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Document 4: Definitive Care for the Critically Ill During a Disaster: A Framework for Allocation of Scarce Resources in Mass Critical Care
This document provides guidance for standardized and fair means to distribute scarce critical care resources. Modern health-care experience caring for hundreds or thousands of critically ill and injured victims from civilian catastrophes is limited.6712 There are few randomized, controlled trials involving the subject matter of this Supplement, so this document is a consensus statement derived from senior-level, experienced, expert opinion rather than an evidence-based guideline.
Patients will meet exclusion criteria when they have a very high risk of death, little likelihood of long-term survival, and a correspondingly low likelihood of benefit from critical care resources.
Decisions involving triage for care and the allocation of medical supplies also must take into account the values of personal rights and fairness to all. Critical mission requirements may require allocation of resources based on operational rather than medical risk
The MTF Commander shall designate an emergency management team to prepare and execute their facility's response plan.
Public health laboratory confirmation of suspected cases should be pursued in accordance with current CDC and DoD guidance.
As this outbreak evolves, laboratory confirmation may not be required for every clinically suspected case.
Computational quantitative projections for H1N1 flu dynamics in the United States
The following maps show the projected number of cases in the United States at the county level. The range of numbers represent the most likely outcome according to our model, a confidence interval of 90% (see below for explanation). This is a worst case scenario, in which no containment measures are taken to mitigate the spread. We used the confirmed cases as of May 6th for calibration and project from there on.
Because we adjust our simulations every 24–48 hours, our projections are subject to changes. At the moment our model projects a probable range of 6600–7900 by May 17, 2009 in United States.
March 2, Reuters – (National) Resistance to flu drug widespread in U.S. – study. Virtually all cases of the most common strain of flu circulating in the United States now resist the main drug used to treat it, the U.S. Centers for Disease Control and Prevention reported on Monday. CDC researchers said 98 percent of all flu samples from the H1N1 strain were resistant to Roche AG’s Tamiflu, a pill that can both treat flu and prevent infection. Four patients infected with the resistant strain have died, including two children. This year, H1N1 is the most common strain of flu in the United States, although the flu season is a mild one so far, and still below the levels considered an epidemic.
But here’s the potential smoking gun, the facts that suggest a potential source of the pandemic could be CDC labs. And at the very least, this possibility deserves thoughtful examination and research. The University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP) is hardly a place most Americans have heard about and, apparently, the Center’s web site has news the MSM isn’t familiar with, either. But information they published years ago has now taken on an urgent importance. CIDRAP, along with the Canadian newspaper Canadian Press (CP), revealed back in 2004 that the CDC was launching experiments designed to mix the H5N1 (avian) virus and human flu viruses. The goal was to find out how likely it was such a “reassortant” virus would emerge and just how dangerous it might be. Of course, it’s logical to wonder if they also worked with the addition of a swine flu virus, too.
Here’s some background from the five-year-old report by the University of Minnesota research center: “One of the worst fears of infectious disease experts is that the H5N1 avian influenza virus now circulating in parts of Asia will combine with a human-adapted flu virus to create a deadly new flu virus that could spread around the world. That could happen, scientists predict, if someone who is already infected with an ordinary flu virus contracts the avian virus at the same time. The avian virus has already caused at least 48 confirmed human illness cases in Asia, of which 35 have been fatal. The virus has shown little ability to spread from person to person, but the fear is that a hybrid could combine the killing power of the avian virus with the transmissibility of human flu viruses. Now, rather than waiting to see if nature spawns such a hybrid, US scientists are planning to try to breed one themselves — in the name of preparedness.”
And CDC officials actually confirmed the government had plans for the research. The CIDRAP News folks did a great job covering this important issue, which was apparently mostly ignored by the MSM back in 2004, and CIDRAP News wrote to the CDC for information. This e-mail produced an answer from CDC spokesman David Daigle who admitted the CDC was working on the project in two ways. “One is to infect cells in a laboratory tissue culture with H5N1 and human flu viruses at the same time and then watch to see if they mix. For the human virus, investigators will use A (H3N2), the strain that has caused most human flu cases in recent years,” the CIDRAP story stated. This co-infection approach was described as slow and labor-intensive. However, it was a way to produce a new virus that appeared to be closer to what develops in nature.
There was another, faster way CDC scientists could create the mix, too. Called reverse genetics, it involves piecing together a new virus with genes from the H5N1 and H3N2 viruses. Reverse genetics had already been used successfully to create H5N1 candidate vaccines in several laboratories, the CDC’s Daigle wrote. “Any viable viruses that emerge from these processes will be seeded into animals that are considered good models for testing how flu viruses behave in humans… The aim will be to observe whether the animals get sick and whether infected animals can infect others,” he revealed in his e-mail.
What’s more, the CP reported the CDC had already made hybrid viruses with H5N1 samples isolated from patients in Hong Kong in 1997, when there was the first outbreak of that virus, dubbed the “Hong Kong flu”. It is not clear if the results of that research were ever published. Back in 2004, Dr. Nancy Cox, then head of the CDC’s influenza branch, would tell the CP only: “Some gene combinations could be produced and others could not.” The CP’s report noted that the World Health Organization (WHO) had been “pleading” for laboratories to do this blending-of-viruses research. The reason? If successful, these flu mixes would back up WHO’s warnings about the possibility of a flu pandemic. In fact, Klaus Stohr, head of the WHO’s global flu program at the time, told the CP that if the experiments were successful in producing highly transmissible and pathogenic viruses, the agency would be even more worried — but if labs couldn’t create these mixed flu viruses, then the agency might have to ratchet down its level of concern.
The 2004 CIDRAP News report addressed the obvious risks of manufacturing viruses in labs that, if released, could potentially spark a pandemic. However, the CDC’s Daigle assured the Minnesota research group the virus melding would be done in a biosafety level 3 (BSL-3) laboratory. “We recognize that there is concern by some over this type of work. This concern may be heightened by reports of recent lab exposures in other lab facilities,” he told CIDRAP. “But CDC has an incredible record in lab safety and is taking very strict precautions.”
Five years later, we must ask more questions. Were those safety measures enough? Was the CDC creating or testing any of these virus mixes in or near Mexico? What other potentially deadly virus combinations has the US government created? Don’t US citizens, as taxpayers who funded these experiments, have a right to know? And for all the residents of planet earth faced with a potentially deadly global epidemic, isn’t it time for the truth?
For more information: “New flu is a genetic mix”, www.reuters.com...…
“CDC to mix avian, flu viruses”, www.cidrap.umn.edu...…
“CDC to conduct avian flu pandemic experiements”, www.ctv.ca...…
Originally posted by cosmicpixie
reply to post by Cloudsinthesky
I think that article relates to "normal" flu, not the new flu. I listened to today's WHO conference and the speaker was asked about the comments going around stating swine flu was resistant to tamiflu and the other anti-viral they use -can't recall the name- and she explained that "normal" flu was more resistant but this new virus is "sensitive" to the anti virals in question and she also pointed out the confusion between normal flu/the new flu and tamiflu resistance issues......
B. Influenza in Individuals
Increase understanding of influenza pathology and pathogenesis in humans
Fully describe human cellular immune responses to influenza infection
Describe innate and mucosal immune mechanisms in influenza
Map genomics and proteomics of human responses to influenza viruses
Strengthen infrastructure for clinical influenza research
Many fundamental aspects of human clinical and immune responses to influenza infection have not been fully described. These include innate and adaptive responses and the role they play in pathogenesis; host genetic factors that may affect susceptibility
to severe influenza outcomes; and the innate immune mechanisms that prevent or slow infection or, conversely, exacerbate illness.
Recent NIAID research has advanced basic scientific understanding of viral and host contributions to influenza disease. Several studies have examined the role of immune cells in protection against influenza infection across drifted strains. For example, one study found that B cells may be important to the development of cross-reactive immunity. Other studies have examined how immune responses contribute to severe disease outcomes and how host and virus factors contribute to secondary bacterial infection during severe influenza infection. A recent study, for example, showed that interferon gamma production during influenza infection may increase host susceptibility to secondary bacterial infection. Multiple approaches—including computer modeling, in vitro laboratory techniques, and clinical studies—have further characterized the immune response to influenza virus. For example, the CEIRS program has begun several new clinical research projects in influenza to examine immune responses and transmissibility of the virus among human populations. (For more information, see Appendix B, pages 17 – 21.)
More at Link...
Swine flu has full pandemic potential: Research
Tuesday , May 12, 2009 at 1643 hrs IST
Swine flu that has triggered global health scare has "full pandemic potential" and is fatal in around 4 in 1,000 cases making this strain of influenza as lethal as the one found in the 1957 pandemic, research by British scientists reveals.
The first detailed analysis by researchers at London's Imperial College, found that the virus spreads easily from person to person infecting around one in three of those who come into contact with it.
Professor Neil Ferguson the author of the research said it was too early to say whether the virus will cause deaths on a massive scale, or prove little more lethal than normal seasonal flu.
"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 Ferguson.