Using Our Time WiselyJust last week, Margaret Chan, the Director-General of the World Health Organization, called bird flu the greatest global health threat of the 21st century. A pretty strong statement by any measure. You’d think that newspaper editors would have screamed “Stop the Presses”, and “Set aside 20 column inches above the fold on the front page!” . . . but they didn’t. If it appeared in your local paper at all, it was probably tucked away somewhere deep inside, nestled inconspicuously between refrigerator ads and a recipe for rhubarb pie. Bird flu, you see, is the Rodney Dangerfield of global threats. It doesn’t get any respect. The idea that we could be facing a pandemic is such an alien thought to most Americans, and that includes newspaper editors, that they relegate it to the same threat level as an asteroid strike, or a tsunami hitting the Atlantic coastline. Possible, maybe . . . but unlikely. And so most Americans, when asked about avian influenza, think, “Oh that, I remember last year there was some talk about it. I guess it fizzled.” But the H5N1 virus hasn’t gone away. Far from it. It continues to mutate, spread, and infect new hosts. And as it does so, it increases its chances it will adapt to human beings. How long that will take is unknown, but scientists who are watching it are no less concerned today, than they were a year ago. For the first time in history, we have the ability to observe a virus as it evolves and moves towards a pandemic strain. We can watch as it picks up genetic changes that make it more adaptable to non-avian hosts, or resistant to medications, and we can track its progress as it spreads around the globe. But since we’ve never watched this progression before, we really don’t know how long it takes. Unlike our grandparent’s generation, we have an opportunity to prepare. So while there is uncertainty, the signs are ominous that we may be moving in the direction of a pandemic. In light of these developments, for more than a year the Federal government has been urging Americans to prepare for a pandemic. The HHS has a website, www.pandemicflu.gov , with checklists and advice for families and businesses on how to do so. To date, very few of our citizens have taken heed. In some ways, this reaction is perfectly understandable. We are inundated with media reports of new threats to our health, our security, and our pocketbook every day. If it isn’t terrorism, or a looming oil crisis, it’s contaminated pet food, or the dangers of high cholesterol. After awhile, we either become fatalistic over such threats, or our eyes simply glaze over from the continual assault. As far as most people are concerned, bird flu needs to take a number and get in line. There were other global threats here before it. The media has, to date, been very inconsistent in its coverage of avian influenza; vacillating between breathless hyperbole and dead silence, and that has hurt awareness. The public honestly doesn’t know what to think. In their defense, it is a difficult subject to cover. It is a complex story, filled with nuance and scientific jargon, and one that often moves at a glacier pace. Until the idea that a pandemic may be looming becomes part of the public’s daily consciousness, the idea that we should be preparing is unlikely to gain traction. Obviously, for pandemic planners, this presents a real problem. They need people to understand the gravity of the situation, and take action; but that won’t happen until they actually believe the threat is genuine. Federal, State, and local planners know they cannot prepare for a nation of 300 million people. The logistics are impossible. Unlike the aftermath of a hurricane, or flood, or earthquake, where the damage is localized and help can be summoned from surrounding areas, a pandemic will strike the entire nation at roughly the same time, and the effects could last for months. As Michael Leavitt, Secretary of the HHS has said many times, “Any community that fails to prepare with the expectation that the federal or state government will rescue them will be tragically mistaken.” The clarion call to prepare couldn’t be clearer. And yet, it goes largely ignored. I will spare the reader apocalyptic visions of a world engulfed in a pandemic. Until we actually see a pandemic erupt, we won’t know how bad it will be, and so estimates of the number of deaths, or the total impact on our economy are mere guesses. Any number I might choose could legitimately be challenged as being either too optimistic or too severe. Suffice to say, it will likely be very, very bad. Billions of people worldwide could be stricken, and many millions of those would likely die. Economies would suffer, and some might even collapse. And the psychological trauma of all of this will be incalculable. But even without knowing the exact scenario, there are certain things we can be pretty sure will happen during a moderate or severe pandemic. Things we must prepare for today, if we are to be able to handle them when they come. We are likely to see major disruptions due to absenteeism, travel restrictions, and fractures in our supply chains. Goods and services we take for granted may be in short supply, or temporarily unavailable. Communities may be isolated, and largely on their own. Since the prospects of having a vaccine or adequate supplies of antiviral medications are slim, we will need to use NPI’s, or Non-Pharmaceutical Interventions to slow the spread of the virus. This means schools and day care centers will be closed, perhaps for months. Some businesses may be forced to close due to high absenteeism, lack of raw materials, or because they would contribute to the spread of the virus. Public venues and meetings may be prohibited, and people will be instructed on the merits of `social distancing’ and preventative hygiene. Basically that means frequent hand washing, avoiding crowds, covering our mouths when we cough or sneeze, and staying home when we are sick or suspect that we’ve been exposed to the virus. I know, in a world where we’ve come to expect that we can take a pill or a shot to prevent illness, that this sort of response seems inadequate. But these measures can make a difference in how many are sickened at any given time. And quite frankly, they may be all we have. One of the hallmarks of the CDC’s plan to slow the spread of the virus is the use of voluntary home quarantines of those exposed to the virus. If a family member is infected, then everyone in the household will be asked to stay home until the incubation period has passed and they know themselves not to be infected. This means that entire families may be unable to leave their homes for several weeks. Without food, water, and medicine already stockpiled, these people will either face deprivation, or must leave their homes and risk spreading the virus in order to get supplies. When people are prepared, they are not just securing their own safety; they are helping to protect their community. And there are no guarantees that the grocery store shelves will remain stocked during a pandemic. With an anticipated absenteeism rate of 40% in the workplace, deliveries may fall behind, factories may be unable to produce goods at the normal rate, and raw materials may be held up in a faltering supply line. Shortages of some goods are not only possible; they are likely. People who rely on prescription drugs may find that obtaining heart medicines, insulin, or other needed medicines may be difficult or impossible during a pandemic, and they need to be acquiring extras to see them through. When you look at the ripple effect a pandemic would have on our economy and our ability to provide essential goods and services, the need for individual preparation quickly becomes obvious. Added to this we must also anticipate that, if we become ill, most of us will have to be treated by family members in our homes. With fewer than 1 million hospital beds, most of which are occupied at any given time, there is simply no way to provide hospital services to millions of concurrent flu victims. When you add in the attrition rate of health care workers to the virus, the prospects of receiving hospital care grow even worse. Households therefore need to be equipped and informed on how to take care of their own medical needs during a pandemic. No one in the government likes this reality, but they’ve run the numbers, and they know what is possible, and what isn’t. We pride ourselves on being a modernized society, with superior medical care, and a broad safety net for those who are unable to care for themselves. We rally as a nation to rush aid to areas stricken by disaster, both here and abroad. It’s what we do, and who we are. To be unable to do these things is almost unthinkable. But during a pandemic, the numbers simply don’t work, and our government’s options are limited. When we think about a pandemic, we think of it mainly as a public health problem. And while that is undoubtedly a large component, it is also a logistics problem. How do we move goods and maintain services during a prolonged crisis where nearly half the nation, or for that matter, half the world, is unable to work? The answer is, we can’t. Not at normal levels, anyway. System failures are inevitable, as are shortages of essential goods. We simply must be prepared to deal with that eventuality. The HHS has advised all families to be prepared with enough food, water, and medicine to last at least two weeks. The operative words here are `at least’. In a severe pandemic, two weeks probably won’t be enough, but it is a start. Everyone needs to find their own comfort level with how much they need to prepare, and frankly, since we can’t know how bad the next pandemic will be, no one can know what is adequate. For me, 2 to 3 months seems a reasonable minimum; but some will regard that as insufficient while others might consider it an over reaction. Here, every individual family will have to decide what is doable, and what is reasonable, given their location, circumstances, and personal assessment of the threat. And it must be stressed that preparing today, while supplies are abundant and the supply chain is intact, is not hoarding. In fact, it may be the most ethical thing you can do for your community. By being prepared in advance, you remove your family’s needs from the last minute rush that will inevitably occur when a pandemic begins. By being reasonably self-sufficient, you will be one less household looking for assistance from overtaxed relief efforts. If you have more than you need, you can elect to help out neighbors and friends. And if you aren’t obsessed with finding your next meal, you might even have time to help out in your community during a crisis. Preparing is as ethical as it is essential. Ninety years ago, when the last great pandemic struck, it was common for families to have a month or two worth of food set back. It was a way of life. People raised gardens, canned food, and generally bought in bulk. They bought sacks of flour, corn meal, sugar, and salt. Convenience foods didn’t really exist. They didn’t rely on home pizza deliveries, fast food restaurants, or stopping by the market three times a week. In many ways, our great-grandparents were far more prepared than we are today. By being prepared for a pandemic, we are also prepared for other disasters. The food in your pantry will be just as valuable during the next hurricane, or flood, or other natural disaster. And buying in bulk now, while prices are relatively low, is economical, too. Most scientists admit `it isn’t if, but when’ the next pandemic strikes. Another pandemic is a virtual certainty. The only real question is the timing, and the severity. Our government agencies, and governments around the world, are spending billions of dollars to prepare for a pandemic. To them, this is not some obscure academic exercise, or a drill. They take this threat seriously. I’ve no doubt, if they thought they could afford to ignore it for a few more years, they would. But the evidence grows stronger with each passing day that we are growing nearer to seeing another pandemic. According to the WHO, we are closer to a pandemic today than we have been since 1968, the last pandemic year. While not conclusive, the evidence is convincing. Pandemics occur, on average, every 30 to 40 years, and it’s been 39 years since the last one. Over the past 300 years, we’ve seen 10 pandemics, and there is no reason to believe this historical pattern has changed. We currently have a particularly lethal influenza virus, H5N1, circulating in the wild that has already proven its ability to jump from birds to humans and other mammals, and we’ve seen indications of limited human-to-human transmission. It only lacks one thing to spark a pandemic: a mutational change that increases its ability to spread. That change could happen today, tomorrow, or next month. Or perhaps it will take another year or two. Admittedly, it may never happen with this virus. We simply don’t know. But we do know, that once it happens, our time to prepare will have ended. With modern airline travel, the virus could spread around the globe in a matter of weeks. Anything we haven’t done by then will likely not get done. David Nabarro of the United Nations said last year, when discussing the threat of a pandemic, that we are operating on `God given time’. We need to use it wisely.
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You mention that the prospects of a vaccine are “slim” - why is that? I think I have seen in the news that an Avian Flu vaccine is currently available (I think the US and other countries are stockpiling this vaccine). Also, since we can make a vaccine for the seasonal flu, why not for a pandemic flu?
Posted May 22nd, 2007 at 8:55 amMike,
You’re right. It’s important that community and business leaders understand why individual preparedness is crucial. Some additional ways of understanding the problem:
1. supply chain failure – In a pandemic, the wellbeing of your community is intimated connected to the wellbeing of communities halfway across the world. Americans need to realize that > 70% of your imports have to cross oceans . Anything that affects manufacturing or shipping in any part of the world will affect your supplies long before the virus gets to the country.
If you look at the rankings for busiest shipping ports in the world, #1 to #6 are all in Asia . Let’s just take one of them, for example, Hong Kong, situated in the southern province of Guangdong in China. It sits at the epicenter of one of the likeliest places for a pandemic to start. Last year $40 billion of US imports went through Hong Kong alone, ie not counting other Chinese ports. Much of these originate in China, along with 90 million people who crossed over the land border last year. If a pandemic were to break out in the area, the HK government is very likely to shut down all cross border traffic immediately. With the experience of SARS behind them, the people of Hong Kong are very likely to take extreme precautions against disease, such that at least initially absenteeism is likely to be so high that all shipping can stop literally overnight. In our interconnected world, crisis and absenteeism in distant places can affect you much faster than the virus can.
2. scale of impact – The best way to illustrate the possible impact of a pandemic is to compare it to known events. Let’s take Hong Kong again, with 7M people, with the SARS outbreak in 2003. This is one of the richest cities in the world, with very high standards of living and healthcare. SARS infected 1700 people and killed 300. It brought the city to a standstill: all hospitals were closed to all non-emergency care, all schools were closed, hotel occupancy went from 90% to single digits almost overnight. H5N1 at 1/30th of its lethality will kill 42,000 people (ie 140 x more) in the same timeframe. Notice this is only 0.6% of the population. ie the risk of any individual dying in a pandemic is very low, but the systemic effects will be huge.
An unmitigated pandemic of similar severity in New York will kill 48,000 in 3 months. A crisis of such a magnitude will stress any system to the limit. In fact, it may be quite hard to predict exactly what impacts you might experience in your community simply because how the sum total of the knock-on effects will play out will vary.
3. you’re on your own - every country and every community will be experiencing it at the same time or following quickly one after another. The tsunami in the Indian Ocean killed 280,000 people. It was tragic, and the whole world poured in aid to help. But a pandemic, again of 1/30th the severity of the current H5N1, will kill 40 million people, or the equivalent of 140 tsunamis (or 23 per month) in 6 months, rolling over different regions of the world over and over again. No one will have the spare capacity to help anyone else. All help will have to come from local resources.
In a pandemic, personal and local community resilience will be key.
Posted May 22nd, 2007 at 9:08 amwe can, but it takes time and costs.
In especial : testing the vaccine takes much time.
Some additional problems since H5N1 is so virulent and kills the eggs.
The seasonal vaccine is produced from exact knowledge of the last year’s
Posted May 22nd, 2007 at 9:10 amdominant strains. So, if a new strain appears you’d have no exact matching vaccine in the first year.
Good questions.
We currently have a limited quantity of pre-pandemic vaccine, based on an older strain of the virus. We don’t know how effective it will be in preventing infection. In any event, it is only enough for a few million essential workers, and will not be given to the general public.
Since viruses continually mutate, we need to wait until we see the pandemic strain emerge to begin manufacturing a pandemic-specific vaccine.
Right now, using current technology, it takes between 4 and 6 months to develop a new vaccine. That clock won’t start until the pandemic begins.
Scientists are working on better ways to produce vaccines, but they are not yet in place. Perhaps in a year or two, our ability to create vaccines will improve.
So, it appears the public won’t begin to see a vaccine until six months into a pandemic, and then, only in limited quantities.
Posted May 22nd, 2007 at 9:33 amOur great-grandparents were better prepared; food in the larder and no expectations of a medical miracle. But our great-grandparents had something else as well; they had an appreciation and an intimate awareness that something as “simple” as a case of the flu could kill them or those they loved. We in 21st century developed world have lost the larder and the appreciation of the danger and we still lack that medical miracle. But it’s that medical miracle that most expect to make the other two problems non-problems.
The message has failed thus far; perhaps ill-timed, perhaps entrusted to a media that fewer avail themselves of, but fail it has regardless of reason(s).
Is public awareness a measure of the message, the messenger, or the media?
Posted May 22nd, 2007 at 9:47 amJ.Johnson, perhaps I can step in with an answer.
The global yearly production ability for flu vaccine is 500 million doses, according to Margaret Chan of the WHO, in her last address to the UN, if memory serves.
The U.S. population alone is 300 million, with the whole world population of 6 billion vying for those potential 500 million doses.
In addition, avian flu is so deadly, it actually kills the live chicken eggs in which flu vaccine is produced. There are production barriers above and beyond the actual time necessary to get production moving — and at the worst possible time (during a pandemic) if there are supply and delivery problems, as is likely.
And, as noted above, one needs the actual pandemic strain to produce a closely-matched vaccine. The need for a closely matched vaccine is why one needs a seasonal flu shot every year; flu changes so quickly the old vaccine isn’t effective.
Posted May 22nd, 2007 at 10:01 amI am prepared for a pandemic in part because I live in hurricane country. I’ve seen store shelves empty in a matter of a few hours when panic sets in.
And so, I am prepared to shelter in place for an extended time. However, no one will be able to shelter in place indefinitely. Being prepared also provides me the ability to choose when, in the course of a pandemic, I venture out of my home and, therefore, limit my exposure.
Being prepared has also meant making arrangements with my employer to be able to work from home. This provides even more flexibility for social distancing.
I am also prepared morally and ethically for the tough situations I may be confronted with. I have done this by considering the possiblities and discerning in advance where I stand on these issues.
Most of the possible outcomes of a pandemic are far beyond our individual control and can seem overwhelming. But, addressing the issues we do have control over is, in my opinion, an ethical responsibility as a member of a community and nation.
Posted May 22nd, 2007 at 10:31 amJanuary of 2006 we stockpiled for a pandemic. We assumed we’d need 3 months of supplies, that we’d have water and electricity part, but not all of the time, and that we would need to maintain the stockpile indefinitely (so we’d be rotating the inventory of most items). I made a spreadsheet to figure out how many cans of beans & tomatoes, jars of peanut butter & fruit preserves, boxes of cereal and milk, bags of sugar, gallons of water, etc. that we’d need. We also stockpiled toiletries, cleaning supplies, latex gloves, first aid stuff and bought real hard-core space-suit-type face masks. It took about $2000 and frankly, we’re not really “done” because we never got to the stockpile for pet food.
When I started the project I was disappointed (to say the least) at the lack of information on the HH&S website on what to stock, how to figure how much you need, how to figure out a minimum of calories a day, how long you can keep certain foods, how long you can keep water safely, how much water a person needs, what food groups you should have, and realistic advice on length of time, what services your community might not be able to provide. Is this blog going to be addressing and providing advice on such questions?
Posted May 22nd, 2007 at 10:50 amThe development of a vaccine seems to be pivotal in stopping a pandemic. In light of the recent headlines concerning the sharing of viral samples of the leading pandemic candidate the H5N1 bird flu virus, what can we expect in the way of a cooperative and collective effort to further expedite the development of a successful vaccine.
My concerns lie in the *safe* development of a vaccine as quickly as possible which seems less likely given the recent “winner take all” atmosphere of the global race to take ownership of any viral sequences. Just how trustworthy is this whole process.
Posted May 22nd, 2007 at 11:10 amas a limey, I would like to thank all the contributors.I have very limited help available in the UK, and as such I have learnt most, and as such actively prepared, courtesy of my USA cousins.
Posted May 22nd, 2007 at 11:57 amPanic now and avoid the rush!
Anything you do now will cost less and be easier to get done!
I don’t see science as coming to our rescue, and I do see the system as fragile and breakdown prone. In the great intermittent induced by a pandemic even the simplest things will vanish at times, life with out coffee is no life at all!!!
Posted May 22nd, 2007 at 3:54 pmI hope we do no die or kill ourselves out of of boredom. We can see H5N1 coming, but because it is not “the Emergency of the moment” people forget about it and do not act. Even after Sept-11th, people got bored with “Threat level Orange.”
One should not give up. From cartoons, to boy scouts, to radio programs there *are* ways to keep people engaged and active on a weekly or daily basis. How? Give them some news and a teaser about what is coming next week. Give them a situation report and let them decide.
Does it work. Once a hurricane, tornado is forcasted people hit the web sites to track it. Problem - this is so far out the news is not engaged. Is it the News fault? No. pandemic has not happened so why report it has. U.S social security could falter but “its not today’s problem” so very few bother with it and there is no news until an election year.
Mr Coston I agree with you about “we have the ability to observe a virus as it evolves and moves towards a pandemic strain.” With the new technology we may be seeing the pandemic months or years ahead of its impact. This is a blessing for those who take head, a curse for those with short attention spans. I would hate to be the first generation to die of a pandemic they saw coming but looked away to “save the _____ ‘insert your favorite cause’”
If you are asking how to motivate people - please them. No not “Please prepare” but tell them how to be happy so they have a stake in the outcome. “Those who prepare suffer far less than those who do not. Here are some good ways to prepare. ”
Yes, each house hold needs to be able to take care of their own medical needs. Start here - red cross first aide, CPR & AED, wilderness first aide, etc. How can the government help - buy some medical supplies in bulk and offer them at a discount to see how many purchase them. May HHS help us help ourselves.
Posted May 22nd, 2007 at 4:54 pmMichael: A couple of comments -
Are you concerned that even with our ability to watch it develop, that many people and countries will see it only as a threat to ‘others’ (unlike themselves) living far away?
Belief in a genuine threat most often arrives with some level of real fear as a companion (some would say as the driver).
Do you think that an unreasonable or irrational fear of panicing the public is causing the official pandemic preparedness message to take a schizophrenic approach that says take this threat seriously, but don’t be afraid?
One of the other ways they were more prepared is that they had more than a passing or mass-media acquaintance with death. The mortality rates (especially for the young) were much higher in those days before modern medicine, wonder drugs and better hygiene and nutrition. We may lose our acces to all of these bulwarks, and face mortality rates that will seem even more severe because of their extreme contrast with those we currently live with.
In the last 2 years alone snow and ice storms and equipment failures have brought regional disruptions to electrical power from east coast to west coast - many that lasted weeks and occurred during extremes of summer or winter weather.
A little discussed concern is that those more common seasonal disasters will not take a holiday during a global pandemic - and the pandemic will act as a force and duration multiplier to every ‘ordinary’ disaster that occurs within its term.
If anyone is choosing not to prepare because they think the risk is low, they should think about how often they see news of a regional weather-related disaster and then think about how it would be to face one if their community was operating on only 5 of 8 cylinders and without the help of surrounding communities’.
Posted May 22nd, 2007 at 5:44 pmKobie, you make excellent points about our being distracted, and not keeping our eyes on the most immediate threat. That’s why I address the `ho hum’ attitude about bird flu in the country.
To my mind, apathy may be as deadly as the virus.
Yes, I believe we do need to take the message to the people, and drum it in. I’ve already got next week’s entry prepared, and in that I present some ideas about how we can do that.
But your ideas are excellent. We need to create a preparedness meme in our nation, we need to make it `cool’ to be prepared. It should come second nature to us.
If advertisers can sell us millions of pet rocks, they should be able to sell us on the idea that being prepared, and alert, is a good idea.
Perhaps it will take a catch phrase, or jingle. “Safe, at Home” comes to mind. But we must change our priorities, and our collective consciousness, in order to really make a change.
Posted May 22nd, 2007 at 6:08 pmJoel, I do believe that most Americans believe `it can’t happen here’. The first thing people ask me is, “Is it in this country?”
When I tell them, “No, right now it’s in places like the mid-east, or S.E. Asia”, they relax. I then have to explain that once it acquires pandemic potential, it won’t matter where it starts. It will rapidly spread around the globe.
To many people, pandemics are a `third world’ problem. Getting past that mindset, and making people realize that a pandemic knows no borders, is a challenge.
I’m sure that there are concerns about sparking panic, and that tones down the message a bit. But I also believe that there is genuine concern that if the message to prepare is given too soon, and too stridently, and nothing happens within a few weeks or months, people will begin to think it was all a bunch of hype and stop listening.
You see that now, on some websites. Bird Flu is a `conspiracy’ to distract us from other issues.
You are correct that in this country, we hide death. People go to hospitals, or nursing homes, or hospices to die. In 1918, most people died in their own bed, surrounded by family. Not so, anymore.
For many, dealing with death (or even illness) will require a major adjustment reaction.
And finally, we do live on a violent planet. Earthquakes, hurricanes, floods, and all manner of natural disasters occur on a regular basis. We are currently in an `up-cycle’ of Atlantic hurricane activity after nearly 30 years of relative quiescence.
Growing up in hurricane country, and living a good deal of my life aboard a sailboat, I’m used to the idea of scanning the horizon for threats. It’s what has kept me alive for 53 years.
Should a pandemic arrive, and stick around for 12 to 18 months, there will undoubtedly be concurrent disasters around the country. Our ability to respond to those disasters will be degraded, and therefore, recovery efforts will take longer.
More evidence, as if we really needed it, that being prepared is the best policy.
Posted May 22nd, 2007 at 6:28 pmQuote from Kobie above:
If you are asking how to motivate people - please them. No not “Please prepare” but tell them how to be happy so they have a stake in the outcome. “Those who prepare suffer far less than those who do not. Here are some good ways to prepare. ”
I like this suggestion. Only problem I have with it is this: People aren’t even aware that they personally or their family and friends will SUFFER and possibly die in a flu pandemic.
People just do not understand what pandemic flu is. They think: “Oh, flu. So you feel lousy for a few days, stay in bed, drink lots of liquids, then you feel well enough to go back to work/school, and go at a slower pace for a couple of weeks. So, what’s the big deal?”
No, I think first before you can motivate people to help themselves avoid this disease or treat themselves at home (as soon as hospitals are over-run), first you have to educate them what this disease really IS.
How many parents of young children or teens understand that they could be watching their children gasp for air through bloody mucous for hours or days? How many know that the fever spikes very high and is hard to bring down, and what to do about that?
The answe is hardly anybody.
No, I think you have to be quite upfront and honest and educate people first to get their attention. Else they think it’s no big deal, so why are you bothering me with this?
Posted May 22nd, 2007 at 6:31 pmAt the very least we have to educate people that this is NOT ordinary flu. It is much more serious disease and will be life threatening to many, including previously healthy children, teens, and young adults.
We must get people to hear that this is serious, not “just flu.”
Posted May 22nd, 2007 at 6:42 pmJust questions here - Does determining what is for the greater good depend upon how close we are to experiencing the initial wave? Can we know when that will be with any certainty? I am still of the mind to give it wonderful, undeniable shout. I would hate to have people not know.
My fear is that if you couple a good shout with immediate grave illness there could be more panic than if we prepare, find as many to help as we can, and be ready with direction and answers when panic strikes.
Posted May 22nd, 2007 at 9:13 pmPlanning is essential, and the population should be made aware of the problems and risks if we do not prepare.
At school, we were taught “poor planning produces poor performance*. We could change it to “poor planning and preparation produces panic and poor performance”.
So those who suggest we should not advise the public, for fear of producing panic, need to return to school. Our problem now seems to be related to the “pandemic fatigue”.
Posted May 23rd, 2007 at 3:51 amPhil, I am not suggesting to not advise people but I am suggesting that there should be some local answers when the general public begin earnestly seeking guidance about how to prepare for their families.
There will be more trust when citizens hear this from their neighbors on the local level with locale appropriate responses.
We do need the validation from our federal government to move forward with this planning, telling the public to listen to us local planners.
When I told my SIL she wrote back saying ” I just can’t understand why - if all you say is true - we are not hearing about it. Yes, of course, there are snippets about what is happening abroad, but if the gov’t is truly advising us to stock up 3-6 months worth of food, why isn’t it on the 6:00 news - or on the front page of the paper? Are we supposed to be surfing the net to find out this information? It just doesn’t make sense to me. I don’t have time to argue about this either. So, let’s not.”
I am sorry to make this so personal, but it really is that personal at times.
Posted May 23rd, 2007 at 8:22 amFirst, thanks for reading my comments as I have read yours. Some of my posts will be right, some will be wrong and I look forward to your posts.
Second, low path H5N1 is in America. High path H5N1 is not. High Path H5N1 should be everyone’s concern for at least three reasons.
First I hope we find out what does and does not work in prevention and healing the H5N1 infection. The WHO and others are handling this part. However culling chickens culls a families food supply of chicken and eggs. Culling can only go so far. Some people in those countries rely on chickens for food because they can not buy food. Hence, those families have limited alternatives when the government culls their food supply.
Third: What happens when countries stop shipping food to us in order to feed their own people because so many chickens and pigs have been culled? Prices will go up. We can control price gouging in our country but not others. For example we can set limits on the price of gasoline but not the price of oil, oranges or wheat on the international market. When those prices go up, our farmers will sell over seas to make a profit. The price in our stores will go up. Yes, some of this food has to be grown in the souther hemisphere so we can have fresh food in the winter and vise versa.
Just the treat of a war will changes the futures market and the price we pay. Unlike 1918, our global economy is tightly interconnected like a spider web. Pulling on one part puts strain on the other parts.
Like Phil posted - poor planning produces poor results. Joel Jansen wrote “we may loose the bulwarks of modern medicine, wonder drugs and better hygiene and nutrition.” In 1918 cutting off water and electricity may have pushed them back 40 years to 1860’s. We have much further to fall - 140 years.
Now is the time to find out what works, what does not and prepare incase fuits and vegetables, coffee (eeek!) are cut off.
Posted May 23rd, 2007 at 8:56 amAs someone who wears both bldg mfmt and community affairs “hats” for an owner occupied non-profit headquaters bldg in NYC name 3 activities now, at this stage, i should be making sure I am involved in doing.
Posted May 23rd, 2007 at 10:11 amJohn, right off the bat, I’d say
1. Get the word out to the occupants of your building. Send them to www.pandemicflu.gov to start. Ask the local health dept. if they have any pandemic flu literature you could hand out.
2. Hold an owner’s meeting and discuss ways you can help each other in a pandemic. Perhaps see if you can get a speaker to come in, maybe from one of the flu forums, to help in the discussion. Identify risks that may be unique to your locale, and try to find ways around them.
3. If any of your occupants fall into an `essential worker’ category, and will likely be on call, or on duty, during a pandemic, find a way to `adopt’ their families.
Some people will have to make a choice between serving their communities, or staying home and protecting their families during a pandemic.
It won’t be an easy decision. In fact, it may be the hardest one of their lives.
Whenever possible, we need to find ways to protect the families of those serving and protecting us in a crisis. They deserve no less.
Of course, that’s just a start. But it will lead to other things that will become obvious as you proceed.
Posted May 23rd, 2007 at 11:25 amJohn Colligan/Building Mgmt
With a 60% death rate you may encourage people to discuss their final arrangements.
What will you do if all the people in an apartment get sick and pass on? Where will you ship their affects? Should you notify the other tenants? What happens when “family” members arrive to collect the property? How do you validate their identity? What if they are not the people but those left in charge because the people mentioned have died as well?
What will you do when people can not pay? They live pay-check to pay check and their job has been shut down for three months. This is likely for hourly workers at movie theater, some restaurants, etc.
What if one tenant starts raiding others for food because they are going to starve?
What if one tenant is sick and will not isolate themselves? They roam the halls and touch many things.
If trash pickup shuts down - where will people put trash?
If power fails - how will people cook?
Posted May 23rd, 2007 at 1:41 pmBad time for a fire.
Exceptionally well written, as usual. I just hope someone other than the dedicated few take the time to read the postings on this site.
Posted May 23rd, 2007 at 2:01 pmGrace RN,
If others do not take time to read our words this may be the most well documented failure to date.
My words here are good only because others have helped me hammer out the ideas. I thank those on NewFluWiki2, my family, a neighbor and my English teacher. Still there is more to said and worked out. Much more.
We are all going through this for the first time, we do not have to go alone nor without help nor without support. If it has not been lost, then remember “United we stand, divided we fall.” I believe in 1918 even some of the super rich could not find help.
Posted May 23rd, 2007 at 4:18 pmStanding Firm:
Yes, there will need to be answers from trusted local sources (governmental and community) when interest spikes. ( And interest will probably spike a number of times before the true beginning of a pandemic.)
Yes, it will help (would help right now) if what we say is confirmed and reinforced by official federal and state sources and public statements.
And no, we should not have to be grunging through media left-overs to glean either the significance or urgency of the pandemic threat. But then if the measure of an issue’s importance was the the level of media coverage, Anna Nicole would be our biggest worry. A better measure right now might be the level of concern and investment that we have seen by national governments and by global business interests (who rarely spend money on imaginary risks.) An example of the latter can be found in the Global Risk Report 2006, put out by the Global Risk Network/World Economic Forum.
At this point, everyone who is already informed, convinced and prepared needs to be planning for how they will sell their message when the public starts buying again. Think of it as infecting people with the urge to prepare. Each time you infect one other person, they will pass it along to others.
The the incubation period and transmissibility for this message of get prepared-get protected may be long and low right now, but when and if the virus moves, so will the message.
For some excellent ideas about how that message can be more effective, you might look at What to Say When a Pandemic Looks Imminent: Messaging for WHO Phases Four and Five by Peter M. Sandman and Jody Lanard
Posted May 23rd, 2007 at 8:00 pmThe Monster Under The Bed
Those of us in the flu forum world (Flublogia) wonder why the general population is not preparing for the next pandemic. Some speculate that we are too busy with our lives of collecting more stuff and entertaining ourselves with trivial pursuits of all varieties to pay much attention to a threat that admittedly may not materialize in the near future. Others believe that ‘the sheeple’ haven’t been told the truth by the awful ‘Powers That Be’. Still others blame the mass media for failing to cover the emergence of the H5N1 virus for fear of burning out their audiences and subscribers, and thus, loosing advertising dollars. So, more Paris Hilton and Anna Nicole.
I wonder if there isn’t a more subtle reason people are not preparing. I am speculating that an avian flu pandemic is the ‘monster under the bed’, the ‘Boogeyman’ – the same one that was under our beds when we were children.
I have two remembrances from my childhood that cause me to think so. The first is the remembrance of laying in the dark in a state of terror for fear that the Boogeyman was hiding under my bed in the dark. I thought that he only came out from under the bed in the dark, so I struggled with my fear, trying to gather the courage to jump off the bed and tear madly across the room to turn on the light before he got me. I never did turn on that light; I just fell asleep after awhile.
The second remembrance is that of asking where my father’s mother was – my paternal grandmother. I lived my early childhood with my maternal grandmother, so this was a natural question. My father told me that she died when he was very young and he had no remembrance of her. He never mentioned her, and never talked about his early childhood. My father was born in Philadelphia in 1916.
I only recently made a connection between the 1918 Flu Pandemic and my grandmother’s death because, throughout my years of formal education, there was absolutely no mention of it. It wasn’t until I read John Barry’s book “The Great Influenza: The Epic Story of the Deadliest Plague In History”, that I even knew there was a pandemic much less having knowledge of the severity of it.
Is it possible that the event was so horrifying that the entire human family repressed the event and buried it deeply into their subconscious? Most combat veterans I have known haven’t liked to talk about their experience. Could the pandemic of 1918 been so psychologically and emotionally horrific that it became a civilian equivalent of battlefield experience? For the civilian population, could it have become the monster under the bed?
In a similar way, is it possible today that more people are aware of the threat of an influenza pandemic than we are aware of? Mentioning avian flu at a social gathering certainly seems to be a social faux paux. It’s on the list of topics you don’t discuss - like politics and religion.
Perhaps having the courage to seriously examine the possibilities is the equivalent of having the courage to dash for the light switch. But, if you can just get to the light switch, the Boogeyman can’t get you, and your fears become manageable with taking action and with education.
If what I’m speculating has some merit then it’s clear that overwhelming people with frightening information will only drive the Boogeyman deeper into our collective subconscious. On the other hand, soft peddling the message will allow us to just fall asleep after awhile.
It seems to me the message should be twofold. The threat is real, but you are not powerless. You can turn on the light.
Posted May 24th, 2007 at 10:58 am“There are no precidents to put the words in the mouth of the presidents”-Sting. We have 1918 but the world is more populated and more complicated.
Joel Jensne (P#27) Thanks for the website. Forming a message to the people now is difficult IMHO becuase not all the piecs are out. Along with quarantine, marshal law, SIP, school closings what about Blood drives? What message should be sent.
What message should be sent about”All regularly scheduled disasters will happen on time during a pandemic.” Hurricanes, floods, tornados, earthquakes, snowstorms, wild fires, droughts, etc., etc. will happen like they always do. They will not take the pandemic off. One must be prepared not only for the pandemic but a natural disaster with little chance of rescue.
Unlike the news, these are warnings. How do we keep the deaf and blind up to date and involved? There is not much closed captioning on the radio. Text messages on TV do not work well for the blind or when the power is out.
Now would be the time to find a solution.
Posted May 24th, 2007 at 11:04 amI have heard it said so many times that our message for pandemic preparedness is being overshadowed by a jaded public glued to American Idol and Survivor.
Recently, AmerIdol sponsored a highly successful charity, “American Idol Gives Back.”
Is there some reason why the federal government can’t make use of this kind of audience attention and ask American Idol to present pandemic info as part of its message? Or Survivor - what more appropriate venue? Survivor helps US population prepare to survive?
I believe that these two shows would jump at the chance to do something to help save their countrymen. It will cost them little, and they can even solicit sponsors of preparedness products specifically for these shows.
In the course of an hour or two, MILLIONS of Americans, including young people who are most at risk, will be given the message that a pandemic is threatening us.
An 800 number on the screen, plus a website addy directing people to get more information on pandemic planning and preparation would reach millions of unprepared households.
If you choose to use the pandemicflu.gov website, then the home page should have a direct link (with show logo) citing AmericanIdol or Survivor TV shows so people will immediately recognize the link.
Most importantly, though, the information MUST be clear, non-wishy-washy and direct. Worst case scenario descriptions must truly be worst case, based on what we now know of H5N1’s current capabilities. Even using statistics from 1918 might not be the next pandemic’s worst case. We need to say that too.
A phone call from Secretary Leavitt’s office or Homeland Security to AmerIdol and Survivor’s producers would probably be enough to get them on board.
In the interest of raw patriotism, I simply cannot imagine them turning you down.
SaddleTramp
Posted May 24th, 2007 at 11:15 amJohn Colligan:
Some useful resources on pandemic preparedness relating to commercial buildings can be found here:
www.boma.org/Advocac…
I know the BOMA Toronto Workshop Report from March of 2006 on Addressing the Threat to Commercial Buildings of an Avian Flu Pandemic is available online here: www.bomatoronto.org/…
As is the IFMA Foundation Pandemic Preparedness Manual:
Posted May 24th, 2007 at 2:23 pmwww.ifmafoundation.o…
I see two housing-related issues that are not being addressed in any public forum.
1. What can we do to prepare for the continuation of food, healthcare and supervision to populations living in congregate settings (everything from homeless shelters to nursing homes to domestic violence shelters and treatment facilities)? Will the entire facility be quarantined if one resident becomes ill? What about staff? Will they be locked out of the facility–or locked in? What if there are simply too few staff to preserve the health and safety of elderly, disabled, homeless,or other special populations? Who is responsible for planning for such a catastrophe? Each individual facility? Local government? Federal? will we have the National Guard toileting the elderly or passing out psychotropic medications to persons with mental illnesses?
2. Beyond this issue, how can we successfully and ethically quarantine extremely low-income households in their own homes? We know that nearly all households at 30% or less of Area Median Income are spending as much as 80% of their income on rent and utilities. Many have no paid leave at their jobs. If they are quarantined, will they be evicted? Would they truly stay home if they can’t earn enough to pay the rent? Perhaps we need pre-emptive laws that forbid filing evictions on any household under quarantine if they are financially needy? Or some source of public funds to pay the rent for such households? Or provisions that low-wage workers under quarantine will receive paid sick time, whether or not the employer normally offers it? (That employer might make a claim later for reimbursement from public funds.)
Does anyone know of a community that has addressed these issues?
Posted May 24th, 2007 at 3:56 pmI have been interested in the development of therapies and vaccines for use in the event of a pandemic for the past few years. Sometimes the answer to many problems stares us in the face but we don’t realize it. Recently during my research I was introduced to a book about the use of ultraviolet light from back in the 40’s and 50’s that was proven to irradicate viruses. Unfortunately just as the technology and treatment was being excepted by the medical community, antibiotics and vaccines were introduced and as fast as it was being excepted it fell out of favor.
Recent research of ultraviolet light suggests that a vaccine can be safely made from a subjects own infected blood, that when reinfused to the body causes the immune system to respond.
From what I read about the technology in the book and in various sites on the internet, it appears that this old world technology could be the answer to a new world pandemic.
The point I am trying to make is that reserachers and gov. agencies need to look “outside the box” to have any chance of controling a pandemic.
Do any of the commentators know about this type of technology and if it has been considered?
Posted May 24th, 2007 at 4:45 pmSarah comment #8:
Try these sites:
Latter Day Saints-look under Home and Family-then Provident Living
www.providentliving….
and look under Pandemic Preparation, family and personal:
www.fluwikie.com/pmw…
Hope it helps.
Posted May 24th, 2007 at 8:58 pmMarge-comment #32
What about the newly orphaned children?…
I see a repeat of Katrina-but to the 10th+ degree. If neighbors, service groups, churches etc don’t step in and help, I feel that the death rate will triple-at the bare minimum.
Posted May 24th, 2007 at 9:04 pmYou point out that “Margaret Chan, the Director-General of the World Health Organization, called bird flu the greatest global health threat of the 21st century”. You would never guess that a pandemic flu was a threat at all based on the PA Department of Health’s response to it. If you look at their official web site (www.dsf.health.state…) the word “pandemic” doesn’t even appear on the front page.
The PA Dept. of Health is conducting a pandemic flu seminar in Franklin County, PA on June 18th, but I had to call the County Emergency Services Coordinator to find out about it. (And of course, no reference to this seminar is found on the Health Department web site!)
Given this kind of response at the State level, is it any wonder that local governments or their citizens do not know or care? Something is seriously wrong with the risk communication that is occurring.
Posted May 25th, 2007 at 6:21 amJohn, I suspect the problem is `paralysis by analysis’.
If this were strictly a public health issue, then it’s a no-brainer. Everyone should be prepared, and should be prepared now. Simple.
But when the govt. begins looking at the ramifications of telling the nation to prepare, certain problems crop up. And there aren’t any really good solutions.
Can the supply chain handle it, if tomorrow PSA’s appeared on the TV urging everyone to have 2 weeks (or more) of food in their pantry?
What happens when grocery store shelves are quickly wiped out? Will that induce panic?
You may not remember this, but in December of 1973, during the oil shocks, Johnny Carson made a joke on the Tonight show about an impending toilet paper shortage. One line, tossed off-handedly in his monologue.
The next day millions of viewers went out and bought up all the toilet paper off the shelves. Within hours, we really did have a toilet paper shortage!
That night, Carson went back on the air to say it was just a joke, folks. But it was too late.
People could see the shelves were bare, and the moment a new shipment arrived, it was gobbled up by the first few customers. People were wheeling entire shopping carts of toilet paper out of the store.
It took 3 weeks to restore things back to normal.
Imagine that happening with canned foods, or rice, or beans, or whatever else you might expect to find on the shelves.
If tomorrow, 30 million families decided to stock up, there would be 70 million families staring at empty shelves. People would literally go hungry, or at least be badly inconvenienced, and there would be outrage and a political price to be paid.
So I appreciate the government’s dilemma here. They want us to prepare, but they have legitimate concerns as to how best to do it, without causing unwanted side effects.
Now, that said, I think we do need to get the word out, and we do need people preparing. We can’t dither about this forever, for at some point, we will run out of time.
But no one should think it’s an easy decision, or one that can be made without consequences.
As far as the PA State Health Dept not having pandemic information readily available, I find that curious. Most states at least mention it.
Posted May 25th, 2007 at 9:50 amSide effects,
There are side effects to acting and side effects to not acting. We get to decide which batch to pull from.
I like your Johnny Carson example. It shows how little things mean a lot. Just look at the problems political candidiases have in making simple remarks. Orson Wells doing “War of the Worlds” is where the side effect of doing a realistic radio show being taken for fact was demonstrated.
I also understand the risk of “Crying Wolf.” That if the pandemic does not come quick enough people will ignore the warning signs of “Bad Wolf” out there. They will stop listening - which means the message will have to change. As C Mundy Said in P#28 ” people will have to stop collecting more stuff and entertaining ourselves with trivial pursuits of all varieties” and listen. Which is Anna Nicole smith is so entertaining, why not use entertainment. The show “Survivor” was popular. No one want to get voted off the planet. Where is Bert Gummer when you need him.
I know the use of T-shirts and School House Rock like videos has been brought up before. Perhaps the use of YouTube is dangerous because any bad piece of advice can be distributed. If it where, it would be corrected. Just like if the government gave out bad advice it would be corrected. Just like the WW-II survival manuals where corrected over the years when people actually tried them.
If families buying supplies is a problem, then let it happen now before the pandemic. As you said “If we can be sold millions of pet rocks why can’t they sell us on preparedness” - IMHO profit. BTW, one guy built a pet rock cemetery and made money. I kid you not!
Here is the take away - field test the plan. Keep the message up to date. Lots of groups have existed for decades with a few simple messages. People hear and follow the message. Most people want to know what to do. Look at HG TV, Survivor Man, Flip That House, etc.
It is not always the action. Gambling 5 days a week for 10 hours a day is a problem only if you are not making $120K + a year at it.
In using our time wisely, I hope the government will help with testing and advice on what does and does not work before, during and after a pandemic. If not, others will come up with their own solutions of what they think works.
Hopefully this is a wis use of time. It is a beautiful sunny day outside and we are in here typing away.
Kobie
Posted May 25th, 2007 at 12:36 pmMichael Coston, I wanted to take time to thank you for your integrity, character, and honesty, and for trying to get the right things done to mitigate a deadly pandemic influenza year’s impact on families and society.
All the best to you, and the others commenters who are trying, in the face of incredible odds, to keep history from rhyming quite so much.
Posted June 6th, 2007 at 7:28 pm