Reporting Response Time Needs Improvement

WHO Presses for Quicker Bird Flu Reports

By MARGIE MASON
AP Medical Writer
Posted May 6 2006, 10:29 PM EDT


DANANG, Vietnam -- Only half the world's human bird flu cases are being reported to the World Health Organization within two weeks of being detected -- a response time that must be improved to avert a pandemic, a senior WHO official said Saturday.

Dr. Shigeru Omi, WHO's regional director for the Western Pacific, said it is estimated that countries would have only two to three weeks to stamp out, or at least slow, a pandemic flu strain after it began spreading in humans.



LocalLinks

The first move would be to identify cluster cases and report them to WHO, he said. International teams would then be deployed to investigate the site of the outbreak, the area would be quarantined and antiviral treatment would be administered.

"All the steps have to be done within two to three weeks. As of now ... even reporting the first step, it takes sometimes more than two weeks for half of the cases," Omi said at the end of an Asia-Pacific meeting on bird flu in central Vietnam.

Omi said political commitment to fight the disease is now strong among governments across the region, but public awareness must increase so ordinary people will know what to do if they see a large number of people or birds getting sick at the same time.

Omi attended a meeting with agriculture and health ministers representing the 21-member Asia-Pacific Economic Cooperation forum. On Friday, they endorsed a plan aimed at stamping out bird flu and preparing for a potential pandemic.

Meanwhile, other delegates donned masks, goggles and biohazard suits Saturday morning as they toured a chicken farm in central Vietnam for a firsthand look at hygiene practices.

"These countries have been dealing with avian influenza for several years and have clearly advanced thinking on it, so that's why I wanted to be here this morning to look at the activities that were successful here in Vietnam," said John Lange, the U.S. special representative for avian influenza.

Experts fear the H5N1 bird flu virus, which began ravaging Asian poultry stocks in late 2003, could mutate into a strain easily passed among humans and potentially spark a global pandemic. The virus has killed at least 114 people worldwide. Most human cases have been linked to contact with infected birds.

The farm in Hoa Quy village in the coastal town of Danang has about 7,000 chickens, all of which had been vaccinated. Laying hens were kept in cages in an enclosed coop sprayed with disinfectant.

Much of the poultry in Vietnam and throughout Asia, however, is produced on a much smaller scale, with many households raising handfuls of chickens in backyards. Such farming practices are much harder to control and make it easier for the H5N1 virus to spread.

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Event Detail
Ethical Hazards in Pandemic Flu Planning and Response

May 11, 2006

Harvey Kayman, MD, MPH. University of South Carolina Center for Public Health Preparedness, and Public Health representative to the South Carolina Medical Association Ethics Committee.

Program Description:
An influenza pandemic will confront many people in our society, including health professionals, political leaders, and ordinary citizens, with terrible challenges that they are not accustomed to facing and will raise questions they are not used to addressing. Resources of all sorts may be in short supply. People may have to choose between caring for their usual responsibilities and taking care of themselves and their families. The right of non-interference by governmental officials may be suspended. How can we prepare for the moral choices we may have to make? Many, in positions of leadership, will need to prepare to deal with ethical issues in advance, while others will only begin to grapple with these dilemmas when a crisis is imminent. Dr Kayman will present the audience with some of these issues, and begin to address how we define an ethical framework for decision-making and raise questions about ethical principles we might apply, as we try to decide on a moral course of action.

Also see Dr. Kayman's previous broadcast:
Ethics in the Age of Bioterrorism (with special focus on Hurricane Katrina)

Continuing Education Units:
Nursing Contact Hours, CHES and CME credits are available upon completion of evaluation and post-test. More info about credits.

Flyers: Word Format PDF Format

Objectives:
At the conclusion of the presentation, the participants will be able to:

1. Review an ethical framework to help people address dilemmas raised by crises
2. Acknowledge the tension between unarticulated ethical constructs and assumed moral norms, that will be brought out by crises
3. Attend to action steps that may help prepare for and address the dilemmas and tensions

Who Should Attend:
Healthcare and public health personnel in any setting who are concerned with emergency preparedness and patient care in disasters, including clinicians, administrators, emergency planners, training coordinators, and federal, state, or local public health professionals. Community organizations, public administrators, ethicists, news media/journalists.
When:
May 11, 2006 10-11 AM ET Rebroadcast Time:
4-5 PM ET

These projects are supported under a cooperative agreement from the Centers for Disease Control and Prevention (CDC). Grant number U90/CCU224249-02. The contents of this program do not necessarily represent the official views of the CDC.

TOP

Flu experts opinion

Date: Tue, 02 May 2006 07:54:42 +0200
From: C Griot
Source: Newsgroups: agen.ape.international /
AP [edited]


A top bird flu expert on Tuesday predicted that the H5N1 virus will
not reach the United States this year via migratory birds, but warned
it will eventually arrive -- possibly through infected birds smuggled
into the country. Robert G. Webster, a virologist at the St. Jude
Children's Research Hospital in Memphis, Tennessee, said it has been
historically rare for avian influenza viruses to reach the Americas
from Europe.

He said infected birds being smuggled into the U.S. pose a bigger
threat right now than fears that migratory birds en route to America
might mix with infected birds from Europe or Asia. "While wildlife
people in the United States are watching for the appearance of this
virus, I would suspect that it may not come this year," he told The
Associated Press. "If it doesn't come this year, don't relax, because
it will eventually come," said Webster, who is in Singapore ahead of
a 2-day conference this week that is expected to draw many of the
world's leading scientists on bird flu.

Webster said he's most concerned about the virus becoming established
in the world's wild bird populations. He said most highly pathogenic
avian viruses usually do not last long in nature. They typically
start in wild birds, infect domestic birds and then eventually die out.

"This one has broken the rules and gone back from the domestics into
the wild birds. Is it going to be perpetuated there as a killer?
That's the million dollar question," he said. "Will that virus go to
the breeding grounds in Siberia and Africa and come back again? If it
does, then the chances are eventually it will learn to go human to human."

Webster, who's been researching avian influenza for decades, said the
spread of the virus to Africa is especially worrying because of the
lack of infrastructure, political instability and a health system
already overrun by diseases like HIV/AIDS. With "all of those things
going on in Africa, you could get human-to-human transmission started
and not have the opportunity to do anything about it until it's out
of hand, he said.

[Byline: Margie Mason]

--
ProMED-mail


[It will be interesting to see how well this 'flu virus persists
south of the Sahara, as this virus normally likes cool climes. There
is an interesting discussion in the New York Times

on the problems of using the poultry vaccine in humans in an
emergency. - Mod.MHJ]

Ethics debated

Inside OneWorld UK
Ethical guide for bird flu pandemic planners

Ethics in a Pandemic

Ethicists Offer Guide to Decision-Making in Predicted Flu Pandemic;
Quarantine, Duty to Care, Resource Allocations among Key Issues

Coping effectively with a predicted influenza pandemic that threatens to affect the health of millions worldwide, hobble economies and overwhelm health care systems will require more than new drugs and good infection control.

An international medical ethics think-tank says that all-important public cooperation and the coordination of public officials at all levels requires open and ethical decision making.

The Influenza Pandemic Working Group at the University of Toronto Joint Centre for Bioethics today recommended a 15-point ethical guide for pandemic planning, based in part on experiences and study of the Severe Acute Respiratory Syndrome (SARS) crisis of 2003.

The report says plans to deal with a flu pandemic need to be founded on commonly held ethical values. People need to subscribe in advance to the rationale behind such choices as: the priority recipients of resources, including hospital services and medicines; how much risk front line health care workers should take; and support given to people under restrictions such as quarantine. Decision makers and the public need to be engaged so plans reflect what most people will accept as fair, and good for public health.

"A shared set of ethical values is the glue that can hold us together during an intense crisis," says Peter Singer, M.D., Director of the University of Toronto Joint Centre for Bioethics (JCB), which undertook the advisory report. "A key lesson from the SARS outbreak is that fairness becomes more important during a time of crisis and confusion. And the time to consider these questions and processes in relation to a threatened major pandemic is now."

The report concludes that flu pandemic plans universally need an ethical component that address four key issues:

1. Health workers’ duty to provide care during a communicable disease outbreak.
2. Restricting liberty in the interest of public health by measures such as quarantine;
3. Priority setting, including the allocation of scarce resources such as medicines;
4. Global governance implications, such as travel advisories.

Health care workers duty to care

The SARS crisis exposed health care systems to hard ethical choices that rapidly arose. Dozens of health care workers, for example, were infected through their work and some died. Other failed to report for duty to treat SARS patients out of fear for their own health or that of their family. A flu pandemic, where there may be no absolute protection or cure, would put far greater pressures on health care systems around the world.

"Workers will face competing obligations, such as their duty to care for patients and to protect their own health and that of families and friends," says JCB member Ross Upshur, M.D., Director, Primary Care Research Unit, Sunnybrook and Women's College Health Sciences Centre. “Medical codes of ethics in various countries provide little specific guidance on how to cope with this very real dilemma. Professional colleges and associations need to provide this kind of particular guidance in advance of an infectious disease outbreak crisis.”

Governments and hospitals also need to provide for the health and safety of workers, and for the care of those who fall ill on duty. This might include an insurance fund for life and disability to cover health care workers who become sick or die as they place themselves in harm’s way.

Ethics of health care in bird flu debate

Many of us expect the fireman to enter the burning building to rescue the baby, the policeman to go up the dark alley and face the robber; do we also expect nurses and doctors to face possible illness and death, just because they are health care workers? I know when I became a nurse I never thought of it as a hazardous job. Nursing could become one in a true flu pandemic: where the flu surge would overwhelm hospital resources and protective devices like masks and gloves would not be available for the care providers.

I reported earlier in this blog about a health care worker survey which stated that many health care workers would not work during a flu pandemic. The sited workers included the secretaries, housekeepers, dietary people and others who help hospitals to run. It also included doctors and nurses, many who said they were concerned about their families needing them and not wanting to spread illness to them.

I think the images of New Orleans Hospitals struggling following Katrina first got me to thinking about my role in an emergency. I worked thru the Northridge earthquake in 1994, where my hospital, like many others in the area suffered major damage and yet remained open for several days. It was an extraordinary time and health care workers including doctors and nurses all pulled together to manage the patients who were in the hospital when the quake struck and those who needed to be admitted. They rallied and perservered until the hospital was finally evacuated and all the patients placed in less affected facilities.

Throughout the emergency there was a sense of family and community and that we were working for nobler reasons than ususal. I do not recall anyone balking at the duties required, although certainly the aftershocks were terrifying and many health care workers knew that their homes had suffered major damage. They worked and worked hard taking care of the needy patients. We set aside our personal problems in order to facilitate the greater good. We delayed our personal reactions to the earthquake by keeping busy working and providing care.

The earthquake experience was time-limited. It seemed to be forever as we were going thru it, but it lasted less than five days. We always had resources available. We were not cut off from the world and ususally had phone and power available.

Katrina showed me a less positive side of being in an emergency nursing situation and not getting the expected help in a timely fashion. I do not know how many of the stories about generators failing and ventilated patients needing to be hand ventilated are true, nor have I seen actual death figures from these hospitals, but the feelings expressed by the nurses and therapist lead me to believe that it was a hellish time to be a nurse. They could not escape and were stuck being "heroes".

The flu pandemic has the potential to be a worse hellish experience. It is not time limited like the earthquake or Katrina. The pandemic problems in health care settings could go on for a year and then recur with the next wave of the pandemic.
I think working in an Intensive Care Unit as I do, that I will notice the trend of pneumonia cases being admitted. The news reports will tell us that the pandemic flu is here. What do I do then? Just merrily go to work and care for patients with masks and gloves until these are gone. Then do I wrap a t-shirt around my face to protect myself from the virus? What if my husband gets sick? There is no one else to care for him. Isn't my moral and ethical obligation to care for my sick husband as opposed to strangers? Or does my committment to being a nurse mandate that I go to work as assigned and personal needs come second?

How much of a risk is too much risk to take for a nurse? What if I have the flu, do I still work, or protect those who don't have it by not working? We have the example of SARS. Health care workers caught the disease and some of them died. What if we get quarantined AT work? Not allowed to go back home and be with family. What if I get sick and never get to see my family?

I do not have answers for these questions, but believe they should be debated, even if no flu pandemic occurs. I look forward to others input.