Fwd: Re: [FoRK] avian flu/home grown/PastFutureTense

Tracie K Meyer con10gent_sentience
Sun Oct 16 15:46:10 PDT 2005


On Sun, 16 Oct 2005 15:28:50 -0700, "Justin Mason" <jm at jmason.org> said:
[...]"BTW the report also talks about observed human-to-human
transmission:"

THERE GOES ANY/ALL THE INTERMEDIARY VECTORS

there goes hope unless the protocol you specifically mention; ie
_"Tamiflu and
Relenza,_ but not amantadine." are followed. WHY ISN'T BUSH STOCKING UP
ON THESE DRUGS? why is he using this incident to finally bring to life
all our` worst nightmare of THE MODEL STATE EMERGENCY HEALTH POWERS ACT?
[Section 103,subsection(a)  To authorise the collection of data and
records, the control of property, the management of persons, and access
to communications.]/drafted 23 oct 2001 georgetown university
SIGN. YOUR. LIFE. AWAY.





> -----BEGIN PGP SIGNED MESSAGE-----
> Hash: SHA1
> 
> 
> This is pretty old news btw ;)  It is significant that it's being
> published in Nature, though.  
> 
> Here's the source Reuters story that channelnewsasia is probably
> working from:
> 
> http://news.yahoo.com/s/nm/20051014/hl_nm/birdflu_resistance_dc_1;_ylt=Av.gf5WaZ0Vb7_f_19yr_jKTvyIi;_ylu=X3oDMTBiMW04NW9mBHNlYwMlJVRPUCUl
> 
> The report's authors still advise stocking up on *both* Tamiflu and
> Relenza, but not amantadine.  This is only one strain -- the one found in
> the Vietnamese case.
> 
> BTW the report also talks about observed human-to-human transmission:
> 'evidence she was directly infected by her brother and not by chickens, a
> rare case of human-to-human transmission of the virus.'
> 
> (PS: Also, the Bebergian depression cloud isn't entirely correct: it's
> worth noting that Tamiflu has been part of the WHO's arsenal in Vietnam
> and elsewhere treating H5N1 cases for a while, so that resistance
> selection has been taking place there already.)
> 
> - --j.
> 
> Tracie K Meyer writes:
> > [dwalker at childrenscentralcal.org: [ccm-l] Scientists say they have found
> > Tamiflu-resistant strain of bird flu]
> > 
> > Now what are we going to do, since the entire world is stocking up on
> > Tamiflu?
> > Sell Roche stocks?
> > Dave
> > 
> > http://www.channelnewsasia.com/stor.../173522/1/.html
> > 
> > Scientists say they have found Tamiflu-resistant strain of bird flu
> > 
> > 
> > PARIS - Researchers have identified a mutated form of H5N1 bird flu that
> > is resistant to Tamiflu, the drug being stockpiled around the world to
> > counter a feared influenza pandemic, a study released on Friday said.
> > 
> > The strain was found in a case in Vietnam involving a 14-year-old girl
> > who may have caught the flu from her brother rather than directly from
> > infected birds, it said.
> > 
> > Sequencing of the virus showed that it had a mutation that made it
> > resistant to oseltamivir, the lab name for Tamiflu.
> > 
> > However, tests on lab animals showed that the resistant virus is
> > sensitive to another drug called zanamivir, commercialised as Relenza,
> > the research said.
> > 
> > The study was due to be published next Thursday in Nature, the British
> > science weekly, but the journal decided to bring forward its release
> > because of its importance.
> > 
> > The findings "raise the possibility that it might be useful to stockpile
> > zanamivir as well as oseltamivir in the event of an H5N1 influenza
> > pandemic," said the authors, led by Yoshihiro Kawaoka of the University
> > of Tokyo and the University of Wisconsin at Madison. - AFP/ir
> > __________________ 
> > 
> > 
> > David H Walker MA RRT RCP
> > Children's Hospital Central California
> > 9300 Valley Children's Place 
> > Madera, CA 93638
> > Voice: 559-353-5575
> > Pager: 559-262-8049
> > 
> > "We will have to learn, before understanding
> > any task, to first ask the question, 'What information
> > do I need, and in what form, and when.
> > '"  We should begin thinking about the delivery system
> > for the information only when this is clear.
> > Peter Drucker 1990
> > 
> > >>> "Wax, Dr. Randy" <RWax at mtsinai.on.ca> 10/14/05 8:00 AM >>>
> > I would also like to emphasize the importance of sketching out the
> > triage
> > plans in advance as much as possible.
> > We have learned from disaster simulations here in Toronto (non-Avian flu
> > scenarios but still helpful) that there needs to be multiple levels of
> > triage for conditions where the patients will arrive in a steady stream
> > rather than rapid bolus.
> > 1.  Field Triage (EMS)
> > 2.  Hospital Triage (Emergency department intake)
> > 3.  ICU Triage Intake (who gets into the expanded ICU +/- on a
> > ventilator)
> > 4.  ICU Triage Exit (after intervention which could be hours/days, who
> > now
> > becomes considered unsalvagable-->withdraw life support and go to the
> > ward
> > with palliation)
> > 
> > EMS and Emergency Departments in many cases have more experience and
> > training in triage (although we have seen many discussions on CCM-L
> > recently
> > about flaws in these systems evident in the Katrina response and other
> > recent disasters).  Many ICUs perform some sort of entry/exit triage,
> > but
> > the rules will have to change dramatically during a pandemic.
> > Most ICU physicians and staff (in my opinion) have minimal training in
> > understanding the shift to a disaster triage mode.  Many will have
> > trouble
> > shifting from looking after the individual patient to viewing the
> > situation
> > from a system-wide level.  Some will also worry about their liability
> > for
> > making decisions to withdraw support on patients who would have been
> > salvagable under normal circumstances.  Considerable training needs to
> > be
> > done in advance, and policy-makers must clarify what protection
> > clinicians
> > have to make these difficult decisions.
> > 
> > I am very interested to hear what has been done in Hong Kong and other
> > locations to help sort out these difficult issues.  We are working on
> > triage
> > plans here in Ontario and I will certainly share our thoughts once
> > better
> > established.
> > 
> > Randy
> > 
> > Randy Wax, MD, MEd, FRCPC
> > Staff Intensivist, Medical/Surgical Critical Care Unit
> > Medical Director, MSH Program for Resuscitation Education and Patient
> > Safety
> > (PREPS)
> > Mount Sinai Hospital
> > Toronto, Ontario, Canada
> > Assistant Professor, Division of Critical Care, Department of Medicine,
> > University of Toronto
> > rwax at mtsinai.on.ca
> > 
> > 
> > -----Original Message-----
> > From: David Walker [mailto:dwalker at CHILDRENSCENTRALCAL.ORG] 
> > Sent: October 12, 2005 11:08 PM
> > To: ccm-l at ccm-l.org
> > Subject: Re: [ccm-l] Avian Flu contingency planning
> > 
> > 
> > Dr. Kelly, we have spent the greater part of the last two years working
> > on
> > how we will handle an Influenza Pandemic specific to H5N1.  This virus
> > as
> > you know currently has a mortality that exceeds 50% generally from ARDS.
> > The virus that caused the 1918 pandemic had a mortality of ~ 5%, so what
> > we
> > learned from the last great pandemic could possibly be much different
> > with
> > H5N1 from a patient care perspective.  In addition, if you check out the
> > CDC's website of the autopsy of a 6 year old male, the report describes
> > how
> > H5N1 destroys the Type II Pneumocytes as well as it can create a form of
> > meningitis.  Therefore, we could face a large number of patients not
> > only
> > Respiratory Distress of all levels, but also may present with
> > multi-organ
> > failure.  However, current lessons from Hanoi and Jakarta show that
> > Respiratory Distress could be the greatest problem we would need to
> > treat
> > and as you mention, how do we ventilate large numbers of ARDS patients.
> > 
> > Dr. Tom Buckley described last April, that the use of a simple CPAP
> > system
> > may perhaps be an option since there is not enough ventilators in the
> > world
> > to ventilate the projected numbers of patients that may require
> > mechanical
> > ventilation (recently described by the "Foreign Affairs" paper).  Unless
> > you
> > are now stockpiling large numbers of disposables, I seriously doubt you
> > will
> > be intubating these patients; therefore, the use of mask CPAP may be
> > somewhat useful. From a triage perspective, one goal may be to set up
> > "fever
> > clinics" outside your hospital so that patients' would be assessed away
> > from
> > your ED so that you are not overwhelmed within your health care
> > facility.
> > In here lies the ethical issue of at what level of respiratory distress
> > do
> > you admit and when do you determine the patient is not sick enough, or
> > is so
> > sick they will not survive?  If you do place many patients on a simple
> > mask
> > CPAP system what do you do when they stop breathing and you are the only
> > clinician caring for 20 or more patients? 
> > 
> > You also mention as one of your concerns is pediatric patients that
> > would
> > need to be admitted to your adult facility.  I understand this fully
> > since
> > having the appropriate disposables and clinicians that are comfortable
> > taking care of the kids will be a challenge to say the least.  One
> > suggestion would be to work with your nearest Children's Hospital and
> > ask
> > for their input as you work on your plan so that you could be consitent
> > with
> > their procedures so that you could share
> > equipment and personnel if the need arises.   
> > 
> > Next week the USA will have a pandemic plan in place that I hope will
> > address some of these issues for us here in the States (as your country
> > has
> > done), but I have a strong suspicion that we will have to make many of
> > the
> > ethical decisions on our own.  Therefore, we are also trying to learn
> > all
> > that we can on how best to prepare for the pandemic that would some how
> > get
> > us through this terrible disaster.  It appears however, that as one
> > makes
> > pandemic preparations it is important to remember that this thing may
> > not
> > happen, at least in the worst case scenarios and makes preplanning even
> > more
> > important to keep from making very costly decisions for stockpiling
> > supplies
> > etc .  
> > 
> > I hope this helps in some small way, but I commend you and your fellow
> > citizens for placing these issues on the table for discussion and
> > preplanning. 
> > Dave
> > 
> > David H Walker MA RRT RCP
> > Children's Hospital Central California
> > 9300 Valley Children's Place 
> > Madera, CA 93638
> > Voice: 559-353-5575
> > Pager: 559-262-8049
> > 
> > "We will have to learn, before understanding
> > any task, to first ask the question, 'What information
> > do I need, and in what form, and when.
> > '"  We should begin thinking about the delivery system
> > for the information only when this is clear.
> > Peter Drucker 1990
> > 
> > >>> daniel kelly <kelly246 at btinternet.com> 10/12/05 2:47 PM >>>
> > Dear all,
> > We are about to try and determine what on earth we are going to do when
> > this
> > hits.I feel it poses special challenges because as the number of victims
> > increases the number of staff available to treat them diminishes.In
> > addition
> > it is clear from Flu Surge that the number of cases requiring
> > ventilation
> > will outstrip any ventilatory capacity.As a director of an adult ICU I
> > am
> > actually more concerned about how we will manage the rise in paediatric
> > admissions. Generally we transfer out to a regional center but I guess
> > that
> > they will fill up very quickly. When disasters occur in the field it is
> > accepted that triage determines who gets treated because this is the
> > only
> > way to deal with overwhelming demand.
> > 
> > Does Avian Flu demand that we use the principles of Triage within
> > hospitals?
> > 
> > All thoughts welcome as I think conventional hospital responses will be
> > flawed in this context.
> > 
> > Dan Kelly
> > Clinical Director
> > Critical Care
> > Blackpool UK
> > 
> > 
> > 
> > Children's Hospital Central California
> > A Great Place to Get Better
> > ------------------------------------------------------------
> > NOTE:  This email and any files transmitted with it are intended solely
> > for
> > the use of the individual or entity to whom they are addressed and may
> > contain confidential, patient health or other legally privileged
> > information. If you have received this email in error please notify the
> > sender by email,delete and destroy this message and its attachments. Any
> > unauthorized review, use, disclosure, or distribution is prohibited.
> > 
> > 
> > ===================
> > 
> > On Fri, 14 Oct 2005 19:37:41 -0400, "Stephen D. Williams" <sdw at lig.net>
> > said:
> > > I thought I clearly alluded to those complications in my later paragraph.
> > > 
> > > Possibly our disagreement, or your missing piece of knowledge, is that 
> > > everyone's immune system is different.
> > > I can't do it justice (see http://en.wikipedia.org/wiki/Immune_system ), 
> > > but I was taught in medical school (Mini-Medical School that is) that 
> > > the immune capabilities include a fixed number of molecular patterns 
> > > that are derived from mixing and matching from the parental sets.  This 
> > > means that only a finite set of molecular patterns can be matched and 
> > > that finite set is different for each person.  (I can't remember if this 
> > > concerns cytokines or T-Cell matching.)
> > > 
> > > I believe I've heard estimates that 5% of humans are immune to HIV.  
> > > This is the kind of thing I was referring to.
> > > 
> > > To wit:
> > > http://www.aidsinfonyc.org/hivplus/issue3/ahead/genes.html
> > > http://my.webmd.com/content/article/97/104268.htm?z=1624_00000_0000_f1_07
> > > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8918278&dopt=Citation
> > > 
> > > sdw
> > > 
> > > Kevin Elliott wrote:
> > > 
> > > > At 23:42 -0400  on  10/13/05, Stephen D. Williams wrote:
> > > >
> > > >> To answer the immunity comment: I was referring to "natural 
> > > >> immunity", i.e. the capability >of someone to A) avoid noticable 
> > > >> infection and/or B) to survive infection either because
> > > >> their immune system reacts quickly enough or they just don't have the 
> > > >> protein structure for
> > > >> a particular virus to bind to.  Those kinds of immunity ARE 
> > > >> inherited, with lots of random
> > > >> exchanges and "mutations", and are said to be the whole point of 
> > > >> dual-sex reproduction.
> > > >>
> > > >> The presence of particular antibodies is not passed on (except some 
> > > >> mother->child), but the >ability to make those antibodies to a 
> > > >> particular response definitely is inheritable most of >time.
> > > >
> > > >
> > > > I think what's missing from your analysis is the very complicated 
> > > > issue of exactly how a given person at the time developed 
> > > > immunity/survived:
> > > >
> > > > Were they exposed to the "full strength" variant or a weaker mutation 
> > > > that their body fought off and in the process developed antibodies 
> > > > that were also effect against the full strength variant?
> > > >
> > > > Did they ever have the disease at all or did the merely avoid exposure?
> > > >
> > > > Even if they survived the full strength virus was this because of a 
> > > > superior immune system or simply because their immune system tripped 
> > > > over an effective antibody earlier than "normal"?
> > > >
> > > > My impressions is that for most viral infections the body is CAPABLE 
> > > > of synthesizing effective antibodies.  The issue of survival comes 
> > > > down to a race between the bodies ability to adapt and the viruses 
> > > > ability to mutate and/or kill the host.  I actually think this bodes 
> > > > well for the first world in the case of a catastrophic avian flu 
> > > > epidemic- at the turn of the century 1st and 3rd world medicine were 
> > > > much closer to each other than they are today.  With the life support 
> > > > mechanism available today, I would think we'd be much more capable of 
> > > > sustaining life long enough for the bodies natural antibodies to win 
> > > > the battle.
> > > 
> > > 
> > 
> > -- 
> > http://www.fastmail.fm - And now for something completely different&#65533;
> > 
> > _______________________________________________
> > FoRK mailing list
> > http://xent.com/mailman/listinfo/fork
> -----BEGIN PGP SIGNATURE-----
> Version: GnuPG v1.4.1 (GNU/Linux)
> Comment: Exmh CVS
> 
> iD8DBQFDUtQiMJF5cimLx9ARAq/gAJ40B2FUOgmt6sHj2mIjCLmGegqAggCfV8Nt
> 2AZYsHc1YLw7ZHiL+zPYkn4=
> =2/ZN
> -----END PGP SIGNATURE-----
> 
-tkm
--
If I could only live at the pitch that is near madness
When everything is as it was in my childhood
Violent,vivid,and of infinite possibility:
That the sun and moon broke over my head.-preface,
'Feast of Snakes'
 

-- 
http://www.fastmail.fm - Same, same, but different…



More information about the FoRK mailing list