Tuesday, March 25, 2008

March 25 Flu Update

The New York Times on one of the key questions of all...who will get ventilators during a pandemic.

But in an epidemic, there could be a severe shortage of machines and, more important, doctors and nurses to run them. At that point, the new report says, doctors and hospitals would have no choice but to start taking some people off the machines so that others could live.

Removal “is absolutely the crux of the problem,” said a lead author of the study, Dr. Tia Powell, who has spent much of her career studying medical ethics. “There are people who might survive who won’t get a chance at a ventilator if someone who is likely to die even with a vent is using it.”


Don McNeill of the New York Times also writes on what is going on in Indonesia.

The US is launching a flu stockpile in Thailand.

CIDRAP on the Asian stockpile, which makes some sense (especially if you believe in the containment strategy) and has been talked about for a long time.

Indonesia details bird flu losses in financial terms.

Apparently, another outbreak in West Bengal.

Outbreak in West Bengal continues to have impact.

CIDRAP on the recent flu exercise at CDC.

"What we recognize is that in the midst of a large event, there's a tyranny of the urgent that overcomes the groups, where there's a constant need to respond and react," Jernigan said. "And we felt it was vitally important to have a group of people that were removed from the constant pressure of the urgent so they could have a thoughtful approach to the development of policy on the fly."


Revere blogs on what is going on in Indonesia--once again, they are doing the right thing in the wrong way.

Germany says it is bird flu free. Who asked?

Orlando paper says we are overdue for a pandemic--likely a disaster.

2 Comments:

At 9:21 AM, Blogger Dreamer said...

Donald McNeil wrote a similar article about the ventilator shortage 2 years ago. About the time I first saw his article (about a year ago) I thought I would try to do something about this problem if I could. Usually we can not rely on governments and bureaucracies to properly plan and prepare for high impact but low (in the immediate term) probability events such as a pandemic (or New Orleans flooding). It does not have a good political payback. My solution is a more grassroots approach.

During the polio epidemic, ordinary people built ventilators to save the lives of children afflicted with paralysis to save those lives when they ran out of commercially made iron lungs. Popular Mechanics even published plans to build them in their edition of January 1952. Modern ventilators may seem to be incredibly complex devices, but to an engineer they are just a collection of valves, sensors and a control system. Even commercially made ventilators from 1952 had very basic control systems. In 2008 we can use a modern industrial controller (PLC) to control ordinary valves, and construct a ventilator that is reliable and can perform many of the functions with the safety alarm systems that many commercially available ventilators have. Most of the hard stuff is in the software that is easily and cheaply reproduced once it is developed.

The Pandemic Ventilator Project (www.panvent.blogspot.com) is working on a design that will allow people to build ventilators even after a pandemic begins using PLCs, ordinary solenoid valves, piping and plastic bags. Please have a look at the site. Every time this issue comes up, I hear the same story, "there will be a massive shortage, we need more ventilators, they are too expensive, nobody buys them".

The situation has not fundamentally changed in the 2 years since McNeil's article. There was a shortage then, there is a shortage now. I think my project is a rational way to at least partially solve this problem. It is however, small,unfunded, and little known. It has not gotten the attention of any of the major planning groups.

 
At 6:42 PM, Blogger Wulfgang said...

Orange;

What more can be said about the dire situation created by limited number of ventilators, that your first article doesn’t already point out: a severe pandemic would force hospitals and the medical staff to make gut wrenching decisions. A sick individual who has the best realistic chance to survive will most likely be given access to a ventilator, while those who unfortunately possess or manifest medical “exclusion criteria” (cardiac problems, cancer, severe burns, organ failure, or other severe chronic problems), would probably not ever see one. This makes perfect sense to me, providing there are uniform published guidelines and they are consistently and fairly applied, during the national emergency. Without rules and established procedures for ventilators, hospitals better seriously arm themselves – the first guy who has a loved one who is dying is gonna pull out his equalizer.

I found “Dreamers” comment about his Pandemic Ventilator Project quite fascinating and accurate. Tip: he/she should phone 281- 483-3809, and they might get some valuable technical assistance (and interest in building an inexpensive prototype model). There is currently a “revolution” going on with computer powered devices or software programs, that enable technology breakthroughs in everything from medicine (physical enhancers, bionics) to manufacturing. The “da Vinci system”, for example allows doctors to operate on patients tele-remotely with exquisite precision. Inexpensive and cutting edge multicore chips produced by Intel and AMD, provide plenty of processing power to easily handle the multi-computing tasks of an inexpensive ventilator.

I found your “US officials launch bird flu stockpile in Thailand” article rather interesting: this is apparently the first of three (sizable) US funded supply stockpiles popping up in the Asia area. I wonder how many stockpiles of similar decontamination suits and specimen kits exist in the US, and where are they located ? Very interesting that our government will openly supply this information and provide assistance to foreign countries, but not divulge any of this same information to its own citizens. My guess as to what is prompting this sudden assistance, is the following statement from the CIDRAP article: “FAO said…high viral loads circulating among birds in Indonesia are creating fertile grounds for H5N1 mutation”. (this is the first time I have seen this concerning statement from the FAO publicized – unless I’m losing my mind).

Finally, in your Orlando Sentinel article, there is this alarmist (but accurate) statement from the 96 year old resident whose father was killed by the Great Influenza Pandemic of 1918: “the world doesn’t know fear and fright any more”. A pandemic on the scale of 1918, or worse, could in fact occur at any time, given the deplorable state of H5N1 conditions in China and Asia. There is actually very little anyone can do to stop it.

The fact that the CDC has “designated a special team of influenza, quarantine, healthcare quality, communications, logistics and legal ‘specialists’ to assist staff members actively engaged in a simulated emergency pandemic exercise”, because there is a “tyranny of the urgent that overcomes the groups” – is extremely discomforting. This can be definately interpreted to mean that the front line workers of the exercise have the responsibility to run the exercise, but are not being empowered with the authority to make real time decisions, and that the real decision makers are the “special team”, or the “over-seer’s”. This scheme shows a terrible lack of confidence. The CDC should take note this simple observation: all 50 states and their EOC’s, including key government agencies and the DOD representing regions of the US should be mandatory participants of the exercises; and there should be a clear well-understood chain-of-command and authority that everybody recognizes.

During a real national pandemic emergency crisis, a “special CDC team of overseer’s and decision makers” will end up pretty much worthless and non-value added – just a bunch of bureaucrats covering their behinds, in my view.

Wulfgang

 

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