Tuesday, February 28, 2006

The Flu Roundup Inspired by "The Doctor of New Media Hugh Hewitt"

Hugh Hewitt did a very thorough and thoughtful interview with an Howard Backer, MD, MPH. one of the Chief Medical Officers State for the State of California when he had him as a guest: I really wanted to ask 2 questions
A.) About the Shortage of ventilators B.) Some people say tamiflu may not Work so well?
  • Michael Osterholm, MD, an infectious disease expert and Department of Homeland Security official, cautioned earlier this week. The infection causes the body to release a rush chemicals that attack the immune system, and there is little evidence showing how well Tamiflu can stop or lessen the release, he told reporters.
  • "Frankly we just don't know," Osterholm said.
  • The antiviral drug being hurriedly stockpiled by governments worldwide may not be reliable protection against bird flu, a U.S. preparedness official warned Tuesday.
  • Experts have long said that Tamiflu is not a cure for bird flu, but the drug could help slow the severity or spread of the disease in the event of a human pandemic. Governments have rushed to order stocks, prompting a worldwide run on the drug and criticism of its manufacturer for apparent refusal to share its patent with generic drug makers.
  • But even that assessment may be overly optimistic, Michael Osterholm, MD, told reporters Tuesday. Osterholm is associate director of the National Center for Food Protection and Defense within the Department of Homeland Security. Questions of Effectiveness
    "I believe that antiviral drugs really represent a tool, a limited tool," said Osterholm, who is also director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "What we don't know is if Tamiflu will work."
  • Tamiflu and similar drugs can mitigate flu severity and slow disease spread — if it is taken within 24 hours to 48 hours of infection. The drug has been shown to have some effectiveness against H5N1, the viral strain that has sickened more than 120 persons and killed more than 60 in Southeast Asia.
  • Studies have suggested Tamiflu has some effectiveness against H5N1, but little real-world data show whether it is effective in infected humans,
  • Osterholm said."People like myself are often seen as scaremongers," he said, "but I'm afraid we are doing this all over again.''
  • Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, warned in his Nature paper of the economic consequences of a major pandemic.
  • "The world today is much more vulnerable to the collapse of trade than it was in 1918,'' he wrote. He dubbed the potential economic fallout "pandemic shock.''
    Osterholm wrote that an H5N1 pandemic strain could rival the devastation of the 1918 pandemic. Industrialized nations reliant on "just in time" delivery of health care goods do not have enough medical supplies to care for the sick. "Nor are there detailed plans on how to handle the dead bodies whose numbers will soon outstrip our ability to process them,'' he wrote.

  • Dr. Michael Osterholm, Director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, and a leading advocate of pandemic preparedness, uses these numbers for his estimate:
    Global Population (2005)
    Clinical Attack Rate
    Case Fatality Rate
    Global Death Toll
    6.6 billion
    180 million
    6.6 billion
    360 million

    Regardless of what the eventual death toll is, it is only a fraction of the damage a pandemic would wreak.
  • Council on Foreign Relations Conference on the Global Threat of Pandemic Influenza, Session 5: What Would the World Look Like After a Pandemic

  • H5N1 A Harbinger of things to? Come by Dr. O

  • Preparing for the Next Pandemic

  • What Would the World Look Like After a Pandemic? page 24 or 113(36 of 100)

  • We have no detailed plans for staffing the temporary hospitals that would have to be set up in high-school gymnasiums and community centers — and that might need to remain in operation for one or two years. Health care workers would become ill and die at rates similar to, or even higher than, those in the general public. Judging by our experience with the severe acute respiratory syndrome (SARS), some health care workers would not show up for duty. How would communities train and use volunteers? If the pandemic wave were spreading slowly enough, could immune survivors of an early wave, particularly health care workers, become the primary response corps? per Dr. Olsterhom

  • Health care delivery systems and managed-care organizations have done little planning for such a scenario. Who, for instance, would receive the extremely limited antiviral agents that will be available? We need to develop a national, and even an international, consensus on the priorities for the use of antiviral drugs well before the pandemic begins. In addition, we have no way of urgently increasing production of critical items such as antiviral drugs, masks for respiratory protection, or antibiotics for the treatment of secondary bacterial infections. Even under today's relatively stable operating conditions, eight different antiinfective agents are in short supply because of manufacturing problems. Nor do we have detailed plans for handling the massive number of dead bodies that would soon exceed our ability to cope with them. Dr. O?
  • Overview article from M.. Osterholm, M.D.
  • 10 Thinngs you need to know about Pandemic Influenza from World Health Organization?
  • Influenza viruses can easily swap genetic material when two of them infect the same host. This exchange is called "reassortment." The pandemics of 1957 and 1968 were caused this way.
    Prior to 1997, pigs were thought to be the mixing vessel for reassortment of viruses, because the cells of their respiratory tract have receptors for both avian and human influenza viruses. The reassorted virus could then pass from pigs to humans. But in the Hong Kong event, research indicated that the virus jumped directly from birds to humans - direct infection with a purely avian influenza virus. (Most human cases could be traced to direct contact with poultry.) It also meant humans also could serve as the mixing vessel for the exchange of virus genes.
  • Economist overview of an Avian flu Pandemic

"The Doctor of New Media" Hugh Hewitt has provided a wonderful public service to us and thanks to him this blogging M.D. is on this issue and trying to make the info digestable! No Tums needed, Hopefully!

Thanks for reading and as always Dominus Vobiscum (The Lord be With You)!
Francis Yubero


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