Avian Flu: not enough ventilators

[Guest]

March 12, 2006

Too Few Ventilators for Bird Flu Crisis

By DONALD G. McNEIL Jr.

The New York Times

No one knows whether an avian flu virus that is racing around the world might mutate into a strain that could cause a human pandemic, or whether such a pandemic would cause widespread illness in the United States.

But if it did, public health experts and officials agree on one thing: the nation's hospitals would not have enough ventilators, the machines that pump oxygen into sick patients' lungs.

Right now, there are 105,000 ventilators, and even during a regular flu season, about 100,000 are in use. In a worst-case human pandemic, according to the national preparedness plan issued by President Bush in November, the country would need as many as 742,500.

To some experts, the ventilator shortage is the most glaring example of the country's lack of readiness for a pandemic.

"This is a life-or-death issue, and it reflects everything else that's wrong about our pandemic planning," said Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University. "The government puts out a 400-page plan, but we don't have any ventilators and there isn't much chance we're going to get them."

A typical hospital ventilator costs $30,000, and hospitals, operating on thin profit margins, say they cannot afford to buy and store hundreds of units that may never be used.

Cheaper alternatives can be deployed in a crisis, but doctors say they are grossly inadequate to deal with a flu pandemic.

Congress authorized only $3.8 billion of the $7.1 billion that Mr. Bush requested for flu preparedness, and nearly 90 percent of it is earmarked for vaccines and the antiviral drug Tamiflu. Buying enough ventilators for a flu outbreak like that of 1918 would cost $18 billion.

The federal preparedness plan leaves preparations for medical care up to state and city health officials, but the only government agency that amasses ventilators is the Strategic National Stockpile, created in 1999 by the disease centers to store medicine and equipment for use in a terrorist attack or a disaster.

But the agency has only 4,000 to 5,000 ventilators, according to a federal official who spoke on the condition of anonymity because of a dispute between government health and security agencies about whether the size of the stockpile ought to be kept secret.

There is also a shortage of trained personnel, said Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

"Ask any respiratory therapist — you have to adjust the gases, the pressures," he said. "We don't have enough trained people to maintain them."

In a recent emergency drill, said Dr. John L. Hick, a professor of emergency medicine at the Mayo Medical School in Minnesota, the 27 hospitals in his area could come up with only 16 extra ventilators when faced with a hypothetical outbreak of 400 cases of pneumonic plague.

"In a pinch," Dr. Hick said, "you can hand-bag people," a procedure in which a fat plastic bellows is squeezed to push air into the lungs. "But in a pandemic, you're stuck."

Dr. Hick wrote a recent paper for The Journal of Academic Emergency Medicine suggesting guidelines to determine in a crisis which patients should be taken off ventilators and allowed to die.

In a national emergency, he said, "it will come down to some really thin cuts on a scoring system."

"Families are going to be told, 'We have to take your loved one off the ventilator even though, if we could keep him on it for a week, he might be fine,' " he went on. "How do you think that's going to go over? It's going to be a nightmare."

Dräger Medical, a German company that is the world's largest maker of hospital ventilators, can double its assembly line capacity in a week, said Mandy Hartman, a vice president for marketing. In a year, that would add "more than 10,000" ventilators to the world supply, said Ms. Hartman, who declined to be more specific.

In interviews, experts in respiratory medicine and emergency preparedness offered other suggestions for dealing with an emergency, including the use of hand bags by teams of volunteers or family members as was done in New Orleans hospitals during Hurricane Katrina. But hand-bagging is exhausting, and flu patients may need assistance for weeks.

"You can do it for maybe 10 minutes before your forearms turn to jelly," said Amy Nichols, an infection control specialist at the University of California at San Francisco. "Think of squeezing a mushy football — that's the kind of pressure you have to create to fill engorged lungs."

A few hospitals are stockpiling disposable emergency ventilators normally used by paramedics and powered by the pressure of the oxygen tank. Their plastic valves can be set to deliver oxygen at various pressures, and they cost $50 to $100 each. They can run for hours if attached to a large bedside tank, or indefinitely on a hospital's oxygen supply.

James Lee, a senior vice president of Vortran Medical Technology, said his company had sold thousands of disposable resuscitators to hospitals worried about blackouts, terrorist attacks, storms and other emergencies.

"In a $30,000 I.C.U. ventilator, you're paying for a computer with a lot of alarms," Mr. Lee said. "In a pinch, ours can do pretty much everything you need to do — but they have to be monitored."

Although they are meant to be used only for minutes or hours, he said, models have worked in tests for two months, "although, obviously, you wouldn't have someone on for that long," he added.

[Guest]

Sweden confirms bird flu in ducks

The deadly H5N1 strain of bird flu has been discovered in two wild ducks found dead in Sweden.

BBC News

The presence of the virus was confirmed by the European Union's reference laboratory in the UK.

It is the Scandinavian country's first case of H5N1, which has killed at least 95 people since 2003, mostly in Asia.

Denmark has confirmed its first case of bird flu in a wild bird and tests are being carried out to see if it is also the H5N1 strain.

The Swedish cases were found in two wild ducks found dead in Oskarshamn, on the south-eastern coast, at the end of February.

Since then, further cases of the H5 subtype have been found in wild birds. Tests continue to determine whether they are H5N1.

There are no reports of bird flu in domestic fowl.

The H5N1 virus can be caught by humans who handle infected birds, but it is not yet known to have passed from one person to another.

However, experts fear the virus could mutate to gain this ability, and in its new form trigger a flu pandemic that could kill millions.

It has been found in a number of European countries - from Greece to France.

The strain has also been found in cats in Austria and Germany.

[ny10570 745]

Gotta love the hysteria factor. What about the pressure powered ventillators used in the field by medics? They are tested to operate for weeks on end without failure. While it would be nice to have a $30,000 vent for each person, its not practicle. The question that needs to be asked is how many of these portable ventillators are stockpiled? Those are teh ones that will save the most lives.

[Guest paramedico987]

There's a much cheaper (I don't recall the exact price) disposable ventilator which attaches to the christmas tree on your o2 regulator or bus. Empress was looking into getting them approved by the MAC committee to put a bunch aside in the SOD trialer. I don't know if it ever happened... Idealy we would like use it on every intubated patient eventually. It would really free up your hands to do things like -oh, I don't know- patient care.

[ex-commish 490]

There's a much cheaper (I don't recall the exact price) disposable ventilator which attaches to the christmas tree on your o2 regulator or bus.  Empress was looking into getting them approved by the MAC committee to put a bunch aside in the SOD trialer.  I don't know if it ever happened... Idealy we would like use it on every intubated patient eventually.  It would really free up your hands to do things like -oh, I don't know- patient care.

←

From what I have read in other articles this strain is not easily passed from human to human so I ask how serious of a threat is this flu to us here in the states? Does anyone have more knowledge on this? Thank you.

Andy Mancusi

Chief

Hawthorne FD

[Guest]

Chief Mancusi, here's the current situation as per Centers for Disease Control-Atlanta :

Assessment of Current Situation

The avian influenza A (H5N1) epizootic (animal outbreak) in Asia and parts of Europe is not expected to diminish significantly in the short term.

It is likely that H5N1 infection among birds has become endemic in certain areas and that human infections resulting from direct contact with infected poultry will continue to occur.

So far, the spread of H5N1 virus from person-to-person has been rare and has not continued beyond one person.

No evidence for genetic reassortment between human and avian influenza A virus genes has been found; however, the epizootic in Asia continues to pose an important public health threat.

There is little pre-existing natural immunity to H5N1 infection in the human population.

If these H5N1 viruses gain the ability for efficient and sustained transmission among humans, an influenza pandemic could result, with potentially high rates of illness and death.

In addition, genetic sequencing of influenza A (H5N1) viruses from human cases in Vietnam and Thailand shows resistance to the antiviral medications amantadine and rimantadine, two of the medications commonly used for treatment of influenza.

This would leave two remaining antiviral medications (oseltamivir and zanamivir) that should still be effective against currently circulating strains of H5N1 virus.

Efforts to produce vaccine candidates that would be effective against avian influenza A (H5N1) viruses are under way. However, it will likely require many months before such vaccines could be mass produced and made widely available.

Research suggests that currently circulating strains of H5N1 viruses are becoming more capable of causing disease (pathogenic) in mammals than were earlier H5N1 viruses.

One study found that ducks infected with H5N1 virus are now shedding more virus for longer periods without showing symptoms of illness. This finding has implications for the role of ducks in transmitting disease to other birds and possibly to humans as well.

Additionally, other findings have documented H5N1 infection among pigs in China and H5N1 infection in felines (experimental infection in housecats in the Netherlands and isolation of H5N1 viruses in tigers and leopards in Thailand ).

The majority of known human H5N1 cases have begun with respiratory symptoms.

CDC Response

Domestic Activities

In May 2005, CDC joined a new, inter-agency National Influenza Pandemic Preparedness Task Force organized by the U.S. Secretary of Health and Human Services.

This task force is developing and refining preparedness efforts with international, state, local, and private organizational partners to help ensure the most effective response possible when the next influenza pandemic occurs.

For more information about the Pandemic Influenza Preparedness Plan of the U.S. Health and Human Services Department and other aspects of this coordinated federal initiative, please visit www.pandemicflu.gov.

In February 2004, CDC issued recommendations for enhanced domestic surveillance of avian influenza A (H5N1).

Following the reports of human deaths in Vietnam in August 2004 and additional human cases in the following months, CDC issued follow-up Health Alert Network (HAN) notices on August 12 and February 4, 2005, reiterating criteria for domestic surveillance, diagnostic evaluation, and infection control precautions for avian influenza A (H5N1).

CDC has collaborated with the Association of Public Health Laboratories to conduct training workshops for state laboratories on the use of molecular techniques to rapidly identify H5 viruses.

CDC is working collaboratively with the Council of State and Territorial Epidemiologists and other partners to assist states with pandemic planning efforts.

CDC is working with other agencies, such as the Department of Defense and the Department of Veterans Affairs, on antiviral stockpile issues.

Henry Gregorio

Vol. FF

Pelham FD

[GFD70 4]

One of my professors this semester is a doctor who is working with the government to study the Avian lfu. He said thatif an outbreak were to occur among humans, anywhere from 200,000 to 2 million would likely be affected.

[llm60 0]

Everyone run out and buy stock in heppa filters, LOL

[ex-commish 490]

Chief Mancusi, here's the current situation as per Centers for Disease Control-Atlanta :

Henry Gregorio

Vol. FF

Pelham FD

←

Thanks for the info Boss. Always something out there to raise aggravate us. What next ?????

Andy Mancusi

Chief

Hawthorne FD

[Guest]

credit: David Furst/AFP-Getty Images

March 17, 2006

Israel Detects Cases of Avian Flu

By REUTERS

BEERSHEBA, Israel (Reuters) - Israel detected its first cases of H5N1 bird flu on Friday, saying the virus had killed thousands of turkeys and chickens on two farms.

The Israeli authorities treated four people in hospital amid fears they could have the virus. Serbia said three children and a teenager from a bird-flu affected area were in hospital after developing fever and flu-like symptoms.

Bird flu has spread with alarming speed in recent weeks across Europe, Africa and parts of Asia, stoking fears the virus could mutate into a form that could easily pass from one person to another, triggering a pandemic in which millions could die.

Three people who worked in poultry coops at the farms where the virus was discovered were admitted to isolation units at Soroka Medical Center in the southern Israeli city of Beersheba.

``All those who were in contact with fowl and have some sort of illness ... will be put in quarantine. Until proved otherwise ... they have bird flu,'' said hospital director Eitan Hayam. However, he said there was only a slim chance they had contracted the virus.

A fourth worker who had also been in contact with turkeys at a farm about 70km (45 miles) further north near the town of Kiryat Gat was admitted to hospital in Ashkelon.

Two farms were confirmed to have infected poultry. Tests were being carried out another two farms where H5N1 is suspected.

Agriculture Ministry officials said that starting Sunday morning, tens of thousands of fowl in the infected areas and their surroundings would be culled and the carcasses would be buried in underground pits.

Edited March 18, 2006 by hoss

[calhobs 110]

What I am more concerned about is detecting it here in the United States. There are many states here that just dont have anything ready to detect it. There are no laws saying a hopital has to report any thing to the CDC. What happend if it starts in a small town or even here in Westchester. This County is so worried about Terrorism is has overlooked public health concerns just as many other counties in this country have. There is a serious case of over taxing our EMS service as it is now. Our hosptials are overtaxed now as is, it does not take much to put them on deversion now, think if and when it strikes how would our hosptials handle it. Public health has become a forgotten issue in this country. We depend to much on the Feds to protect us, when the State and County should be doing it. But many of these agencies through out the country just dont have the resoources to do it. Lets just hope that it strikes first somewhere in this country that has the resources to detect it quickly.