Sunday, December 03, 2006

December 3 Flu Update

The UK is planning a massive bird flu exercise, involving thousands of people working on the assumption that the country is "closed off" due to the flu.

At the Mali bird flu meeting next week, a major outcome will be to seek more $$--and to ID Africa as the weak link in flu prep.

The Cull in South Korea is up to 771,000 birds.

Now the Irish are concerned about the shelf life of their pre-pandemic vaccine stockpile.

Israel is helping Palestinian vets fight the bird flu.

The World Bank has a good insight--if you are going to fight the bird flu, farmers need to know they will get prompt and fair payments.


Though we feel helpless before the uncontrollable power of the influenza virus, we are far ahead of where our forefathers were in 1918. Revere comments.


Guam is conducting bird flu surveillance.

Interesting blog post from a student midwife. Apparently, a physician's group had adopted a position that hospital births were the best way to go. A number of groups objected, some citing pandemic flu as a reason. I had never thought of this, but for a routine birth, a hospital in a pandemic is the last place you would want to be.

Finally, we are distressed that this statement is published at a time when the public health system is preparing for pandemic influenza. The National Pandemic Flu Plan calls for hospitals to develop ‘surge capacity’ plans to maximize their capability to care for seriously ill patients, and create alternative care sites for routine care. Specifically, the plan calls for health systems to explore ways of “increasing the role of home care, and developing off-site care facilities.” It seems likely that in an influenza pandemic, a hospital bed – in short supply and in close proximity to those ill with a virulent virus – may not be the safest place for healthy women to give birth.
Bird flu and its blogging effort was written up on the DailyKos, too.

5 Comments:

At 8:33 PM, Blogger Wulfgang said...

Orange;

Quite a few articles you have today, very impressive cadre of good sources and selections. You never cease to amaze me with your diligence.

On "Belly Tales - The Diary of a Student Midwife"... my comment is simply this to Katherine: in view of our litigious society, the best of luck with your venture. In my opinion, the ACOG is compelled to take the shortest and safest answer regarding out-of-hospital births due to lawsuits. To do otherwise is a personal injury attorney's dream come true. Follow the money.

The International Herald Tribune article about the U.S. government looking in the wrong place for bird flu has a very important message that our policy makers need to pay attention to. It seems a most recent study published in the National Academy of Sciences reveals that H5N1 spreads three ways: by poultry trade, migratory birds, and by both methods. What a surprise. I imagine the taxpayers paid several hundreds of thousands of dollars (or millions) for this piece of work. I think we need more study groups, to review the findings of this study, then we can set up some committees to assess the study groups. That will get us somewhere quick. We have well over 10M undocumented aliens living in the US and Canda and we think we are going to curb or police the poultry trade in North America ? I got an original idea, let's build a fence.

Switching to the article on needing more money to combat the spread of bird flu, the World Bank and the U.N. say about $ 1.8 B more money is needed. This money will mainly be spent in Asia and Africa. Although this will sound uncharacteristic of cheapster Wulfgang, this money is necessary. Compared to the money we are dumping down the Iraq rat-hole, this is actually cheap insurance. Most of this money will undoubtably be paid to reimburse poor peasant poultry farmers. We could call this $ 1.8 M insurance money: "Bird-Farm", "Bird-State" or even "GEI-Bird". Even "Mutual of Bird-maha" would work.

I see Britain has plans to conduct an extensive giant bird flu outbreak exercise, that will include stopping people from entering exclusion zones and emergency centers. Excellent ! Government experts cite in the article that up to 7 M Britons could die in a major outbreak. This humongous number alone is adequate incentive for everyones cooperation. I doubt the U.S. could successfully pull this kind of mammoth excercise off though. Most people in the U.S. would scream that their civil liberties were being violated and attempt to call the personal injury lawyers above. I'm sure some sort of avian flu "profiling" would also be asserted. So that wouldn't work here.

And finally the very best of all: Flu Stories - The Citizen Communication Project article submitted by DemFromCT. I busted out laughing when I read the subtitle for the project called "Public Engagement Project on Community Control Measures for Pandemic Influenza" (aka, The Public Engagement Project). It talks all about stakeholders and the four emerging themed objectives. This is government speak for q-u-a-r-i-n-t-i-n-e. Get used to the concept, "quarantine" is in for 2007, "social distancing" is clearly out.

And government spys infiltrating the bird flu tracking blogs ?... RepFromDC says - who knows ? They never solved who was on the grassy knoll and how many shots were fired.

Wulfgang

 
At 10:05 PM, Blogger Orange said...

Wulfgang, thanks for the kind words. It is my pleasure. Meanwhile, was that spy thing too much, or what?

 
At 10:47 PM, Blogger Wulfgang said...

Orange;

Yes, too much. Reminds me of an old poem I learned as kid on the Farm.

"Here was an old owl lived in an oak,
The more he heard, the less he spoke,
The less he spoke, the more he heard,
Oh, if men were all like that wise bird . "

 
At 11:36 AM, Anonymous SNM said...

I know this is a blog about bird flu, but I followed the link and felt compelled to say something in response to your comment, Wolfgang.

"On "Belly Tales - The Diary of a Student Midwife"... my comment is simply this to Katherine: in view of our litigious society, the best of luck with your venture. In my opinion, the ACOG is compelled to take the shortest and safest answer regarding out-of-hospital births due to lawsuits. To do otherwise is a personal injury attorney's dream come true. Follow the money."

Homebirth for a healthy, low-risk pregnancy when attended by a skilled attendant is not unsafe; many studies have proven this, even though ACOG has chosen disregard many of these studies for several of the reasons cited in Comacho-Karr's letter (see the link I posted to the BMJ study).

Litigation rates ARE very high for obstetricians, but very few obstetricians deliver in homes, so these cases are being brought against them for work they're doing in a hospital, not in a home. Moving all low-risk births to the hospital will do nothing to stem the rising litigation rate. Homebirth cases very rarely go to court; homebirth patients very rarely sue, and midwives often get sued less than obstetricians. This is perhaps because homebirths attended by midwives are almost always low-risk v. the high risk cases handled in hospitals, but also perhaps because of differences in the *type* of care given in a home v. a hospital setting.

I think ACOG's statement has a lot more to do with *control* over who does and does not deliver babies than with litigation issues. Evidence based medicine demands that research provide the foundation for policy. More research needs to be done on the safety and efficacy of homebirth, and I feel that the ACNM has done the right thing in reaching out to ACOG and pushing for increased collaboration and research on this subject. ACOG would be foolish to turn down this offer. Refusing further research on a subject is like like laying down policy and then sticking your head in the sand.

Homebirths will continue to happen in this country; no ACOG statement in the world is going to erradicate the practice, and it's important to remember that a large majority of the world still delivers at home (and not just the developing world; 60% of all births in England are attended by midwives, and the majority of births in Holland occur in the home). In the US, it's unfeasible to think that all births can be moved to hospitals. Once this has been recognized, then issuing a cross-the-board policy like this suddenly seems tantamount to turning your back on a percentage of women who are still deserving of the best quality of care possible, even if they choose to birth at home. When obstetricians refuse to collaborate and back-up homebirths, women are left with fewer options. Licensed practitioners like certified nurse midwives, certified midwives and certified professional midwives who collaborate with physicians to provide care to low risk women desiring homebirth will not be able to continue to legally provide this care if obstetricians refuse to sign their practice agreements. This will then drive the women seeking homebirth into the hands of practitioners who might not be as skilled or knowledgeable--not at all ideal if the goal is to provide the safest care possible.

When a low risk women laboring at home is recognized as needing to be transferred to the hospital, she deserves a smooth, seamless transfer and a continuity of care that can only be provided by support for the practice of homebirth and collaboration. By turning its back on homebirth and refusing to support it, ACOG is essentially driving a small percentage of women to seek unprofessional, unlicensed attendants, or to deliver without an attendant--in essence, creating a self-fulfilling policy by forcing homebirth to become unsafe. Right now, as it is, homebirth for low risk women when attended by a skilled practitioner can be a very safe, very intimate, and very joyous experience.

 
At 11:39 AM, Anonymous SNM said...

I know this is a blog about bird flu, but I followed the link and felt compelled to say something in response to your comment, Wolfgang.

"On "Belly Tales - The Diary of a Student Midwife"... my comment is simply this to Katherine: in view of our litigious society, the best of luck with your venture. In my opinion, the ACOG is compelled to take the shortest and safest answer regarding out-of-hospital births due to lawsuits. To do otherwise is a personal injury attorney's dream come true. Follow the money."

Homebirth for a healthy, low-risk pregnancy when attended by a skilled attendant is not unsafe; many studies have proven this, even though ACOG has chosen disregard many of these studies for several of the reasons cited in Comacho-Karr's letter (see the link I posted to the BMJ study).

Litigation rates ARE very high for obstetricians, but very few obstetricians deliver in homes, so these cases are being brought against them for work they're doing in a hospital, not in a home. Moving all low-risk births to the hospital will do nothing to stem the rising litigation rate. Homebirth cases very rarely go to court; homebirth patients very rarely sue, and midwives often get sued less than obstetricians. This is perhaps because homebirths attended by midwives are almost always low-risk v. the high risk cases handled in hospitals, but also perhaps because of differences in the *type* of care given in a home v. a hospital setting.

I think ACOG's statement has a lot more to do with *control* over who does and does not deliver babies than with litigation issues. Evidence based medicine demands that research provide the foundation for policy. More research needs to be done on the safety and efficacy of homebirth, and I feel that the ACNM has done the right thing in reaching out to ACOG and pushing for increased collaboration and research on this subject. ACOG would be foolish to turn down this offer. Refusing further research on a subject is like like laying down policy and then sticking your head in the sand.

Homebirths will continue to happen in this country; no ACOG statement in the world is going to erradicate the practice, and it's important to remember that a large majority of the world still delivers at home (and not just the developing world; 60% of all births in England are attended by midwives, and the majority of births in Holland occur in the home). In the US, it's unfeasible to think that all births can be moved to hospitals. Once this has been recognized, then issuing a cross-the-board policy like this suddenly seems tantamount to turning your back on a percentage of women who are still deserving of the best quality of care possible, even if they choose to birth at home. When obstetricians refuse to collaborate and back-up homebirths, women are left with fewer options. Licensed practitioners like certified nurse midwives, certified midwives and certified professional midwives who collaborate with physicians to provide care to low risk women desiring homebirth will not be able to continue to legally provide this care if obstetricians refuse to sign their practice agreements. This will then drive the women seeking homebirth into the hands of practitioners who might not be as skilled or knowledgeable--not at all ideal if the goal is to provide the safest care possible.

When a low risk women laboring at home is recognized as needing to be transferred to the hospital, she deserves a smooth, seamless transfer and a continuity of care that can only be provided by support for the practice of homebirth and collaboration. By turning its back on homebirth and refusing to support it, ACOG is essentially driving a small percentage of women to seek unprofessional, unlicensed attendants, or to deliver without an attendant--in essence, creating a self-fulfilling policy by forcing homebirth to become unsafe. Right now, as it is, homebirth for low risk women when attended by a skilled practitioner can be a very safe, very intimate, and very joyous experience.

 

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