everyone even has a doctor. Will everyone even be able to get his/her doctor in the middle of a pandemic to call in a prescription? I doubt it. There will be some problems getting to distribution centers. People will be sick and not want to go out to get meds for themselves someone in their family. They may have no transportation. What if someone arrives, wants an antibiotic, and has no doctor prescription? How will the person at that center decide what to give out? There will be questions about other current medicines and diseases that the person has and complications with the antibiotic handed out. There should be some in-depth analysis re what antibiotic to give. That is precisely the reason a doctor should be providing the anibiotic beforehand.
I could see a place like a post office handing out antibiotics (to people without prescriptions), but there would have to be 1. security in place 2.at lease someone with medical knowledge like a nurse or pharmacist to answer questions about medicines (complications, contraindications), and sort out who should get what. I see problems with staffing and even people getting to the post office. But this could be a partial solution.
To drop off antibiotics on doorsteps is not the best idea either. I understand your thinking. But, less decision making will go into whether that antibiotic is proper for that person to take. This would be the last option to take.
Also, if tomorrow the government decided to hand out a course of antibiotics to each person in the US, do we have enough? I have no idea. I have heard that in a pandemic, we may run out of antibiotics (at least in some areas). I don’t know the true answer, but I am worried.
The very best thing to do is for people to TAKE THE TIME NOW and either get prescriptions from their doctors or research it themselves as to what would be best to take (and the get pet meds). This is the whole idea of prepping. People who are prepping now are probably trying to get their meds in order too. During a pandemic, those who have not prepped will be at the grocery stores trying to get food, the hardware store trying to get flashlights/lanterns, and all of a sudden trying to figure out what to do re medicines.
I have asked my vet re a number of the broader spectrum pet meds (like azithromycin, levofloxacin, etc) as to how to obtain without a prescription for a horse, goat, etc. He has not yet given me an answer. I know many of these meds are given I.M. and not in pills to animals. Maybe someone else has the answer on this issue.
Bottom line: Everyone should try their best to get ALL prepping done now, and urge their family and friends to do the same. In the end we will all be helping each other by sharing our food, and probably even our medicines! We will be in this together as a community.
Grace. I really enjoyed your comment yesterday on Effect Measure…you are something!! Keep up the good work.
Nautical Man. Nurse practioners are still discouraged in Canada as well as nurses. My father was a physician…much of my opinion of nurses comes from his opinion of nurses…and he said many nurses are as smart or smarter than some doctors…there are 25,000 patients in our small country, my family included, that don’t have doctors…many Canadian doctors have emigrated to the USA.
…now, if I could get Dr. Grace to treat me…I wouldn’t have a problem.
Average Concerned Mom.
“That’s how I would do it if I were queen of the country, anyhow”
LOL. If I have my facts right, you are living in the wrong country if you want to be Queen…we have lots of room in Canada…why don’t you come on up!!
RPh. Thanks for the comment. I’m not sure I get the point however.
If we get a pandemic within the next few years…what do you think the odds are that all who require it will have antibiotics avaliable…and if the answer is not very many then should someone, at some level, not be stockpiling antibiotics.
I really don’t think that antibiotic resistance or expiry dates are as big a concern as children being treated like we are back in 1830. I am particularly concerned if the pandemic hits within the next two years.
As it stands, the pressure on you and your drug store will be immense when the pandemic starts…what are your plans?
Thanks.
RPH at 13:55
you definitely have some appropriate concerns and in an ordinary situation I would have no argument with what you say.
Medications should be prescribed by a person who is licensed and competent to do so…. and we should have enough meds to go aaround….
BUT in an emergency, when there aren’t enough doctors; when perhaps med students are being drafted to take care of the patients; when hospitals close to new patients because they don’t have the staff; when people treat severely ill patients at home because there is no medical care; when the number of patients overwhelms the available medications — is the time when I would start thinking “Something is bettert han nothing, because people were afriad to step away from business as usual”.
And your analogy about prescribing morphine to a teen smoker because he MIGHT get cancer — well, it would only be a good analogy if you were worried about a cancer pandemic, right? (-: Where suddenly, within the course of one month, 30 to 50% of the population would all, simultaneously, develop inoperable and presumably extremely painful cancer? And that hterefore you were worried there wouldn’t be enough morphine to go around.
So yes, in that analogy (and of course presuming the cancer were also extremely contagious and therefore no one would really want to be around any of these cancer patients) it would indeed make sense to start stockpiling morphine for these patients ahead of time, and make sure there was a way for them to be delivered to them when the time came.
I think.
Just remember no answer is going to be perfect.
If these were solvable problems, a pandemic wouldn’t be a catastrophe.
It would be a simple logistics problem.
My point is this:
Nobody knows if(when?) a new pandemic will start. Those antibiotics can (read will) be stored in places where conditions are suspect (ie. bathrooms, kitchens, basements). Expiry is a concern not because of harm resulting from a degrading product, but because of loss of potency. The manufacturer guarantees maximum 10% loss up to the expiry date on the bottle, provided it is UNOPENED and stored under labelled conditions.
In our store as of right now, we have only enough medication to treat - at most - 800 people, assuming that every course of treatments works out perfect re: susceptible organisms/allergies/adverse reactions, etc. etc.
Realistically, if you consider that most empiric treatment will be with macrolides or quinolones, we currently have treatment for a maximum of about 100 people (that’s out of 12,00 don’t forget).
Those 100 courses will cost on average $65 each. If our store “stockpiled” enough to provide one course for everyone in the catch basin, it would cost close to $1Million. To treat every Canadian? $2.5Billion (1 course only remember).
Of course, that’s assuming the medication is available in the first place.
Of course, not everybody will need antibiotics in the first place. Of those that contracted H5N1 so far, how many had secondary infections? Is it really appropriate to give blanket coverage to everybody when only say… 10% may acquire secondary infections?
“Something is better than nothing”? Not always.
There has been more than one person who has died due to an adverse reaction from an antibiotic (Ketek, anyone?). And that is under medical supervision. Imagine unfettered use of antibiotics….
Most of the deaths in a pandemic influenza I would expect to be attributed to hypersensitive inflammatory processes in the lungs. Essentially drowning to death. (read - not secondary infections)
At $65 for an antibiotic course and $55 for a Tamiflu course, I can tell you where my money would be spent…
Rph, the fish antibiotic tablets you can get from reputable pet stores are claimed to be pharmacy grade. What would that mean for penicillin tablets? Thanks
Since this has turned to antibiotics and drugs. Please let me tell you something from the perspective of someone that has been involved in the manufacture of antibiotics and all sorts of drugs. Everyone that reads this go do this right now…Take all the drugs out of your medicine cabinet in the bathroom and put them anywhere else. The bathroom is the worst place in the world to store drugs due to the constant heat and humidity changes. Cool, dark, and dry is the way to go for every drug. Also if you have any expired tetracycline throw it out! It is one of a very few drugs that gets wicked toxic past its expiration point.
I can’t comment directly on the quality of penicillin intended for consumption by fish, although I would expect a reputable company to use pharmaceutical grade products.
However, penicillin is of virtually NO USE in any secondary infections associated with a pan flu, and is indeed only now used regularly for tooth abcesses and strep throat.
On top of its limited spectrum of use, the source I found for fish penicillin cited a cost of $26 for 30×500mg tablets. Including dispensing fees and markup, a similar supply (50×300mg tabs) can be purchased with a prescription for $12.
Esentially, the only people I personally would recommend talking to their doctors about getting a prescription “just in case” are those with underlying respiratory problems like:
Asthma - COPD - Emphysema - Chronic Bronchitis - TB
Anyone in that category probably already has a good relationship with their doc, and would likely not have much of a problem getting an Rx for an antibiotic to have “on hand”.
Thanks, my doc is very much against giving extra rx. So if we had it for standby for tooth abcesses and strep throat etc, then it might work. I know it not is good for flu, just in case we can get antibiotics if this thing really goes bad and the pharmacies and or my doc is closed.
Btw what would be the standard adult dosage for an infecion. Remember we do not know who you are, so please volunteer an answer unless you think it is too dependent on the particular use, ie strepp throat etc.
“Thanks, my doc is very much against giving extra rx. So if we had it for standby for tooth abcesses and strep throat etc, then it might work.”
- yes, it would work the same as “people penicillin”, but would only be useful for tooth abcesses and strep throat. Most people can count on one hand the number of such infections. It is pointless purchasing penicillin as part of pandemic preparation. (how’s that for alliteration?)
Monotreme – at 22:11 Actually, the fate of the human host is irrelevant to the survival of a flu virus. Because flu viruses spread before an infected person is sick, there is no selective pressure for the virus to decrease its virulence in it’s first pass through the human population.
---
Also known as Wave 1
Which is why Wave 2 of the 1918 pandemic was deadly devestating.
The public will need not just access to antibiotics, but what they need now, that may get disrupted;
psych meds, insulin, anything (including electricity) for some sort of maintenance intervention (kidneys, cancer treatment, breathing problems) meds for surgical interventions if the hospital still plans to do them, epi pens, infant formula, extra meds for whatever diseases may go around with bad food or water or sanitation, infected injuries, ect, when normal medical care is unavailable.
Wildfires, earthquakes, hurricanes, tornadoes, gang fights, ect, won’t stay away just because pandemic breaks out, either.
Average Concerned Mom, they haven’t exactly disclosed what exactly, but I imagine the postal service (I think they got some of the pre-pandemic vaccine shots)is planning on some sort of emergency distribution functions,
but, I haven’t heard anywhere having the political will to ask the public for budget money to stockpile all the things the public will wish their local/state government had to give them during a pandemic influenza year, so, I’m not sure what there will be to distribute. More reason to clearly tell the masses to try and prep to be on their own.
I can’t envision the postal service adquately providing any distribution of “stockpiles” of anything.
Our local post office is not even as big as a grocery store, and most of that space is occupied by parcels, mail sorting stations and whatnot that will still need to be present. They have scant extra space for storage.
Perhaps they could use utility trailers, but who would then provide security and parking space for said trailers? These are serious complications for just a small community of 12,000 - never mind an urban centre.
Limited space begs the question - what should be stockpiled? Medication (if so - what kind)? Food? Isolation garments (masks, etc.)? And who will pay for it? Federal, provincial, municipal, or personal?
Everything seems very important to stock, but with limited resources, it’s kind of like chasing your tail - like and exercise in futility.
For mass distribution to be effective, it almost requires central (or semi-central) stations where items are picked up, which encourages congregations of potentially infected people. I don’t know about that one…
Hi everyone interesting opinions here.
I guess the point for me is I am convinced we will have a pandemic sooner rather than later…and that if we continue bumbling along as we have, we are going to be looking into the eyes of children with pneumonia and have zero antibiotics or anything else to treat them with…
…So my bottom line is that if we can’t trust the public (I don’t agree) with stockpiling antibiotics for a pandemic and we can’t convince doctors to provide prescriptions so that people can stockpile if they can afford it…
…then fine, spend the 2 billion dollars and stockpile enough antibiotics for every child and young person in Canada and rather than waiting for them to get pneumonia before treating them…we will treat them prophylactically.
RPh. You can have my allowance of antivirals…my family will take its chances with H5N1 instead. /:0)
If the military, state, Nat’l guard, locals, whoever, have plans to get (small, if any, since they weren’t designed to be needed by everyone everywhere at once) stockpiles of whatever out, I think they could bring it to the postal service, who know their routes, (they’d just need someone to ride shotgun with them in the mail trucks) and even know a bit about who might need what kind of help.
But, I think the Emperor isn’t parading about so the public doesn’t notice the clothes are lacking. If they had good plans and supplies to distribute, they would have told us so.
The feds told us we’re on our own, the state told us we’re on our own, (I wish they then didn’t go back to their regularly scheduled programs, and, that the locals had been brave enough to pass on what they knew, so the public could make informed choices how much they could prep). (Rather than been “spun” to think it was an unlikely event, with vaccine distribution in the works, and very low case fatality rate.)
“…So my bottom line is that if we can’t trust the public (I don’t agree)…”
From my experience, the general population has a very misinformed view of antibiotics in general, and lack the knowledge and training to use them appropriately. Fluwikians tend to be of a more pro-active segment of the populous and perhaps have more competence in these regards, but when one sees requests for PenVK for possible use in pneumonia it begs the question.
Ketek (a macrolide-like antibiotic in a class of its own) was supposed to be the next cat’s-ass anti-pneumonia drug. Problem is that it also causes major liver damage in a small percentage of the population (about 0.1%). Imagine if this was the drug chosen for pandemic planning?
“rather than waiting for them to get pneumonia before treating them…we will treat them prophylactically. “
Prophylaxis is only useful if there is a reasonable expectation of infection and if that expectation persists for a reasonably finite period of time. If someone gets persistent UTIs then prophylaxis is warranted. I can’t imagine the consequences of taking any of the anti-pneumonia antibiotics for months at a time.
I do think that certain susceptible people should talk to their doctors about their concerns. (as I mentioned above). If they dismiss your concerns… find a new doctor.
For the record, I don’t place much faith in antivirals either, so maybe someone else can take your course. I also plan to “take my chances”. Perhaps that’s a tad glib, as I have rather unfettered access to most conventional treatments, though.
crfullmoon, The regular guys on their routes are used to their regular loads of goods (usually just letters and such). Many people don’t even get door-stop delivery anymore either as the corner mailboxes get more and more common. I don’t get home delivery at all, and have to pick my mail up at the office. And of course delivery is dependent upon the delivery guys not being sick too…. I just can’t see how the post office could assume that responsibility. No, we are on our own.
Regarding people talking with their doctors, remember that 40 million Americans are uninsured, many have no doctors, except for the care they seek at the ER.
Al - if they are concerned enough to make preparations, talking in a calm and constructive manner to their (or the ER or whatever) doctor is one of those preparations that should be on their list.
From that perspective, though, it’s advisable to “network” with others who are also prepping to see which docs/hospitals are turning away such requests. There’s no point talking to a brick wall. On the other side of the coin, doctors are people too, and most are quite reasonable if you respect their concerns and opinions.
RPh. Thanks. There are many broad spectrum antibiotics that are relatively inexpensive and with relatively long best before dates that could be stockpiled so that if the pandemic hits within the next two years, antibiotics, oral electrolyte powders, prednisolone and non-steroidal anti-fever drugs would be avaliable.
Communities could direct this effort and the best place to stockpile and dispense the priceless pharmaceuticals would be at the established network of community pharmacies.
Preventative medicine and antibiotics could be given at day two of the infection therefore, not wasting antibiotics on those who are not going to need them while at the same time preventing the pneumonia before it starts rather than trying to put the genie back in the bottle. In the 1918 outbreak, there were as many persons living with chronic sequelae as who died…we can either repeat it again without access to antibiotics or we can stockpile them and use them in a proactive manner…it works…the old time doctors did exactly that for years…and you and I are testaments to the fact that it worked.
You have chosen an antibiotic with side-effects but there are many more that are more or less completely safe…in a pandemic we may not have pharmacists or doctors or nurses or hospitals or veterinarians so the status quo is going to vanish…and then it will either best man for himself or an organized community response.
I have great faith in the ability of the public to follow clear instructions if they are delivered clearly.
Most of the uninsured here in America have no relationships with providers and ER doctors rotate. Most of the uninsured in the states are not living below the poverty level at all. Only 60% of Ammerican employers offer health insurance coverage to their employees. Most of the doc friends I’ve spoken about this with say they would absolutely refuse to provide any antibiotics or antivirals “just in case”. That’s the reality, I believe, at least here in the states.
For some reason, I have found that psychiatrists are more willing to rx just in case, especially when it comes to children dealing with mental health challlenges.
Yes, there are many antiobiotics that, given time can be stockpiled and rotated through regular use in the current system that could be used for a pandemic. I’m sure the drug companies would be more than happy to accomodate such a request. This will require time, and prudent planning however, as manufacturing capacity is limited.
You have an interesting theory on prophylaxis and it is certainly worth considering by the powers that be. But if everyone’s stuck at home it is entirely dependent on already having the antibiotic at home.
I did choose a drug that was recently discovered to have side effects that are dramatic. However the other “safer” drugs are not without their banes.
Quinolones, widely considered the treatment of choice for moderate to severe community acquired pneumonia (the kind that’s expected) are associated with prolonged QT intervals (heart arrhythmias), Stevens-Johnson sydrome (a potentially fatal rash - yeah, a rash can kill ya too), spontaneous tendon rupture and a host of other rare but nonetheless clinically important side effects that NEED to be managed.
“I have great faith in the ability of the public to follow clear instructions if they are delivered clearly.”
…as I watched my neighbour put up his satellite dish whilst the instructions fluttered away in the breeze this afternoon, I would have to respectfully disagree.
If people stocked up and started ‘prophalaxic’ ANTI-biotics during a normal flu season or during a pandemic, then I can just about guarantee that 6–8 weeks later there’d be a ‘run’-sorry for the unintended pun-on yogurt, toilet paper and prescriptions for flagyl (Metronidazole) or oral vancomycin. Not to mention the inevitable increase in drug-resistant super-infections. At this rate, we could land back in the 1940′s from an infection-control point of view.
Other than healthcare workers, few people know about an evil potential consequence of taking antibiotics for a significant period of time-C. Diff, which stands for Clostridium Difficile. It is caused by the unchecked overgrowth of normally benign bacteria in our gastrointestinal tract.If the ANTI-biotics kill off enough of the normal bacteria that maintain a healthy bacterial balance in our gut one could end up with a miserable condition called c. diff colitis. It is also potentially contagious.
The intestines become inflammed, a person could get diarrhea, weight loss, electrolyte imbalance occasionally to the point of needing hospitalization to get iv’s to correct dehydration and intravenous electrolyte (such as potassium, magnesium) replenishments.
Yogurt with active cultures (PRO-biotics) can help keep up the healthy balance of bacteria in the gut while taking antibiotics. (This culture material can also come in a pill called Lactobacillus.)
link:http://www.rnweb.com/rnweb/article/articleDetail.jsp?id=114135
Are we getting too lazy to wipe down commonly used surfaces and wash our hands more?
Hi Grace. I agree with you but what I meant by preventative antibiotic therapy was that when a child becomes very ill with pandemic influenza in the future, say on day two, then we would start a normal course of antibiotics before the child became even sicker with a secondary pneumonia…I didn’t mean for persons to take the antibiotics before they got the flu for months…and we won’t have that much antibiotic anyway.
I have a bit of a disagreement with the reason for antibiotic resistance and I do not believe it is necessarily because of the overuse of antibiotics but because people have stopped the antibiotics before they were supposed to or taking a lower dose than they should have…but this is probably a discussion for another day sometime in the future.
I think the bottom line is that we not only have to worry about those that might die but also an equal amount of persons who will live that may wish they had died afterwards…emphysema etc.
I have found in animals that if you time things properly, this does not have to happen…those that die from direct viral pneumonia will probably not be saved no matter what we do but those with the secondary pneumonias that start on day three can be completely healed if the antibiotic concentration is high enough at exactly the time when the pneumonia is taking off but before the direct clinical signs of it.
RPh.
“…as I watched my neighbour put up his satellite dish whilst the instructions fluttered away in the breeze this afternoon, I would have to respectfully disagree.”
Could it be that the instructions were not delivered clearly? /:0)
Tom DVM – at 21:16 re: “I agree with you but what I meant by preventative antibiotic therapy was that when a child becomes very ill with pandemic influenza in the future, say on day two, then we would start a normal course of antibiotics before the child became even sicker with a secondary pneumonia”
I understand what you mean, but not in 100% agreement.
“the reason for antibiotic resistance and I do not believe it is necessarily because of the overuse of antibiotics but because people have stopped the antibiotics before they were supposed to”
I think antibiotic resistance is tiedto both-over-prescribing and under utilizing. My mother-in-law and my own daughters (gnashing of teeth here) very frequently don’t complete the prescribed course of antibiotics because they want a ‘few to start with should they get sick over the weekend.’ Auugh!
New here, so hello. This news is disturbing and requires meaningful protest. Go to the link. We in Canada pay for our “medicare” system, through our taxes, so it is not free. No doctor has the right to arbitrarily decide stopping treatment. No doctor should be given that right. I can see very clearly, the cut-off points that would be used in the event of a pandemic when dispensing drugs that are in short supply, let alone the shortage of equipment. How do sick people prepare for a pandemic if they, for example, are having kidney dialysis? Anyway, this article forebodes of unimaginable tragedy in a pandemic but it should certainly not be foreboding of unimaginable tragedy in normal times.
http://www.cbc.ca/health/story/2006/10/13/manitoba-physician.html
Hi Kleenex. Interesting handle…welcome to fluwiki. If you don’t mind, could you post this on the Canadian preppers thread. Thanks!!
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