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The use of good judgement during the discussion of controversial issues would be greatly appreciated.

If you had the opportunity...

by: DemFromCT

Thu Jul 16, 2009 at 09:09:09 AM EDT

This a follow-up diary to the 6/26 NIH flu summit and the US federal summit a week later. It was partly prompted by SusanC's diary, Swine Flu Vaccine in 5 Days?

Assume for the moment that a decision is made to go with a vaccine program. Assume there's going to be vaccine, but not enough for everyone at once (see CDC interim guidance; schools go first.) If you had the opportunity to present your views, or if you were a decision maker, or if your state or local public health folks asked for your advice as an informed citizen, how would you answer the following questions?

How can the need for action be best communicated to the public? ("action" can be decision to vaccinate, or info on prepping, or explanation of school closure, or whatever needs to be conveyed)

Who are the best messengers?

Are the answers different for vaccine and for non-vaccine non-pharmaceuticals?

If we are serious about the fall, what's the best way to address the questions? Between SusanC's diary, the news, and the CDC guidance, these questions are in need of some candid answers.

DemFromCT :: If you had the opportunity...
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see also tess' diary
What are you hearing from YOUR physicians?, in which we learn that all the docs aren't on the same page.

partial answer
I am not ready to answer all these questions but my first thought is this:

The WHO, the national and international media and the silence of authorities on various levels along with the fiasco that was the way various parts of the US did or did not close their schools all has served to deprecate any message that will come out here forward.

It seems to me that effective credibility needs to be re-established up and down the line.

There needs to be unequivocal hierarchy of authority with articulate spokespeople at every level who do not waffle when the chips are down (as they will sooner than later, chips being any sort of unfortunate outcome related to this event).

I am speaking from a US POV, there needs to be CLEAR lines of authority even down into my tiny town of 1700 people in rural MA, where the rubber meets the road.  

There isnt now.

The localities need to be empowered.  Not in any firearms sense of the word but in terms of a strong netting together of existing emergency responders and local docs and hospitals with PRE-planning and directives specific to dealing with nH1N1.

I fear this is just a fantasy.

Our older citizens in our tiny town remember the cohesive nature of services and people back in the 1950s and all that time of prep.  WWII and the cold war kept people engaged.

We live in a lazy Wal-Mart outsourced culture that will wait for an amorphous "they" (state gov, staties, national guard, etc) to sweep in.

We all know thats not how it works once we hit a phenomenon as large as this.

thank you
cynicism appreciated, but still, if you had the opportunity...   ;-)

[ Parent ]
not cynicism
From experience.

Our town and surrounding towns are run by selectmen and town meetings.

On the BEST of days we have horrific fights at these meetings.  In Sturbridge, punches have been thrown.

The factions are generational and the turf is too. (rolling eyes)

It is what it is, period.

Its from this background noise that some sort of coordinated action has to happen?

My husband is on our local school board.  They have had ZERO discussion about any issue even remotely relating to H1N1.

[ Parent ]
Who are the best messengers?
If things go south this fall, and if a vaccine that is viable is available, the best messenger to get the word out about any vaccine program or emergency response, at least in the US (and maybe more), would initially be the President.
Based on his popularity, people will most likely listen to him in a nationally televised statement that should take place in the Oval Office, behind his desk, staring straight into the camera with the certainty of a man on a mission.
Don't leave it to local politicians or emergency personnel...they're going to need guidance from someone before they can make certain decisions. Word from the top-most government official about how, when, and who vaccines are distributed to would be the best way to get the ball rolling and move organizations and people to action.
He could order, or most likely highly recommend, local health districts to put their PanFlu plans into action immediately, with input from HHS and FEMA to help with vaccine distribution.
Decisions have already been made, for the most part, as to who will receive the vaccine first. Make certain that those people receive their vaccines within the first 24-48 hours, then move immediately to the next tier.

Is that what you're looking for?

I am well aware of the polls on the president (trust me on that, not material for this site) and 35% of th epopulation don't like him and/or his programs, and some don't trust govt at all. How do we reach them? Is a presidential directive or any govt. directive (CDC head standing next to president) enough?

What about people who in general don't believe in vaccine (this is a VOLUNTARY program, so at least that message needs to be given as well as need to consider getting a jab)?

What about the need to do minimal prep?

What about the need to stay home if you are sick?

What about managing the expectation of not being tested if you are sick?

What about prepare for home care?

[ Parent ]
What about people who in general don't believe in vaccine?

Honestly, unless this is a high CFR event, I don't think you are going to get these folks to accept a vax. I think it's a wasted effort. FIDO.

What about the need to do minimal prep?

The MSM could be helpful here. "What if you are really sick for a week? Do you have enough supplies in your house so you won't have to drag your carcass out of bed?" Also, "there may be temporary shortages of certain high-demand items like flu meds and kleenex. Wouldn't you rather just buy them now and have them on hand just in case you need them?" Explain possible disruptions to the supply chain because of sick truckers etc.

What about the need to stay home if you are sick?

Tough one in this economy. I would target employers not employees. Employees are too concerned with holding onto their jobs. Again, tough one in this economy. I don't know how many businesses can withstand high absenteeism rates for an extended period. Again, unless this is a high CFR event, I think a lot of sick people will show up to work if they can make it in.

What about managing the expectation of not being tested if you are sick?

I don't think this one will be too hard for people to accept. Just explain the strain on resources to test everyone. Explain that if you have x,y,z symptoms you most likely have H1N1.

What about prepare for home care?

The MSM is your friend. I particularly think parents will want to know how to care for their children. Get Sanjay Gupta to do some PSAs. Have CNN and Fox run flu care segments. I am guessing that the public will be mostly receptive to this type of information.

Final note:

I think the phrase "teachable moment" is going to come back to haunt the authorities. We've missed a lot of those moments and now they are trying to ramp everybody up in a very short time. They need to start the messaging NOW.  

[ Parent ]
It will take a major special announcement
The president, surgeon general, and head of CDC will have to have major speach, primetime Wednesday on all the Networks.  

The press, broadcast and print, will have to promote it for at least two days prior.

Do it ASAP to allow time to prep before September, and for the current infections.

PS.  As a doctor you have a full plate, the latest Rasmussin poll 7/13 to 7/15 has Approve/Disapprove at 51%/47%

To calm the wife buy cases of chocolate, to calm the husband buy cases of booze, and to calm the children...... heck the booze and chocolate should work.

[ Parent ]
rasmussen most unreliable and GOP friendly
poll, structural issue (they look at likely voters, others look at all adults.) Better to look at the aggregate from pollster.com (54/40)


[ Parent ]
that's where I got it
Rasmussen is the most accurate. At least they were in the last election. They pegged it.

To calm the wife buy cases of chocolate, to calm the husband buy cases of booze, and to calm the children...... heck the booze and chocolate should work.

[ Parent ]
everybody got it
one of the most accurate polling elections in recent memory.


But on the eve of an election, likely voter makes sense. Not now.

[ Parent ]
I'll cede you 40% and steadily rising.

To calm the wife buy cases of chocolate, to calm the husband buy cases of booze, and to calm the children...... heck the booze and chocolate should work.

[ Parent ]
Absolutely, and on the preps side
part of the message could be

"We are asking you to put these preparations together over the next TWO months (August and September). You do not have to rush out and get everything today, there is no need to panic, but there is a need to get prepared."  

Then break it down, what you can/should do this week, next week, the next 2-4 weeks, etc.  Just like all the prepping info is broken down here.  

This would allow them to send the message of Urgency without the side effect of "Panic".

A heads-up could and should be to some of the biggest retailers - "order more now because we'll be asking people to stock up" -  and that message should be given NOW.  

[ Parent ]
Vaccine distribution
A message from the President will focus public attention but it must be a single strong and clear message.  It will do no good if it soft sells and rambles.  It has to be a short, clear concise message.  It should not include any agency heads.

DHS, HHS messages need to be sent to governors, and state agencies as directives not press conferences.  the first week of May(very early in the Mexico break out), I spoke to the wife of a police officer - she told me the local force had already requested the number of nemebers in his immediate family (spouse and children).  This was for distribution of the first available vaccine.  This information had been request by the state in preparation.    

[ Parent ]
The president should open with a short clear message, but more
will be necessary.  Shouldn't the entire moderate-to-severe pandemic scenario be addressed at this time? (Or possibly a preview of the information below, with the full story to be given a day or a week later?)  Agency heads and experts from various fields, with visual aids would help in this education, which should be done in one go and made available for repeated viewing.

Vaccine distribution: explain the tiers

Explain why the sick should stay home and the difference between R=1 and R=2

Toll of 1918 pandemic and the Great Forgetting

Why this statement is wrong: "It can't happen to us because we're so advanced."
***more of us live in cities
***more of us live with chronic diseases, dependent on drugs produced abroad
***our food and other necessities are produced far from where we live
***hospitals are stretched now, therefore the advances in medical science won't benefit you when hospitals are closed to your family
***our way of life is supported by the electrical grid, but it's fragile

Explain the rationale for early school closure (density of classrooms, children highly infectious, etc.)

Explain some ways that a prudent family can prepare for home nursing
***local classes (arrange this in advance, nationally?)
***written instructions and supply list (distributed through classes or libraries?)

Explain some ways to prepare for shortages
Explain how the government will help those on public aid, WIC coupons for food storage, school lunches, etc.  

After finally getting around to telling the public, an apology may be necessary for the tardiness of the message. :-P

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
This is exactly the approach
This is exactly how this needs to unfold. Start with the President's (single/strong) message. Good media briefings from the agencies immediately proceeding the rollout will be critical.  

We can not look to the media, talking heads or some tv or movie person to get it right.  This has to be a straight talk from the top.  As to the issue of politics it needs to go the extra mile to go above that.  

First, the Congress needs to stay out of the conversation - not sure how you do that other than to get party leaders to agree this calls for unity and a single message not a chorus of foolishness.

Second, it would be good if you could get former Presidents on message to agree to speak out about why this is a national bipartisan call to action.  Get past the party politics.

Regarding vaccines if they are made a condition of attending school as with other shots - it won't be a choice.  Not saying this is right or wrong.  

Last, sorry for all the recent typos - have been attempting to post on the run from various devices with limited success.  

[ Parent ]
Excellent idea!
it would be good if you could get former Presidents on message to agree to speak out about why this is a national bipartisan call to action.  Get past the party politics

[ Parent ]
I wish it weren't true but...
.. I think the best messengers are the ones that TV America sees every day -- the tv and movies celebs (including sports figures). The whole Marcus Welby route. (I am only answering for America, but I'm guessing most developed countries would be the same).

We would of course have to have a unified message coming from all levels of government, and I think that BB's comments on Obama are correct - we'd need a strong message from him... but my guess is that unless we get the tv journalistson board, speaking frankly from their own experience, and/or public service announcements from well-known and respected celebs (I dont' have a tv nor do I watch movies, so I don't know which they are), you won't get the public paying attention. One heartfelt interview with a celeb who narrowly escaped serious illness or who knows someone who is ill will cause Americans to take notice and start talking to each other... like I said, I wish it were not the case...but haven't we all see this happen before?

I agree w/Nika that most government officials are viewed with a certain level of suspicion - ie: that they have a bias toward keeping their job, and therefore only giving out information that "they" want "us" to know... I hear too often that "government" tells us only part of the story(we are the employers of and participants in government, but so few believe that), that I think an "impartial third party" will need to be found in order to confirm the governmental message.

Ideally, this is where journalists can shine -- they can shine a light into the government's plans and tell the public what they have found after hard digging. They can complain loudly when they think government is covering up... and I hope that journalists (whether employed or freelancing, due to the economy) will take it as a challenge. And they can confirm that this message (of prepping, or vaccine or whatever) is valid and accurately assesses the situation. THe problem is that we have too many commentators/opinionators (narcissists) passing themselves off as journalists.

But also, this is where "ordinary people" who have earned the spotlight somehow can also verify the government's messages. In this capacity, church leaders would be very valuable to speak to their constituents, union leaders to the unions, etc.

On the issue of different for vaccine/non vaccine - I think rather it breaks down based on populations. Like with any large message, it is most easily carried back to various groups by those most trusted in those groups... identify the community leaders (official or not) and make sure you communicate effectively to them. Most especially, don't leave them out or ignore them!

I think that vaccine messages would be be bolstered by scientific and medical people who are perceived as "having nothing to do with" government (but my caveat there is: sounds like the vaccine might be new and untested - if this is a case of gov't saying "trust us", many 3rd party medical folk might not want to jump on board)

These are just my morning thoughts on all this... I remember hearing about the "war bonds" campaign, and how celebs were used to promote the gov't programs in WWII - this might be a similar situation.

Good questions - thanks!

I disagree with schools first.
It should be HCWs, first responders (police, fire etc.), and people who work in critical industries like power production etc, some National Guard units - and even some in the gov't - then schools, including teachers and administration. I understand that schools can be amplifers but critical infrastructure needs to be protected first. My recommendation would be to explicitly lay out why certain groups are getting the vax first.

I'd like to know how they are going to handle the anti-vax parents. There seems to be a lot of them around. That could really be an issue if we follow the UK's plan to administer an untested vax. How many parents are going to let their kid be the guinea pig?

How can the need for action be best communicated to the public? ("action" can be decision to vaccinate, or info on prepping, or explanation of school closure, or whatever needs to be conveyed)

I'll admit I am not a huge Obama fan but the messaging needs to come from the top. I'm thinking an address from the Oval Office. They need to throughly explain why a particular action is needed. I will say that I think they have shot themselves in the foot because of the "don't worry, it's mild" meme which has been drummed into the populace. I'm betting the response will be "you told me this was mild, why should I bother/risk getting a vax?"

They should NOT politicize the message in any way i.e. "this is why we need universal healthcare." Or, "see, the gov't is trying to use this as a wedge into universal healthcare." Politicians, resist the temptation.

Clearly they are going to have to get the MSM involved. Straight forward information would be helpful. Skip the reassuring platitudes. You only tell someone NOT to panic when there IS a reason to panic.

I think there should be a discussion about possible disruptions to daily life, shortages of certain high-demand goods, etc. You don't have to scare the pants off people but they do need to plant that seed. I think there will be more problems if the populace is totally unaware that such things can happen. The message should be "these things may occur but here are some ways to prepare for that, just in case." Offer the truth and solutions at the same time. Be honest.

I don[t know that schools are ranked ahead
of health care workers, but most people,are not HCW/first responders and don't think of themselves as such.

They are likely all first tier.  

[ Parent ]
We are the best messengers.
Call, e-mail, write, visit your elected representatives, from the local city council to your state representatives, to your national Congresspersons and Senators, to the President.  Tell them your message, whether it is about school closure, or prepping, or vaccine production.  If enough people are insistent, persistent, and sincere, they will listen.  Bureaucrats and civil servants are not accountable to us and do not make policy.  That is the job of our elected officials.  And they are accountable to us.

"I am opposed to any form of tyranny over the mind of man."  Thomas Jefferson

Messengers need practical messages
I think the first task is to agree the messages. Those that you have outlined are not being put out there by anyone, period, and in fact they are contradicted by what officialdom seems to be saying and doing.

Second, you really have to consider the barriers that would prevent people taking the messages on board. That means really understanding where people are coming from, and helping them over those barriers. An obvious problem is that the message to stay at home is not supported by sick leave policies. Many people are very stressed financially, and the thought of getting into further debt, missing mortgage repayments, will lead them to the risk/benefit conclusion that it's better to keep their income safe, as there are very definite consequences to losing it, in comparison with the remote liklihood of dying from the flu. That may change, of course, but for now it's a significant barrier. It would help the message if it were stated to be a clear national priority, incorporating safeguards for people such as a moratorium on mortgage payments for the autumn/winter or whatever period is appropriate.

As regards the messengers, you will get the most bang for your buck with a standard PSA, repeated as widely and as often as possible, boring and obvious as that is. I agree that possibly the most persuasive people to deliver the messages would be the relatives of previously healthy people who have died, or previously healthy people who had a close call. Parents will respond to an emphasis on keeping their children alive and well, and on the fact that their children will need them, rich or poor, to be there for them when they are growing up.

The young single people without dependants will be much more difficult to reach, and I would think will be very unlikley to practice any form of social distancing voluntarily. I do think that the seriousness of the message needs to be absolutely underlined by banning large gatherings if the situation warrants it. Point of sale messaging, where-ever they eat, or buy food. Again, the messages are no use on their own, unless they're facilitated. Practical measures, such as selling prepacked survival food stocks, say for one week at a time, would likely get some attention. You need to get the supermarkets on board. Universities need to be getting ready to operate exclusively online, and workplaces facilitating teleworking. I guess what I am trying to say is that messages won't work so well here, as changing the rules for a time, getting all sectors of society behind them, and providing the practical solutions that people may not be equipped to provide for themselves. These are the real challenges, IMO.

A timely opportunity!!
Not exactly answering Dem's questions, but there will be an URGENT teleconference tomorrow for the National Biodefense Science Board, when they will be discussing H1N1 vaccination strategies and will be taking a vote.  I've put up the relevant documents and details in a new diary here http://www.newfluwiki2.com/dia...

This is the opportunity.  If you have an opinion that you feel the NBSB should take into account before they take their vote, please make sure you take part. I have put up the summary of the experts' opinions in that diary, which IMHO everybody should read, regardless of whether you are going to take part in the teleconference!!

All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

HR Policy, USPS
Dear Dem from CT

I love what you've just started on FluWiki.

WE are all of course the messengers for which we are waiting.

I would add / emphasize the 2 following points:
1. HR and employers should IMMEDIATELY  prepare their policies and inform their staff repeatedly about how much leave they can take if they are ill, if a family member is ill, if child[ren] are sent home due to school closings. In this bad economy people will NOT do anything to jeopardize their employment.

2. Postal workers (and UPS-FedEx-DHL-etc.) should be first immunized - everyone who will self-sequester and practice social distancing will concurrently assume that they can order whatever they need via phone and internet and have it delivered. This of course concerns medication in particular.

Aurelia (former teacher, mother of 2 grown children)

Awareness Empathy Action

Excellent point
Delivery/ infrastructure might not be first tier but might be second tier.

[ Parent ]
This should also consider...
Truck drivers delivering large amounts of cargo to grocery stores, hospitals, etc.  Food and goods will continue to be needed at various points around the country/world, and if all the truckers are out sick, nearly nothing will move expeditiously.

[ Parent ]
Infrastructure Impact Downgraded
Take this, one of NBSB Key Assumption statements:

Catastrophic disruption of societal function, as anticipated in some planning scenarios for a severe pandemic, is unlikely.


Add it together with the 12% absenteeism projection included in the recent UK planning scenarios.

And the picture becomes more clear that unless the severity ratchets up a notch or two, the Critical Infrastructure and Key Resources categories (outside of Health Care and those responding directly to the pandemic) have probably fallen down the ladder a bit for vaccine priority in the Govt's eyes.

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain

[ Parent ]
a fairy tale document
They give no evidence of why they do not expect infrastructure disruptions.

Tell the truth

[ Parent ]
If absenteeism is only 12%, risk goes down
I'm guessing here, but the general level of serverity is tied to both absenteeism and to potential disruption of global supply lines.

We did not crash in 57 or 68, and if this is no worse than those pandemics, why would we crash?  

I'm not saying I agree.  I am certainly not betting my life on it.  But given what we've seen so far, I'm guessing that's the general approach they are taking.  They are also relying on the private sector efforts and may feel they don't have to urge the higher level of preparedness. (Today's FEMA story is an indirect example of this concept.http://www.hstoday.us/content/view/9371/189/)

If that's their view, unless and until they change their assessment of the potential severity, a message of warning and preparedness that is inconsistent with that point of view, will not be forthcoming, at least not from them.  

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain

[ Parent ]
The model says that the NHS should prepare for up to 12 per cent of the workforce to be off sick.

Do they mean 12% actually sick and off work or are they including those who have taken sick leave to take care of family members.  I have a suspicion it is those actually sick.  

Also, 57 and 68 was a different time and economic setting.  No JIT.

I don't think anybody knows just how this is going to play out.  Maybe a mole hill...maybe a mountain.

[ Parent ]
I think that's right

No one really knows. But the US working assumptions appear to be next wave, October peak, based on Susan's diary.  Exec summary:


[ Parent ]
If you...
prepare for the mountain, then the molehill will be easy.

Unless...it is rabid, zombyfied, flesh eating moles...then well...that is a different matter.  One cannot prepare for all eventualities.  ;-)

Note to self:  Buy more ratshot for my .22

[ Parent ]
Top down
The President speaks, backed up with majority and minority leaders, during prime time television and on radio, giving a straightforward assessment of the present risks for this fall, and the potential future risks.  On national networks.

Immediately following the President, the Governors of each state speak on local television networks.  Reiterate what the President has said, then enter into discussion of state and local issues as they relate to the present risks this fall, and what is being done to prepare.  Both the risks this fall and the potential future risks need to be addressed.  The Governors in turn then call for county, city and school leaders seriously begin preparedness.  Broad guidance from federal and state governments will be provided, but local governments will be told that it is up to them to work to protect themselves, since the feds and state cannot be everywhere at once.

Good luck.  We'll need it.

Do the governors know enough about all the issues, especially family preparations?
I doubt that most of them do.  IMO, the governors should be the third presentation (after the president and the experts), explaining things in their states.  It would probably be reassuring to know that state and local plans have been made, even if each family is way behind in doing what they need to do.  

If the true pandemic situation is told on national tv, everyone will be shocked and worried about their families and their jobs.  I think they might need to get some prepping work done before hearing what local plans are, because the governors' details will be more distant from their concerns,  because the states can't promise to keep them safe from flu or feed them.  (Seeing the full story on tv would be great, but will they ever do it?)

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
Apparently not...
or they would have already been telling folks to prepare.  Texas at least has told folks, I don't know how loudly, that they should have two weeks of food, water and medicines.

We are already into the reactive phase.  It will be events which drive us and not the other way around.  They have waited too late in my opinion.  But as in all my dealings with government concerning planning, I have always had to settle for getting "something versus nothing".  I hope it is enough.  I have a feeling that within two or three months we will be seeing Katrina Super Dome events at every major hospital in the country.  Consider this, the new Harry Potter movie started yesterday, and within a month every child and young adult in this country will have been inside a packed theater for over two hours.  

Calm reactive planning is what is occurring now.  Some very different reactive behavior comes later.  But again, something is better than nothing.  

[ Parent ]
I'd just be happy with a single clear message.

"These vaccines are safe, there's just one everyone will need, you will need x inoculations and here's when to expect to get them."

Pretending to be a partially informed and protective parent: What is the higher risk for my 3  yr old daughter?  This pandemic flu that "isn't much worse than regular flu" or these vaccines I hear they make from bacteria?


Too late
Sorry Dem,

They've had 4 years to get the public ready.
They've had since April to get the public prepared for this Fall.

I believe it's too late.

Too many people believe... want to believe that H1N1 is mild and nothing to worry about.

The Gov & MSM have seen to it.

Tell the truth

Hi, Goju
Never too late to try and do better.

[ Parent ]
It's never too late to try
But sometimes it is too late to have much hope of success.

[ Parent ]
we might well fail, but not trying is unacceptable. And no one is going in with expectations of "...and a miracle occurred" and suddenly everythng's okay.

[ Parent ]
I agree completely. n/t

"I am opposed to any form of tyranny over the mind of man."  Thomas Jefferson

[ Parent ]
Even if I think we're going to fail, the thought of looking back and thinking I didn't try as hard as I could for my family is totally unacceptable.

[ Parent ]
I wasnt talking
about our families. I am talking about the general public. It is too late for that now and they wouldnt listen anyway.

Tell the truth

[ Parent ]
we nonetheless have a duty to our communities
as well as our families. We will continue to try locally and nationally to build resilient comunities. Some ideas that we try won't work. If so, we will try others.

we will be less successful that we would like. That's a fact.

[ Parent ]
unfortunate for sure Dem.

We were way ahead of the curve so long ago.
Too bad we were alone on an isolated island surrounded by a sea of stupid.

Tell the truth

[ Parent ]
I find it curious
That TPTB have asked the public, who are not well educated about panflu or how to prep for it have been tasked with creating the communication videos.

I am actually shocked by it. How much money have we spent on panflu preparation, on surge and vax drills, on plans on paper.

This stinks to me of more Sandman work... keeping the opposition busy. let them think they are doing something for the cause... when in all reality they just want us to busy ourselves... managing the outrage.

After 4 years of this, I am really shocked.

Tell the truth

[ Parent ]
someone has a created a myth
attached the name Sandman to it, and now speaks in code as if anyone newly tuning in know what they are talking about.

Those who are prepping are prepping and should not stop. it's a mindset. But I completely reject the idea that every human that "didn't agree with me" or "see what I saw" 4 years ago missed the boat and therefrore it;s too late for them. Better late than never. The world is not ending, but it is quite possibly going to get messy.

[ Parent ]
Not 4 years ago
We have had every day for the past 4 tears to get the public prepared. There is no way there is enough in the pipeline between now and the Fall wave for enough people to "prep appropriately". This has been discussed endlessly. Sandman = risk communicators to TPTB has advised them to the point we are now. Almost no one is prepared. Almost everyone believes H1N1 is mild and has gone away. The risk communicators work has ended up with us being lied to by CDC. It is a disgrace. I was at a party last night. The subject of Swine flu came up. Not one person there thought there's a problem. Not one. No one believed anything I said. They cannot believe they have been misled about something so important. I do not think anything anyone can say now will change that. It is too late. sorry. Best just to top off your own preps and hope for the best. Hope... thats right... its all we have left. except for all those great plans and drills that meant nothing. wasted time and money.

Tell the truth

[ Parent ]
not minimizing the emotion
at all but I would like to point something out.

I have moved in various "prepper" circles now over the past few years.

Peak oil, peak food, transition initiative and now flublogia. (NEVER the "patriot prepper" side tho - white nationalism is tedious)

There is clearly a whole and predictable dynamic people have to move through that is akin to what we all go through after a death (I am sure this is not the first time you have heard this)

One of those stages is anger.  I see a lot of people in flublogia get majorly hung up in the anger stage.

Be angry, sure.  Its especially hard when dealing with a viral origin of collapse because the anger can not be easily articulated or expressed at the danger agent.

Dont be angry at people who have not had the opportunity and privilege of preparing for a disaster that will take them by surprise.

For your own good, let it go. Just let it go.

There is nothing you can do to convince people who are not at a place where they are ready to hear about any of these scary things.

I come from a zen worldview - I see this as attachment (to anger, to prepping, etc) and attachment is the cause of all suffering.

Once you are able to release the attachment or even see it for what it is, you can move on to compassion.

Compassion for all, zombies included.

I wrote on attachment, not to anger but to energy, at one of my blogs.  Some of it might be of help to some people - link -


[ Parent ]

My anger is aimed at TPTB who wasted the public trust for 4 years and got us to where we are now. That we in Flublogia have tried for all those 4 years to move them to spread the prep message only to have utterly failed, and to be asked once again to compose a new message is insane. That HHS has tasked us to create the TV commercial is ridiculous. It really smacks of "managing the outrage" and really just getting more of the same.

Bottom line... they do not want the public to prepare for this event. They want us to continue working, shopping, going to school and the mall. I understand this. We may actually have given them the idea since we were screaming about it since at least 2005. The collateral damage of mass SIP could bring everything down... so keep everyone in the dark, shut up the agitators by busying them thinking they are finally being addressed. In the meantime, this Pandemic will burn through our people like an uncontrolled wild fire.

Tell the truth

[ Parent ]
I've come to the conclusion
the reason they only recommend 2 weeks preps is that they don't want a significant portion of the work force to SIP.

If 50% (hypothetically) is the percent of workforce absent to cause a break down of infrastructure, and at it's peak the pandemic causes 40% absenteeism from dead, sick, and caring for sick;  they do not want an additional 10% of the worried well SIP.  Or whatever the actual numbers would be.

To calm the wife buy cases of chocolate, to calm the husband buy cases of booze, and to calm the children...... heck the booze and chocolate should work.

[ Parent ]
I've come to the conclusion
That no one can find the recommendations for 2 week stockpile since no one knows about flu.gov because of the reasons you state... however, the Energy & trucking industry stated 30% outage and they cannot operate.

Its not a far cry to see that happening even without stockpiling.

TPTB have chosen to take the viral hit rather than the collateral hit of JIT collapsing.

I think they have chosen wisely... and I think that ONLY because they have not adequately prepared the nation. A huge dereliction of duty if there ever was one.

Greed, selfishness, laziness, corruption... the list goes on and on why we are in this leaky boat with no life preservers, life boats or buckets. The iceberg has been hit and we are sinking.

Now everyone get in line and go make a youtube video... but dont make it scary... "Make your video fun, smart, and entertaining."


Tell the truth

[ Parent ]
If your family or
even one being in it doesn't "make it," and if you know in some little "truth" corner of your mind it just might be because others were not persuaded of the need to prepare, and if you can live with yourself knowing you "gave up" the effort of persuasion, that's fine. Go right ahead. Congratulations!

I'm guessing you could both "top off" and keep yelling your head off at your friends. You do not know that your yelling in combination with something else that happens down the line will not "trip their trigger" to do some sort of meaningful preparation. YOU JUST DO NOT KNOW THAT!!  

[ Parent ]
Thank you for this mature exchange. n/t

[ Parent ]
Posted in the wrong parent n/t

[ Parent ]
Sandman Advocates Preparing - Why Blame Him?
I fail to see your logic.

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain

[ Parent ]
actually no
He has suggested that the pandemic be on the back burner for the general public. His company advises and the message is clear.

Tell the truth

[ Parent ]
Sandman's 2007 Out-of-context Quote vs His Consistent Message to Prepare
If that 2007 out of context quote is what's driving your assessment of Sandman, its a pretty old, small (and disputed) sample of his message from which to draw such a broad and negative conclusion.  

Setting aside for the moment the issue of that 2007 statement (more on that - see below), maybe your assessment of him would change if you considered some more current, H1N1-specific commeents, like his May 2009 Nature commentary:

The CDC's biggest failure is in not doing enough to help people visualize what a bad pandemic might be like so they can understand and start preparing for the worst.

For the ordinary citizen, the US government has so far recommended only hygiene. It has told people to stay at home if they are sick and to wash their hands. It hasn't told people to stock up on food, water, prescription medicines or other key supplies. Two years ago in response to 'bird flu' worries, Mike Leavitt, the then US secretary of health and human services (HHS), was criss-crossing the country with that advice (http://www.pandemicflu.gov). Today, CDC officials won't say whether it is still good  advice. It is. Why are officials so wary of describing the worst case vividly and urging people to prepare for that?...

First, consider the people officials are most worried about - those who are excessively alarmed. Here is a secret of preparedness that is easy to forget: it is calming to prepare. Having things to do gives people a sense of control. It builds confidence, and it makes them more able to bear their fear.

Second, there are those who are not worried, or who have already 'switched off'. Each time officials repeat practical advice, more people take it. Some of them take it sceptically, but take it nonetheless. Whenever someone acts, the scepticism is reduced. So urging people to prepare can calm those whose concern is excessive and rouse those whose concern is insufficient. It also offers the practical benefits of putting key supplies to hand.


(Emphasis added.)
More here:

Whatever you think his message was then (and I disagree with you on that) his message now is clearly in favor of both frank discussion with the public and government advocacy of individual and family preparation.

Back in 2007, the "back burner" comment you are referring to got a lot of conflicting response and interpretation:
and the link to his subsequent clarifying response statement was posted in those comments (by you)

You evidently were not persuaded or have not read his more recent statements.

I remain convinced both by the circumstances of the original "back burner" statement and by the overwhelming bulk of his writings both before and after that he was and remains a strong proponent of both unvarnished citizen engagement and serious individual preparation.  

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain

[ Parent ]
i have read
recent statements. And like the WHO and CDC, the message is too late and too mild. Years have been wasted. There just simply is not enough in the JIT chain between now and Sept to adequately prepare the public. All messages now are simply a CYA routine.

They've had years to stand and shout. I still dont hear the shouting.

Bottom line is TPTB do not want us staying home longer than the 7 days to get over the illness.

The biggest fear is JIT collapse. I don't blame them. Now. But they had the time and blew it.

How many are prepared for what's coming?
Not enough that is for sure.

Tell the truth

[ Parent ]
you still need to explain why
what's coming is the aporkolypse. You are treating H1N1 as if it's H5N1, and that's a big mistake. It's not a mistake others are making.

we are looking at 'highly disruptive', not collapse of infrastructure.

[ Parent ]
Argentina isn't collapsing
They instituted NPIs fairly late.  They have certainly had a lot of cases, and deaths.  But they aren't collapsing.

Truck drivers whose driver's licenses expire the end of July are having trouble getting in to see a doctor for the required health exam.  So the government has given these drivers a 1 month extension to get their licenses renewed.

That doesn't look like collapse of JIT to me.  

GetPandemicReady.org - non commerical website with practical ways for families to prepare.

[ Parent ]
I pray
You are both right come this Fall when caseloads overwhelm HCC and the Tami runs out or if H1N1 Tami resistance shows, then the true CFR will show itself. Even a 2% CFR could blow the system. We all know that. Why are you singing a different song now?

Tell the truth

[ Parent ]
I don't believe
that the H1N1 pandemic we are anticipating, this fall, will cause collapse of the JIT system; in the way that a 60% CFR H5N1 pandemic, with no possibility of a vaccine, even for those who are critical workers, could.

So I'm not all that worried about water barrels and 12 weeks of food, and back-up heat, all that.  Not for this pandemic, this fall.

Access to medical care, yes, I think that could be affected.  Possible access to certain medications.   These are areas that concern me, especially as I have a relative who is in need of dialysis and a kidney transplant.

And I am anticipating the need for school closures, and a slow down in some areas, and perhaps spot shortages for a week or two.  But not "collapse".

That's just my prediction.   And it's not a "change in tune".  It is thinking things through, logically, based on evidence one has, at the current time.  

GetPandemicReady.org - non commerical website with practical ways for families to prepare.

[ Parent ]
because there's no evidence of 2% CFR
where are you getting that number from? 2% GFR would be frightening, 1918 style, but there's no data to support that we are looking at 2% CFR.

what happened (timeline) is the outbreak, concern, assessment of CFR and reassessment with ratcheting down of concern... not to zero, but away from 1918 predictions. That is not based on messaging, it's based on the science and the data available.

[ Parent ]
has a second wave started anywhere in the world?
When will we know for sure?

Or does it depend on the number of generations since the first swine-to-human jump, whenever that really happened?

My guess is we'll muddle through and find out in retrospect, which is a much softer way of finding out than the big bang we've sort of been expecting for several years.

Retrospective vision is 20/20.

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
You're right - no evidence
However, absence of evidence is not evidence of absence.

With countries around the world having decided to stop counting cases, it then becomes impossible to accurately calculate a CFR.  The message I am increasingly perceiving is that even organizations such as WHO are now acting as though they believe this fall and winter will be much worse than was believed even a few weeks ago.  

Perhaps that's a failure of perception on my part - as was said, we'll have a much better idea in retrospect.

As Goju said, it wouldn't take an H5N1 pandemic with a 60% CFR to create havoc - a much lower CFR would prove far more problematic than I think most would be willing to acknowledge yet.

What we've seen so far is the herald wave, first wave.  We do not know what the second wave, if there is one (and it seems only logical that there will be one) will mean in terms of the ability of medical systems to cope, or the other aspects of our society to manage high absentee rates and the other accompanying problems.

I believe if reliable data were available, we might well find ourselves looking at something that looks a whole lot more like 1918 than some are now willing to believe.

Time will tell - and believe me, I'd much prefer to be wrong.  

[ Parent ]
I agree with all of that
I'm not ruling it out, and prep is for the unknown.

I just don;t like acting as if "we all know it WILL be 2%" (we don;'t know that). Lots we do not know. When and how severe lead the list...

[ Parent ]
CDC numbers from Mexico
from an unmitigated start...

These high CFRs by ages were known to WHO/CDC by at least May 20th, from the confirmed Mexican case data.

see 2nd page in, broken down more than CDC's ages:
as of May 20

0 to 9 = 8.1% of total deaths, .6% CFR

10 to 19 = 5.4% of total deaths, .4% CFR

20 to 29 = 28.4% " " 2.8% CFR

30 to 39 = 23.0% " " 4.1% CFR

40 to 49 = 16.2% " " 3.9%CFR

50 to 59 = 13.5% " " 5.5% CFR

60 and older = 5.4% of total deaths, 5.9% CFR

Tell the truth

[ Parent ]
initial figures from Mexico, other figures
My understanding is all figures are subject to different biases, giving us CFR estimates that are more severe than reality, or less severe than reality.

I'd say the initial figures from Mexico would give us a picture darker than reality, because mild cases wouldn't be counted, while severe cases would.

I don't know how much less reality would be, but less.

Hard to prove but that's my current honest assessment.

How will things change is hard to tell too.

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
view on Mexico numbers
Yes, I normally hear arguments that CFR's are lower than the numbers we calculate from cases and death reports.  But I think they will come in on the global average about the same.
My reasoning is that many H1N1 deaths may have been counted as pneumonia or as other complicating things.  Also the numbers that are seen now are at times when the hospitals are fully up and running and later they may have 40% reduction in staff, and more cases than beds. Also Tamiflu resistance will set in later.  Not only that, many African countries will have AID complications and do not have the health services of Mexico.

So, if I had to pull a number out of the air, it would be around a percent - perhaps as small as 0.25% in major countries and perhaps as large as 2  to 5 % in high AID infected countries with little health services. But then again, what do I know?  I can't even get my crank operated crystal ball to light up.  

Be Prepared

[ Parent ]
but that didn't pan out
Mexico really didn't turn out to be an order of magnitude more severe than anywhere else, and we now see the same virus doing the same thing in 100+ countries.

[ Parent ]
could be
1 - tamiflu still works
2 - hospitals are not yet overwhelmed.
3 - severe cases can still get professional medical help.

Tell the truth

[ Parent ]
Variations on a theme, Goju
1.  Tamiflu still works in most cases.
2.  Most hospitals are not yet overwhelmed.
3.  The majority of severe cases can still get professional
   medical help, altho some aren't getting it in a timely
   and/or appropriate fashion.

HCW at Pitt Memorial Hospital in Greenville NC (daughter's friend) had all the symptoms of swine flu last week, saw his MD who diagnosed a sinus infection and prescribed antibiotic, yet held him out of work for several additional days (which would have amounted to 7 days from onset of symptoms).  Would not prescribe Tamiflu even though he was a HCW and was within the window of opportunity for antiviral benefit.  Should have returned to work yesterday but because he was still running a fever was told to remain at home until the fever returned to baseline.

Now - is that typical behavior in relation to a patient with a "sinus infection" or does it better fit the instructions that would be appropriate for a patient with swine flu?  He couldn't get out of bed for more than 48 hours during the peak of the illness, and although he did seek medical help, it obviously wasn't rendered appropriately - he works in respiratory therapy for pity's sake, and likely would have exposed patients to his illness before being symptomatic - and if HCWs are to be at the head of the line for vax, shouldn't they also be at the head of the line for antiviral treatment when they present during the appropriate time frame?

[ Parent ]
I would love it of 100% always followed guidance
but then again ~50% of HCW get their seasonal flu shots. ;-(

We need to ramp up communication to docs, no question about it. However, no one should be thinking that docs follow directions all the time on anythign else, either.

[ Parent ]
These will end
1.  Tamiflu still works in most cases.
2.  Most hospitals are not yet overwhelmed.
3.  The majority of severe cases can still get professional
  medical help, altho some aren't getting it in a timely
  and/or appropriate fashion.

When the 100 million americans become ill in the Fall (thats 30%)

Tell the truth

[ Parent ]
it'll be likely between 20-30%
and a huge strain, but most people will still be home care. The big 'hole' in govt prep has been home care. We've told them that.

July 8


July 16


and more complete guides can be found here:


Not to downplay it, but that's still not infrastructure collapse.  

[ Parent ]
and btw
most people still don't need tamiflu to recover.

[ Parent ]
and 98% of them survived in 1918.

The 2% was a bitch though.

Tell the truth

[ Parent ]
Do you really think this is 1918?

[ Parent ]
I think
That when all is said and done, The Fall wave will infect a lot of people... much more than any health care center can accommodate. They are already at the breaking point and a huge surge will shut them down... very soon after all their PPE and supplies are gone.

I think when the tamiflu is not used, a large portion of the population will be at risk of severe symptoms. i know that almost no one knows how to care for a sever novel flu illness at home.

This spring/summer wave will be nothing compared to the Fall IMHO.
The numbers of sick will cause a higher CFR due to lack of professional care all by itself.

I think when you factor in the underlying health issues which so many Americans have, we could be looking at 1918 numbers with H1N1 as it is.

I think even if the Tami holds, the numbers will overwhelm the system.
I think the Vax is a non issue for most Americans, IF it works and IF they can make enough of it anyway.

It is the number of sick that will make or break this next wave.

Tell the truth

[ Parent ]
I don;'t know if it'll play out that way
My opinion, of course. ;-)

I think you underestimate the resilience of Americans in general, but your biggest error is in assuming every aspect of what you wrote must be the way it plays out.

For example, I think the biggest hole, as you have identified, is home care, but that's info that can be blasted out pretty quickly if needed. All the elements are there, already. Putting it as a supplement to newspapers, adding it to hospital web sites, handing it out in doctor offices... can be done (two towns near me/us have already done so.)


All the elements are there, and it's more a matter of will than technical expertise.

[ Parent ]
if you think that we resilient Americans can handle severe H1N1 cases at home especially those with underlying health issues, like obesity and pregnancy.

Have you seen the death % of HCW in Argentina? 10% is it?

The lack of propositioning PPE in the hospitals will end up killing our HCW or giving them pause for coming to work - see allnurses.com pandemic discussions.

I know with all the info I have at home about panflu care, I would have a tough time dealing with my now perfectly health family if they took a turn for the worse.

Dem, how many will get sick within a 4 week period during flu season?
20%? thats 60 million sick. CFR 0f .5% = 300,000 dead.
Those are huge numbers.

Tell the truth

[ Parent ]
more than 60 Million
The 20% is a bit optimistic.
see the latest NZ study:

it seem to indicate it might get to 79% in total.  
perhaps 20% at the few weeks near the peak.

If you use the new NZ numbers, of 79% attack rate...
it could well get near 1/4 to 1/2 million dead in the US alone. Depending on what CFR you estimate.

Any way you go it could get bad.
This is getting depressing.  I am going to walk away for a while and watch a comedy.....

Be Prepared

[ Parent ]
the only fantasy here
is that you'll take every worst news report or case scenario you can find and assume it's inevitably true. How often have you been wrong over the last 4 years when you do that?

I expect 45K to 100K, could be worse, could be better, but I don't really know and you don't, either. No one knows (hence the need to do what one can to mitigate.) Not the end of the world. Not good, but not 1918. In fact, sounds and looks a lot more like 1957.  

[ Parent ]
For the best BUT Plan for the worst.

What did Leavitt say?

Something about if it isnt so bad then your preps seem to have been overdone but when it its, its never enough... something like that.

I went into this thing in April thinking "om my god its happening". Then after watching how it unfolded i thought "gee, its not bad at all".. then watching these past few months, the progression, the deaths, the tami usage, the gov response, media response and latest data from the ground and from the research... I'm thinking "hey, this looks like its gonna be bad and the Gov is only interested in keeping the money flowing".

So I have come to the conclusion that we are supposed to just go to work, go to school, line up for the vax in October, If i get sick it will be mild... and if its not they'll give me tamiflu at the hospital and all will be ok.

NOT - I have come to the conclusion, which just keeps getting reinforced with every news story, that we are headed for a nightmare this Fall, and no one outside Flubogia seems to know or care.

I also find it rather disconcerting that the tone here is that all will be well. Dont worry its mild like 1957 or 68, its not 1918.

Page after page on this forum foretold of system collapse with enough people out of work. Yet its all ignored in the face of facts. I just don't get it.

Tell the truth

[ Parent ]
because there's little to suggest system collapse
were this H5N1, different story - and the references you had to previous discussion was entirely about H5N1.

I see advice moving from N95 at all times to simple mask for HCW unless there are aerosol generating procedures.

I see advice moving from stay out a week or no fever, to stay out 24 h with no fever.

It's best advice, based on what we are seeing.

I see much less system collapse numbers than we expected. Rigid thinking without adjustment to changes? Plans are supposed to be 'decision support tools', not destiny written in stone.

[ Parent ]
re: "...much less system collapse numbers than...expected..."
What about adding...at this time?

I anticipate the collapse of the American Health care System in the fall. My Phila hospital ER is on divert much of the time-in July. We have ER boarders all the time-in July.

What lay ahead? Who knows, but I sure am concerned, especially after this conversation yesterday with my county's head of the public health nursing department:

Q-me: What are the plans for the dual flu season this fall and winter?

A-head person: Vaccines...

Q: What about public education?

A: We're working on it.

Q: What about telephone banks (to answer calls/screen potentially ill people)?

A: We're working on it.

Q: What about (hospital overflow) surge management?

A: We're working on it.

Personally-not too reassuring.

DH had major abdominal surgery in May with post op lung problems, was told to see his lung doc within 10 days of discharge (this doc is also his primary care). He was not able to get in to see him until July-2+ months later!!!

Doubt anyone in N.O. after Hurricane Katrina complained they had prepped TOO much....

It is better to look ahead and prepare than to look back and regret.

[ Parent ]
my concern-explained
most of my concern is:

1. 2 year old grandson with severe asthma, induced by infection. It used to be called intrinsic asthma (his mom-my DD, has it), don't know how it's referred to now.

2. I was just diagnosed with secondary adrenal insufficiency. This can get REALLY ugly should I get a bad infection, need surgery.

   But to look on the bright side, at least I am diagnosed now and have the meds and knowledge to treat what comes up!!

It is better to look ahead and prepare than to look back and regret.

[ Parent ]
hospitals are unprepared, no question
I think the emphasis has to be on home care because it's too late to get hospitals surge-ready (and impossible to do no matter how much time we have.)

This still doesn't mean collapse, though it will be messy, especially at peak. it all depends on whether it's stretched out or all at once.

[ Parent ]
mutual help networks?

1) Say I'm ill.
2) You bring me my groceries.
3) I don't have to go shopping.
4) There's less infection around you.
5) The health care system is more able to deal with your illness if/when you fall ill.

Maybe same with kids' care.

Maybe different networks for different things.  I'd trust you with my groceries but not with my kids, etc.

This is another layer in the swiss cheese strategy.  How much of this might work?  Better in rural or in certain oldish towns?

How do we operationalise it?  Where's the data about social networks?  Is it being done already?  Is it working?  Could it work better?

Dormant networks put to emergency use ... sounds like a concept?

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
Very good idea
..but for communities that either ignored the call to plan or were never realistically appraised of the need to plan, it's getting real late.

Neighbors must work together-maybe a talk-free basic communications system ie signs posted in a visable spot ie front-facing window. Low tech,cheap. Green means we're ok, yellow means we need: XYZ-whatever; red means help needed now-illness,death etc. Just who will respond to that with what resources needs to be worked out.

I'm trying to find a spot locally to get as many of my neighbors (small development, maybe 25-30 single family homes in rural area) together to start this. The local fire hall people refuse to call me back-don't get me started.

So if need be, in September it'll get done in my house. Good place to glean ideas; I plan to put a copy of pandemichomecare.com in everyone's hands.

It is better to look ahead and prepare than to look back and regret.

[ Parent ]
NOT 10% of Argentinian HCW are dead
but 10% of the flu dead in Argentina are HCW. These two - and I'm not vouching for the accuracy of the latter - are COMPLETELY DIFFERENT! Please don't anyone spread the former any further. It's utterly baseless and it's done enough damage already.

[ Parent ]
My own analysis
is that for my family to have a good chance of making it through a severe pandemic, the general public/society must also prepare.

I agree that there are those who will not listen, but I disagree with you that it's too late to get the general public/society working vigorously and effectively on preparation. (I can't prove that, though -- you may be very right, and I may be very wrong.)

It seems clear (to me, at least) that the big thing that is missing at the moment is effective leadership at the highest levels of government (and also to a large extent at the highest levels of the MSM and business. I expect essentially nothing from the ____, ____ AMA). Just after last Thursday's flu pandemic summit at NIH, I felt like such leadership signaled it was emerging. But now I think I was probably wrong.

However, we ain't dead yet.


[ Parent ]
Probably not the place for this discussion...
Watching this unfold I have come to believe that the Government is primarily concerned about the systems collapsing from worker outage and they will do whatever it takes to guarantee that does not happen.

To that end, I don't think we'll see any meaningful messaging to prepare. The news will be managed so the average Joe will basically be ignorant of anything wrong.

I think they will be successful but we will lose many in the process.

Tell the truth

[ Parent ]
The meme
the message, from CDC is officially "it's like 1957." They note that in 1957 "the schools were not closed."

Also:  "if your child is sick, keep them home from school, if your child is well, they belong in school."  

Goju, it has been declared, and "so it is written," as it were.  No one who is affiliated with CDC will move an inch from that messaging.  

Any ship attempting to deviate from that messaging will be heeled tightly in.  

Oh, and they are right now preparing PSAs to promulgate the new message, oh yes they are. It'll be a national campaign, soon to roll out.  

[ Parent ]
bizzare thinking about CDC
pretty conspiratorial, but they don't control thinking from ECDC or euro centers, or state DPH, and everyone in those areas pretty much thinks the same thing based on the data, not based on some central command from CDC, itself not always unanimous.

Go where the data takes you. 1957 was hardly "mild".

Just like CDC, no one should take either officials or bloggers at face value. We don't expect that of anyone. Bring the data and let's make up our own mind.

[ Parent ]
one of many non-USA non-CDC examples
"Our study shows that this virus is spreading just as we would expect for the early stages of a flu pandemic. So far, it has been following a very similar pattern to the flu pandemic in 1957, in terms of the proportion of people who are becoming infected and the percentage of potentially fatal cases that we are seeing," said professor Neil Ferguson, the corresponding author of the new research from the MRC Centre for Outbreak Analysis and Modelling at Imperial College London.


My italics; statements like this are where the concept comes from.

[ Parent ]
Ferguson comment from May
but yes, I think the thinking is still the same.  With more data now than in May.

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
First the Message, then the Messengers

What to Expect this Fall

1.  The pandemic outbreak we expect this fall will likely be 10 times (insert #) more widespread than what we had this spring. (It also might lead to more severe illness.)

2.  It would not be unexpected if the fall outbreak was made up of a significant portion that might not respond to the antivirals like tamiflu.

3.  Even though we are doing everything we can, it is not possible to produce a specific vaccine for more than 1 in 10 (insert #) Americans before this second expected wave will have passed and the vaccine that is available in time will be rationed according to priority lists set by States (with non-binding Federal guidance.)

How that will affect you and your family

4.  It is very possible that during peak periods of the fall outbreak, our health system may not be able to meet the demands put on it and you will need to delay some health care and care for your own flu patients at home unless and until their condition becomes serious or severe. (We'll be giving you information later about how to prepare for that, how we will keep you informed on that issue and how you can tell when to get additional advice or professional health care.)  

5.  It is not likely, but still possible, that other segments of our society and economy may experience some level of delay or temporary disruption during peak periods of the fall pandemic wave.

6.  You may be asked to stay home for a week or longer if someone in your family catches the flu.

What you should do, starting now, to make sure you're ready.

7.  You should prepare for both minor disruptions in your access to ordinary necessities and the possibility you may be asked to stay home to care for loved ones by gradually accumulating a back-up supply of food and other necessaries to last about 2 weeks.  (These should include the kinds of things you would need to provide care to your family members if they are ill.)

8.  Many of the things we will suggest you do to prepare for this fall should be considered not only for this purpose but as a general change towards a more responsible and common sense approach to building some backup resources for both our families and our communities.

9.  We expect that the discussions on this effort will match the kind of response that will be needed and encompass the entire community - calling on everyone to pitch in for a common, coordinated effort to make each of us and all of us stronger, more resilient to unexpected change and better prepared for whatever comes, this fall or any other time in the future.

Messengers:  (Think Community Mitigation Strategies - Early, Targeted and Layered.)

President (with pre-recorded support messages from Congressional Leaders) gives intro and broad message from Oval Office.

Key agency heads pick up specific detail (maybe from the couches in the Oval Office - like they are there to brief the Pres.)

Each State would follow that time slot with one of its own, on local TV to give state-specific resources and guidance (in similar format with Gov leading and using others to fill in detail.)

National TV would follow next night (or within days) with Townhall meetings (like used in Pres campaigns) to let the public raise questions and get answers from experts.

Local townhalls or neighborhood discussions could be conducted by local TV and Radio, Universities, Cities, civic groups, nonprofits, Churches, health care providers, local leaders etc.

PSAs should be used extensively and should combine both high-profile folks with ordinary folk who are Drs and Nurses no different than your own health care professionals look (or you'd imagine they should look.)

The general plan should be in place and elements could be added or subtracted depending on the percieved need.

The approach is not that different from a modern national presidential campaign and should include the email, social messaging networks etc.)

I also want a pony.

I'm just guessing here, but I think I've got better odds on getting the pony.


ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain

strange message
We're going to have a seasonal flu vaccine some September.   But we will be prepaing for pandemic H1N1, and seasonal flu is probably not going to be around, in all liklihood, anymore, right?

And seasonal flu vaccine isn't really for pandemic H1N1.

So what's the explanation going to be about the seasonal flu vax?  I'm trying to figure that one out....Why exactly shoudl people get it?

GetPandemicReady.org - non commerical website with practical ways for families to prepare.

above comment not directed at ITW! n/t

GetPandemicReady.org - non commerical website with practical ways for families to prepare.

[ Parent ]
Lull the masses

Tell the truth

[ Parent ]
the expectation is that seasonal flu
will co-circulate, and vaccinating kids and others will help slow co-infection and slow viral mingling.

[ Parent ]
yeah, but
how realistic is that expectation?

Isn't most flu in Australis and Argentina now, like 90% of it, pandemic H1N1 (or whatever it is being called now?)

I'm just going on memory of reports I've read recently.... not sure that's accurate.

GetPandemicReady.org - non commerical website with practical ways for families to prepare.

[ Parent ]
We don't know
This spring they both existed. No reason to think seasonal will disappear, even if novel H1N1 is predominant.

IOW 10% is still a significant number, and more may come later.

[ Parent ]
contacted a few nongovt researchers I know
and they all agreed to expect seasonal and pandmeic flu to both be circulating.

[ Parent ]
oh please

Tell the truth

[ Parent ]
I think they want to prevent a situation where there are two different strains (or more) circulating.  One pandemic, the other seasonal.  One sensitive to Tamiflu, which pandemic H1N1 is at least up to this point.  The other, seasonal H1N1, is resistant to Tamiflu.  Pandemic flu may simply crowd out seasonal, but there is no guarantee of that.

My take on the reason.

[ Parent ]
In other words
From a docs standpoint, which antiviral do you give?  Two or more strains being passed around complicates things.

[ Parent ]
this is a difficult decision
whether or not to give the seasonal flu shot as well as the H1N1 shot.  It's a subject of some lengthy debate, recorded in the detailed report for the NBSB meeting. http://www.newfluwiki2.com/upl...

I don't think they have reached a decision on that yet.  

All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
the scientists I spoke to are fully expecting
seasonal flu vaccine to be given. it'll be a surprise if they don't.

[ Parent ]
I would assume the age groups would be different
I believe this is going to be discussed at the ACIP meeting in Atlanta July 29 http://www.cdc.gov/vaccines/re...

All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
No decisions yet
Just expectations.

[ Parent ]
If H1N1 is replacing seasonal?

Tell the truth

[ Parent ]
it's a mixed picture
In one of the presentations in the NBSB report, they said that it appears that in Argentina and Chile, it's replacing seasonal flu, but in Australia it's still mixed.  1/3 novel H1N1, the rest still H3N2.  Don't know how recent the data is, cos this was presented in a June 18th meeting.  

All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
Australia is mentioned on page 9 of that report
CAPT Fiore summarized what we know so far in those areas where H1N1 is circulating:
- Will the pandemic virus continue to circulate? Yes.
- Will it cocirculate with other influenza viruses? Preliminarily, yes.

I think the next question is "for how long".  If it's a few weeks it matters less than if it's for a few months.

I guess it depends on population density and mixing, in a nice ("nice") fractal thingie.  The Sahara would be different from Tokyo, in this regard.

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
and if you don't know...
...you plan for both. This isn't a case of googling for the right answer, alas. The right answer (whether co-circulatiuon, dominance, timing, etc) is unknown. ;-(

[ Parent ]
It seems they did miss
the vax target for the H3N2 portion of the trivalent, so the seasonal flu vax shipping out now won't be effective against that strain.  

[ Parent ]
does seem that way
every few years that happens. Not a good year for it. ;-(

[ Parent ]
because we can't read the future
could be novel H1N1 in Sept-Oct and seasonal H1N1/H3N2 in January, and there are still vulnerable people to protect.

The seasonal vaccine will almost certainly be a go. Pediatricians are already hearing that from the American Academy of Pediatrics. The novel vaccine will likely be a go, with many uncertainties and questions still to be answered (timing, safety, mechanism, final decision.) We've reported here what many of those uncertainties are.

[ Parent ]
Vulnerable to Protect and Don't Want to Add to Surge
Failure to provide seasonal vaccine would lead to greater illness and death in age groups that 2009 H1N1 might skip over, most specifically those over 65 who typically comprise 80-90% of those who die of seasonal flu.

In addition to protecting the people who inhabit those different risk categories, seasonal vaccination will also avoid adding additional stress on the health care system that will come with the additional illness and death that an unmitigated seasonal flu season would bring.

Until and unless we know for certain that seasonal flu will not come, so we must prepare.

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain

[ Parent ]
Flu Season
Seasonal flu isn't circulating now because it IS seasonal and summer isn't its season.  When regular flu season returns, seasonal strains might be expected to circulate again, in conjunction with novel H1N1.

[ Parent ]
Relenza if you can
An algorhithm if you can't

[ Parent ]
in severe cases, all three.

Rimantadine, tamiflu and relenza.

Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"

[ Parent ]
One more antiviral -
Amantadine.  Old line Parkinson's drug, Symmetrel.

I swear I think it saved my life about 20 years ago, when husband, daughter, and I all got the flu the same day.  Husband was the only one who could function well enough to get out of bed, into the car, and down the road a mile to the doctor's office who, bless his heart, prescribed amantadine for all three of us.

Within a day, I'd stopped trying to figure out if I were going to die or if I just wished I were going to die, and was able to get up and walk around without throwing up or passing out - it was a huge improvement, and it started within 24 hours of beginning the medicine.

I've got some now, even - just in case.

[ Parent ]
amantadine had some neurological contraindications
last time i looked, at least

individualised risk balance is needed, of course, and i don't know how "hard" those contraindications were

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
these days
Novel Influenza A (H1N1) is 100% resistant to amantadine.


click for bigger pic

best choice by the chart would be relenza.

[ Parent ]
thanks, Dem, I didn't know that
I'll say it again.  The hive mind works, if it works at all, because we're all different, know different things, contradict each other, etc.

It's just the way things are, if you ask me. :shrug:

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
Do virus strains ever mutate
away from resistance and towards sensitivity?

As in, if H1N1 is 100% resistant to amantadine currently, is there any chance that when it mutates it could become not resistant?

[ Parent ]
mutate constantly
the mutations that lead to loss of resistance could arise 10 times an hour but the meds select against them so you do not get a population that is dominated by them.

I am not saying that they do arise that quickly or that rate, etc.

As long as there is selection pressure by the med, sensitive virions will be killed and will not replicate to expand their sensitivity.

[ Parent ]
yeah, but if the med is not used, then Clawdia's question is valid
and no, I don't know the answer.  Maybe some resistances are more stable than others.  I think after a certain point, and I'm not really humanising the virus, the virus doesn't care about carrying a "resistance feature" that's no longer helpful since the medication is not used much.  So it will carry it if it's not too heavy, if that makes sense.

Really NO idea!

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
the evidence is that if there's such a thing
it's not quick. The resistance to seasonal H1N1 with amantadine is still with us and that resistance started well before last year.

[ Parent ]
the reason that I suggested all three
was that by the time you get lab results back, even today, it's too late to do anything about it, and if the infection happens to be severe in your case, then you are in a world of hurt.

One of the docs at the Panflu conference in 2008 said that the "shotgun" approach seemed to be the most fruitful approach for coping with H5N1 infection in Indonesia.  At the time, that struck me as a somewhat risky and dangerous approach for seasonal flu, albeit understandable for a 60%+ CFR virus.  Now, though, WRT the Mexican flu, I am more sanguine about the use of antivirals and do intend to request that my attending be aggressive in trying to "knock this out" at the first signs of infection.  There is a weird variability in morbidity that is not understood, and my suspicion is that there is a lot of mutation going on within individual hosts that is not picked up by the present testing regime.

Prudent People Prepare Properly

"better to have it and not need it than need it and not have it!"

[ Parent ]
i remember ;-)
LMWatBullRun (who is a terrific guy in person, btw) took extensive notes.

As long as relenza hits all variants, and because it actually is less mutagenic, it is the most efficient answer. However, for high risk, very sick patients, more than one drug might be used, or higher doses of same drug.

[ Parent ]
evolving ideas on what to do and what to tell fellow citizens

TPTB might help by amplifying this kind of memetic sneezes.

Things to do are not just "cover your cough", but also "phone your neighbor for mutual help with contact reduction".

Know your layer.  Be in charge.

(Can't do harm, can it?)

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

thanks, lugon!

[ Parent ]
I'm coming in late to the convo
But I think ITW's approach is a good one and very similar to what I would have suggested. Although, if he gets a pony, I want one too so I can have something to get me around if I can no longer get gasoline for my car.

Seriously, the only other points I can make are threefold. First, I don't know if it's because it's so soon and clear number cannot yet be formulated but, if disease center, physicians, etc. around the world could just tell us that right now A/H1N1 is "X" virulent and has a CFR of "Y". We would at least know what we're talking about right now. This along with the release of underlying conditions would go a long way toward either allaying peoples fears or, perhaps pushing them toward making the necessary preparations whether it's 2 weeks or 2 months.

Second, I come here and read so much news/commentary that is choc full of information and yet, I see very little of it in American MSM. Frankly, it boggles me a bit. U.S. newspapers are struggling and you'd think that some of what we've read in Argentinian, Australian and British papers would make their way into at least the front section of our larger papers. They haven't. Why is that?? Oh, the WSJ has picked up a few but they're always very down played in their message. Bloomberg does some but, of course, they forcast most to the financial sector and not the general public. Most news casts don't even pick it up and again, when they do, it's always down played - less than 1000 deaths in the U.S. with no talk of what's happening in other parts of the world or might be coming. Why? The kind of stuff we report and talk about on here is news and would sell papers. In part I blame the faulty start we got with the "pandemic or not" message by the WHO but really, if this were such a huge story wouldn't they be covering it? (just playing devil's advocate here). I went back to one of the physicians who treated me like a worried little housewife and I was armed to the teeth with info from this forum. The news...he threw the news at me. He's right! It's not in the news and when it is the comments a re ludicrous with no follow up whatsoever. Again, no Rx for antivirals or antibiotics for my stockpile and no assurance that there would be some available should one of us get sick.

Finally, and I may be crucified for writing this but IMHO this is the best place on the intertubes for getting flu information of all kinds. There's no political BS, little arguing (very rarely), and there's much tolerance for a wide variety of opinions regarding everything from prepping/SIP to anti-virals. What I DO think is missing from this site and will be much needed in the coming months is warmth, the extension of kindness and understanding for those who are angry and afraid. I think we need to find a home for that here on the FW forums.

I've seen the numbers grow on the site, new names, most people on and lurking/posting. I've recommended the site to many. There's a LOT of news and commentary which is good. There's not a lot of places for people to talk about how they FEEL and that's going to be happening more and more the closer we get to fall. Some of the feedback I've gotten (from a few I've recommended the site to) is that, especially when it comes to the talk about vaccines/adjuvants, is that the terminology is way over their heads. Frankly, it's over mine but I Google what I can or ask a question here and there. We're very clinical here sometimes. Yet, this is one of the subjects people are interested in and yes, afraid about and don't even how to discuss in layman's terms. I'm not suggesting this become a "hand holding" type of forum but I dunno...maybe I'm off base because I'm relatively new at 3 months (and others I know at only 2 or so) but I've seen more emotion on this forum in the past week or so than I have since I joined. Maybe we need a place for it.


"History never looks like history when you are living through it." ~John W. Gardner

Some thoughts from an old-timer ;-)
First thank you for your thoughtful coments.  

This forum has always been a user-driven sort of place.  We didn't start off with a particular format.  In fact, this was a spin-off of the old flu wiki forum, which in turn when first conceived was more like an afterthought, some place that people contributing to the wiki can talk to the mods, or something like that.  But it proved so popular that it was unsustainable on the wiki software, so we eventually moved here.  

That's the background.  Apart from some simple forum rules for our collective sanity, there were/are no preconceived ideas about what the FW forum should be about.  So if you or anyone feel the need to talk about how you feel, for more hand-holding, feel free to just start a diary and let others jump in.  Or post on diaries like the ppf series or something.

On the vaccine/adjuvant issue and the general need to use more layman terms, since I've been contributing the most amount of content on this subject, let me just say that I'm fully aware of it AND it's a work in progress, severely limited by my own time constraints.

There is also a somewhat 'technical' reason for the kind of stuff I've been writing recently. The vaccine safety issue is important and controversial.  While it is important to (eventually) lay it out in simple layman terms, I made a judgment that the initial priority should lie with an adequate and public exploration of the science. The public part is important because I personally would like to know if my views are incorrect, and have other people post information that would lead us to a better understanding of the issues.  

I can make it very simple, but it will be no more than my views, and you'd all have to take my word for it.  I'm not comfortable with that.  My purpose for writing, among other things, is to empower everyone to gain as much understanding as they can, to be able to examine the evidence and decide for themselves, especially now that we are in a pandemic and there are REAL decisions to be made by us all, very shortly.

I haven't completed my research on the vaccines yet.  The work is enormous.  My bibliography folder on vaccines now has hundreds of articles.  My total bibliography for flu is now >1,000.  I'm almost ready to post my (interim) analysis of specific vaccines.  There are also ongoing and significant policy developments to follow, like the various meetings coming up.  

In short, it's a work in progress, and extremely time-intensive.  If you want, and can spare the time, you could start a diary explaining what you understand in layman terms, and let others help in developing a 'final product'.  My intention is eventually to write a short summary of the vaccine/adjuvant issue, but to be honest a) I'm not there yet, b) this is very time consuming and it will take a while, and c) often times people look for simple answers, and personally I'm not (yet) comfortable with giving any simple opinion, at all.

Hope that answers some of your questions.  ;-)

All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
to give one example
the transcripts from the FDA/NIH adjuvant meeting have been extremely valuable, and contain really the very latest (Dec 08) understanding of the issues from the best people in the field.  There are a total of 983 pages to those transcripts, and I've read most of it twice. However much time it's taken, I have spent at least the same amount of time again, to chase down the references for my understanding.  

It's been an extremely rewarding journey for me personally, cos prior to that the science was scattered.  The immunologists were saying one thing; the vaccinologists were saying another.  The FDA meeting was the first time when there is some cross-talk between the 2 groups.  It's just a beginning - there was more by way of mapping out the undertainties than giving you answers, but they are still very valuable regardless.  It pointed me to where I needed to go in my thinking...

The very shortest lesson I can share on the subject is this: don't depend on the vaccine experts to tell you the full story about the safety of vaccines.

All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
the heartening part for all this is
I once pursued a senior FDA official on some of these issues, in a meeting, until he had no place to hide, and he eventually admitted "let's just say that we (the FDA) ask the same questions".  

It was one of the most significant comments I ever got out of an official, in 3 years of interacting with them.   ;-D

So, there is at least awareness in the US, at high levels of government.  Can't say the same about the EU, but I'm sure whatever decisions are made in the US will have some impact, if only for PR reasons, on decsions in Europe.  

But coming back to the conversation here, the point is, the subject IS controversial, if only because our/my views are different from those officially endorsed by some in government.  Which means that when it comes down to individuals having to make some decisions for their families, they may have to make a judgment as to whether the official recommendations, when they eventually come out, are appropriate for them to follow.

It may be a life and death decision for some; I'm not comfortable with people just taking my word for it...

All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

[ Parent ]
forums have personalities
like any community, like cities are different tha each other. as Susan notes, the history is poster/commenter-driven.

Put in a diary whatever you want. We do tend to keep the news thread clinical, but the rest is up to y'all. Be kind to each other.

[ Parent ]
Another thought is -- you could start a new Diary. We can bump it.
You may be right---emotions will begin to crawl into posts, on this and every other board. We do tend to get involved in very "loud" arguments, but generally just let most run their course.  

[ Parent ]
emotions need their place - for some people it just seems that place is never here ;-)
And yet, a non-small part of what we do has to do with emotions.

Yeah, please start a diary, see how that goes!

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
Tess - I'll Gladly Share Any Pony That Comes My Way
While I will be glad to share any pony that comes my way, I'm not buying any hay or building any stables.

Couple of comments on your post:

First, next time you go back to your Dr, ask him whether the building financial/economic crisis was reported widely in the "news" before it exploded on us.  

Second, new participants like you play a key role in reminding everyone of the balance that is necessary to both what we write and how we write.  So thank you and please keep it up.  Feel free to ask questions about what things mean if you can't find it out through searching on your own.  Each 'wave' of new participants creates the same needs and we do try to address those needs.

On the less scientific element, I wonder if you were looking for something like this:
You Are Right to Be Afraid
or this:

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain

[ Parent ]
My answers would be:
A.) How can the need for action be best communicated to the public? ("action" can be decision to vaccinate, or info on prepping, or explanation of school closure, or whatever needs to be conveyed)

 1. large number of PSA's on all major TV and cable channels, day and night

 2. Direct appeal from the President of the US, and echoed by each town's governing body leader(s) ie mayor.

 3. Individual schools by pamphlets home, serial meetings, telephone tree communication to each student's home.

B.) Who are the best messengers?


 2.School principals

 3. Mayors

 4. Family Physicans/Pediatricans (too overwhelmed to do it, but still)

 5. ER's

C.) Are the answers different for vaccine and for non-vaccine non-pharmaceuticals?

  1. Yes-
       a.for vaccine need explicit, honest answers of when, where, cost, where to call for questions.

       b. explain HONESTLY why vaccines may not be available, or be available to everyone, and why.


It is better to look ahead and prepare than to look back and regret.

and, just wondering, any idea whether this is being worked on?
Just curious, though I'm sure most things won't be known until they are known.

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
I know we get read
I know the ideas are there.

i don't know what happens next.

[ Parent ]
To see what's being done here, just joined the H1N1 task force at my hospital. I'm expecting to be under-whelmed, tho'..   : > /

It is better to look ahead and prepare than to look back and regret.

[ Parent ]
I hope they use Sept readiness month to good effect.

[ Parent ]
outcome-still pending
I was very pushy at this meeting (local board of health)and explained we are in the 11th+ hour of planning as flu season(s) opens on 10/1. When asked what could be done, I recommended we somehow get a copy of the free ebook from pandemichomecare.com (thanks Dem for highlighting it) into the hands of every township household.

This request will presented at the August 18 township meeting, which is aired on cable TV. I will present each member of our township committee with a copy and provide estimates on printing/mailing costs.

They can then look in the camera and decide how they want their constituants to remember all this come next spring.

It is better to look ahead and prepare than to look back and regret.

[ Parent ]
one town near me
pritned a copy of the citizens guide


for every citizen, and handed it out in a plastic sleeve the essentially said: "do not open until pandemic."

[ Parent ]
Do Not Open Until Next Pandemic Wave - Instructions
Next Pandemic Wave arrives in your community.

Crack hermetic seal on guide.

Read first page, which should lead with the following:

"Too late now, but here's all the things you should have done to prepare.  Good luck."

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain

[ Parent ]
it's about home care.  

[ Parent ]
recognition that most people still are JIT oriented was smart. Don't forget this is going to play out over months, not hours. The idea that "it's too late" for everyone is just wrong. It's too late for some things like institutions, but not too late for individuals.

[ Parent ]
Open when the wave hits . . .
Instructions -
Give fever reducing medicines for temperature in excess of ____

(oops - nobody told us to stockpile anti-pyretics, and now they're telling us there's flu in the community and we shouldn't go out to the store - and we didn't think to buy Tylenol, etc., - or Little Johnny is throwing up and can't keep anything down, and we don't have any anti-nausea suppositories 'cause they're a prescription drug, and so are the oral drugs that might help, and we can't get his fever down, and he starts having seizures . . .)

Another instruction:  Take Tamiflu within the first 24-48 hours of symptoms (oops again . . . nobody has any Tamiflu because docs weren't willing to prescribe it, and now they say you shouldn't go to the doctor because the medical system is overwhelmed, and there's not much Tamiflu left, anyway)

Another instruction:  Go to the hospital if you have the following serious complications XXX (oops . . . that overwhelmed medical system isn't able to provide the 24/7 nursing care and ventilator support needed, and hospitals didn't make necessary arrangements to provide needed emergency care for flu patients)

It's never too late to do something - but if you don't open the instructions of what to do in the event of pandemic before there's really an ongoing pandemic in your vicinity, there are going to be a lot of things that need to be done that aren't possible at the time.

It IS going to play out over months . . . but in some cases it'll be the hours (and the available supplies) that make the difference between a great outcome and a not-so-great outcome.

Home care of seriously ill flu patients requires that some knowledge, some items, be available - we've had years to prepare people to be ready to provide home care, but most people wouldn't have a clue - and giving them written instructions at the last minute is likely to make them feel helpless and hopeless, because they won't have that knowledge and those items available.  

You can't tell care-givers to help patients recover by making sure they stay hydrated without telling them they need to have the things on hand that would make that possible.  You can't tell care-givers to help patients recover slowly using a BRAT diet unless they've stockpiled bananas, rice, applesauce, and toast.  Even the most simple of things will seem simply overwhelming.

[ Parent ]
Great comment-as always!
re: ..." but in some cases it'll be the hours (and the available supplies) that make the difference between a great outcome and a not-so-great outcome..."

God forbid, nothing would be more frightening than to think of being home with a sick kid at 2AM with no idea what to do, no answer from the doc's office (if one could get thru), no answer-no service from 911.

Pre-knowledge, preparation and the support neighbors are make or break it systems at times like that. I'm giving my daughter and my PCP each a copy of pandemichomecare.com

It is better to look ahead and prepare than to look back and regret.

[ Parent ]
all true...
but as we say in Brooklyn, you do what you can with what you got.

We obviously want people to do it in advance, and it is better to do so. However, it is what it is with people.  

[ Parent ]
PS doesn't say when the wave hits
no one but us knows what a wave is.

it says open for pandemic. That's, uh, now. ;-)

[ Parent ]
What a great compliment for the Wiki!!
Att least they were willing to put their money to work FOR the citizens, but agree, it should say perhaps-open and read when stage 6 pandemic declared.

It is better to look ahead and prepare than to look back and regret.

[ Parent ]
Fall preparations
Our local BOH plans an annual October Health Fair on the day the county comes to our hamlet for seasonal flu vaccines. We met Thursday to start some prelim planning, and I urged:

1. STRONG advertising this if for SEASONAL FLU,not swine flu.

2. Have some of the local police there, and visable.

3. We will try to put appropriate, accurate, honest, timely info about H1N1 into the hands of every adult who walks in. Hoping the town will spring for the $$ to publish pandemichomecare.org-I love that ebook!!

Whenever we do the H1N1 vaccines, we will need to have a visable number of armed ploice there, at least as a deterrent. People who are scared, poorly prepared and have access to only inaccurate information are panic-prone.

It is better to look ahead and prepare than to look back and regret.


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