Thursday, April 03, 2008

April 2 Flu Update

Very interesting story from Korea about bird flu crossing the species barrier to dogs, and then go from dog to dog.

A cocker spaniel and a miniature schnauzer were among dozens of dogs in South Korea sickened by an H3N2 strain from birds, researchers said in a study published in the May issue of Emerging Infectious Diseases journal. Viruses taken from the sick canines were used in an experiment later to see if pathogens were capable of spreading from dog to dog.

Revere blogs this as well.

And there are other bird viruses that might also get into dogs or other companion animals. It's about time a serious, systematic investigation and any indicated surveillance of many more animal species got underway.

This story won't go away--Hong Kong expert says surveillance can prevent a pandemic.

Bird flu is reported to be abating in Vietnam.

The Chinese have an approved human bird flu vaccine.

A report from India says that there is confusion over culling numbers.

There appears to be an avian outbreak in South Korea.

China has banned poultry FROM Turkey.....

The US visits India, says flu is transnational concern.

Bird flu in Bangladesh described as "war footing."

Fascinating Revere post. Can healthcare workers be forced to go to work during a law? Interesting. I know some people in healthcare---I'd like to see you try. Anyway, the implications are there for docs, too. When you become a doctor, do you give up the right to say no during a pandemic?


At 6:48 PM, Blogger Wulfgang said...


Probably one of your most interesting and provocative articles you posted today, is the excellent EM Revere post entitled, “Penalties for health care workers who don’t show up in a pandemic?”. Most all of us have had the opportunity to read about this topic for several years now on numerous blogsites, and have been exposed to the excellent various opinions and positions on the subject.

Without a doubt, regardless of what kind of state or federal punitive legislation is passed, or even what the health care associations or medical ethicists say – health care workers themselves will make the final decision whether to report for work, based on how protected they feel they will be, if they have adequate PPE and resources, and if their families are safe. It’s all a matter of personal risk and disease severity. Even a Supreme Court ruling can’t make someone do what they choose not to do. Threatening HCW’s with sanctions, imprisonment, fines and penalties, or loss of certification, or loss of employment, simply will not work: however, institutionalizing proper incentives and by providing supportive enabling resources absolutely increase the likelihood of success.

There are solutions out there to this dilemma. One remedy is for the HHS, DHS, CDC, Congress and the President (Directive, perhaps?), to enact health care and worker legislation immediately to mandate that every government agency and every employer in the US must be required to designate who are “essential personnel” (fire protection, facility maintenance, security, IT, medical, etc) to maintain their infrastructure operations, in the event of a potential massive crippling disease pandemic. Then they must be required in advance to stockpile the necessary equipment, supplies, protection for immediate families of those individuals, compensation packages and incentives, for a certain length of time. Federal and state funding assistance must be provided, if necessary. This information must then be published to all employees, so they know and agree what the “expectations, behavior, and agreement” are, and what is not acceptable. This is exactly what my employer has done, and virtually every single employee where I work, knows where they stand, in advance, and if a pandemic were to break out next week. Those individuals who are not on the “essential personnel” list, know this in advance and have been told that they should stockpile one to two months worth of supplies, minimum. Many have done exactly this, however many more have not and if something happens, they are SOL. That’s their choice. We have been fairly warned and I feel fortunate.

Granted, this approach would be expensive, no getting around it. However, the total cost would be a drop in the bucket, as compared to how much of our national GNP we are literally throwing down the rat hole called “the war in Iraq”. While a deadly influenza pandemic is totally unpredictable in nearly every known aspect, there are certain things we as a nation can and should be doing in preparation.

Waiting until we are smack in the midst of a national health emergency and gambling on how many health care workers, firemen, law enforcement, IT and essential infrastructure personnel possibly show up for work… is not the way to run a super power nation.

We can not through forced legislation and sanctions, MAKE essential people show up for work during a pandemic, any more than we could force anyone to pick up a gun and fight in a ridiculous war like Iraq (forced conscription), or force HCW’s to stay during a hurricane evacuation. On the other hand, if essential people know in advance that they will be reasonably safe and protected, as well as their immediate families, and given the best assurances we can possibly provide as a nation – then we are on our way to a solid solution.



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