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.01% Or .1%? A Big Difference
We will probably know if H1N1 will be a hit or a miss in the next 90
days. The range of possible outcomes is enormous. In an average year we
would suffer 35,000 deaths to flu. This comes to .01% of the
population. There is no indication that this year will be any
different. There are some worrisome issues however.
-Swine flu
has its highest mortality rates in the 5-25 age range. This is
asymmetric to other flu results. Typically the very young and very old
segments of the population would be most affected
-H1N1 ravages the lungs of those severely affected. It is the cause of death.
The
vast majority of those who will be acutely impacted will require a
ventilator. Without it they will die. The question is, “Is there enough
of these machines?” The answer to that is dependant on the number
people who become ill. If that number is high, then we do not appear to
have the respirators that may be necessary.
To my knowledge there is no national public numbers on this topic. In 2007 New York State provided some information and analysis on this issue. I will use that data to extrapolate some estimates. From the report:
*15% of the admitted patients with pandemic influenza will require intensive care,
*7.5% of the admitted patients with pandemic influenza will require ventilators,
*There are currently 6,100 ventilators in acute care settings in New York State,
*At any given time, 85% of the ventilators in acute care settings are in use, and
*70% of deaths related to pandemic influenza are projected to occur in a hospital.
NY State has a population of 20 million. Prorate the NYS information across the total population of 330mm and you get:
-The total number of respirators is 100k.
-The number of respirators that are available net of other needs is only 15,000.
In
a ‘normal’ flu season 200,000 patients require hospitalization. Using
the NYS number of 7.5% needing ventilation you get to that 15,000
number very quickly. In the event of a severe outbreak, triage of
ventilators will be required. If one was concerned about the, End of
Life Counseling debate the discussion on how to handle a shortage of
ventilators will ring a bigger bell. The first group to go will be
those that are being vented and have one of the following:
Severe
congestive heart failure; acute renal failure; severe chronic lung
disease; AIDS with a low CD4 count; active malignancy with a poor
potential for survival; cirrhosis; hepatic failure; and irreversible
neurologic impairment, including persistent vegetative state.
This
seems to be an easy choice. It is likely that teenagers will be
competing for the equipment. But the questions arise if that is not
enough. Some thoughts on that by Dr.s’ Hick and O’Loghlin, * they
propose:
“the Extubation of
any patient “who might be stable, or even improving, but whose
objective assessment indicates a worse prognosis than other patients
who require the same resource.” Thus, patient A’s continued use of the
ventilator appears to depend not only on the estimated survival
probability of patient A, but also upon that of newly arriving patient
B, whose better health status leads to the extubation and probable
death of A, and the intubation of B (at least until C arrives).”
That ‘logic’ is going to cause trouble if it comes down to it.
From the NYS report:
“Patient
consent, the mainstay of ordinary medical care, will not be the
determining factor in allocating ventilators. Threatened and actual
legal actions are reasonable concerns in response to any emergency
rationing scheme.”
At the end of the day what we are really worried about are the lawyers.
»
- advertisements -
If worried about the lawyers ... exclude them first from using ventilators.
Good stuff
Seems I am not the only one interested in this topic. Got this off the grid from a reader:
http://www.cidrap.umn.edu/cidrap/content/bt/bioprep/news/may1308chest.html
No main stream media beating on the Obama administration (shocking) for not having vaccine ready -- therefore no Katrina threat for BO.
Also, no one asking why we don't have more vaccine manufacturers -- because primary answer is government can never stand up to trial lawyers.
I will make it a point to get some D3 and more sun exposure. For those interested in my poorly drawn cartoon about the flu: http://www.fishgonebad.com/Stories/The_Flu/Flu0.htm
Bull Caca:
As a Registered Respiratory Therapist for a dozen yrs- Presently in a Federal Government Medical Ctr somewhere in Metro NY/until a few month ago I was at NYU Med Ctr/Past EMT -Was on duty when the first WTC attack in '93.
Flu-> Atelectasis/Pneumonia=lungs become stiff-hard to breathe/work of breathing issues. Think of energy required to blow up a balloon for the first time. Pneumonia will cause a lot of phlem -best way to deal with it, is to take out of the lung as soon as possible to reduce the lung stiffness. A good hot shower with a lot of steam a hell of a lot of coughing/spitting will do a lot.
This work of breathing and the need for ventilation invasive=intubated with ventilator or non-invasive=BIPAP machine with facemask is dependent on the patient.
What you want to know is how many machines? Is not how many machines but type. If you are asking about regular ICU Servo-i or PB840 $40K each vent. Must hospital have enough of them for each bed in an ICU + extras. NYU between old models & new models -easily a hundred. If really expensive InoVent- Nitric Oxide bleed in - rare & expensive -$136hr
For transport & long-term facilities - ventilators used like the LPV/LTV series - which use an external exhalation valve - are much cheaper $6K+. This are the types kept in emergency stock piles.
For non-invasive machine. BIPAP/CPAPS are common enough for hospital use, but shortages for crisis will occur. But any decent respiratorytherapist can rig up the equivalent with tubing/mask & whisper flow valves. So no big deal.
Finally, there are disposble one about $50 a piece. They are use sometimes for transport/MRI. Being essentially pneumatic plastic valves using high pressure air/oxygen-they need to be monitored - & can do the job for the 48-72 hrs to get you out of the jam.
Hype/Hype & BS. So calm down. Instead of worrying about the FLu so much, which to me is being used as a distraction. Let's get back to burning Goldman Sachs in effigies...
Tks for this.Back to Goldie:
In the global finance world series poker tournament GS is currently in a very strong position. More than half of the card players have been eliminated at this point, GS is the 'chip leader' half way through. They have played great poker and have been getting good cards. They earned the stack in front of them.
Other name players, C and BAC are short-stacked. A Defensive strategy does not work in this tournament. The most likely result will be a desperado 'all in' bet. Those always lose on the 'river'. More chips and more power for GS when they knock the weak players out.
There is one player that is getting a lot of attention. She wears big shades and headphones and a hat that says,PS on it. Insiders to poker know that the PS stands for Public Sentiment. She also has a big chip count. She is a streaky player but when she is hot she can't be beat.
I am putting my money on Public Sentiment. GS is going to get trapped with a big 'position' bet when PS has the top boat.
Is that better?
Finally I understand!! It's about time the people at ZH spoke english.
Bruce,
Your embedded link to the NY state report now goes to an empty page.
Gee, I wonder how that could have happened?
Actually this is not a failure of NYS. I downloaded the document. It is long. I found it in google search: ventilator,NYS 2007 report.
Sorry for the dead end link. My copy editor has a drinking problem......
shaza, i'm interested to see your info in light of these articles from the british journal of medicine that raise questions about the efficacy of flue vaccine...and suggest a link between government efforts and pharma profits:
http://www.bmj.com/cgi/content/extract/333/7576/1020-b
http://www.bmj.com/cgi/content/abstract/338/feb12_2/b354
http://www.bmj.com/cgi/content/abstract/339/aug25_2/b3391
Interesting posts. Reminds me of this one:
http://www.dailymail.co.uk/news/article-1202389/Government-virus-expert-... more here http://www.globalresearch.ca/index.php?context=va&aid=14550
I love this one: Swine flu vaccine maker defrauds Medicaid http://www.guardian.co.uk/world/2009/oct/11/swine-flu-vaccine-baxter Here's a tasty bit of goodness:
Yeah, THAT GlaxoSmithKline, the one from my first link above where they paid that govt stooge to grease their skids.
Also interesting is Baxter: Baxter almost triggered a pandemic in February with its shitty lab safety programs. http://www.torontosun.com/news/canada/2009/02/27/8560781.html and http://www.lifegen.de/newsip/shownews.php4?getnews=2009-02-25-5123
These guys are making the vaccine? Cool. No problem since they are also Medicaid fraudsters. Gotta love modern corporatism. And the goverment gave these pukes legal immunity!
I'm sorry folks if I sound off base here, but these companies scare me more than those cave-dwelling 'terrists' who are out to steal our precious bodily fluids or grow beards on our daughters or whatever it is I'm supposed to believe this week.
Wierd, I don't know what happened when I hit the save button on that comment, but the links broke. Here they are again:
http://www.dailymail.co.uk/news/article-1202389/Government-virus-expert-...
http://www.torontosun.com/news/canada/2009/02/27/8560781.html
http://www.guardian.co.uk/world/2009/oct/11/swine-flu-vaccine-baxter
Give me something tradable. Who makes these ventilators?
Don't forget about all of the operating room and other ventilators that are not included in these numbers, which are used many times for elective, outpatient, and other surgeries and procedures. This would increase the number pretty significantly, though I guess people would have to wait for their boob jobs...
Strom, this is what happened in Australia, the heart bypass machines were used to ventilated the blood of H1n1 patients. Shortages of machines were happening, but the flu subsided in time.
With the vaccine available, why would parents not vaccinate their children. I can send more info on vaccine if need be.
I agree - I will be getting the shot, and my kids will, too (where appropriate).
If you are only interested in Flu and TB viral info in the Podcast from University of Melbourne Lecture, forward to about 30 minutes into the Podcast for anti microbial peptide info and placebo info.
Sorry,, forgot to add that bit of info re Podcast:
http://www.mdhs.unimelb.edu.au/knowledge_transfer/podcasts/the_sunshine_...
Links for Vitamin D3, please make sure you are using D3 Cholecalciferol. D3 is a pre-hormone, Vitamin is bit of a misnomer as the body makes it and is not required by diet. For Flu and colds, you will want D3.
http://www.scientificamerican.com/article.cfm?id=cell-defenses-and-the-sunshine-vitamin
Podcast from Dean's Lecture University of Melbourne Medical School, VitD3 ( Scientific, long)
http://www.mdhs.unimelb.edu.au/knowledge_transfer/podcasts/the_sunshine_vitamin_in_the_21st_century_bone_benefits_and_beyond
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=529704
vitamin D & flu!!! Thanks Anon..thats a great tip for all of us. wonder what impact swine flu will have on economy though....
Run Logan Run!
Google vitamin D and flu...please, everyone take Vitamin D, its cheap, and even mainstream medical community is starting to understand most westerners are deficient,(you don't get much from diet unless you eat fish like a Norwegian or Inuit) and your body makes it in the sun, but that is apparently why fle is seasonal, because are Vitamin D deficeincy gets worse in the dark winters. Take Vitamin D.
I urge you to research what ANON is saying. The evidence base on Vit D3 is coming in very strong. Vitamin D is a misnomer. D3 is actually a hormone as your body manufactures it and it is not required via diet, solely.
HEre are some links.
http://www.scientificamerican.com/article.cfm?id=cell-defenses-and-the-s...
http://www.medicalnewstoday.com/articles/51913.php
Other sites ie, Nature etc require passowrds but have many evidence based articles that are Peer Reviewed regarding D3.
In austalia, where we have passed our major flu season, those of us who suplemmented with 2000 iu of D3 had next to no colds and flus and if we did catch the virus, symtoms were mild and viruses cleard quickly. I get lots of sun, but 2000 seems to do the trick at 60 Kilos and female.
The ventillator issue is spot on. Time will tell how this plays out. THE blow back will be enormous, bigger than Katrina ever was,if this goes larger than expected...TO not have thought this through is just like the economic disturbance we are now in- still.
I work in a top tier hospital (a name you have all heard) and I can tell you that when it comes to ventilators, we occasionally have to rent extras just to cover our needs as it is, let alone in a pandemic response. Happy happy!
As for the H1N1 vaccine, I can also tell you that we received the policy at work and it states that we are strongly encouraged to take the live-attenuated nasal flu mist and if we choose *not* to take this first batch vaccine, we will not be eligible to take the safer dead injection later on when it is available. Joy joy!
The first-run batch of live-attenuated was rush made by one of the five manufacturers who have been granted legal immunity by the US Government in case of 'unfortunate' side effects. One of these five manufacturers almost started a global pandemic all by itself in early 2009 when it shipped live avian flu virus to production labs in eastern europe. If not for a handful of ferrets dying unexpectedly and raising the alarm, resortment in a human host may have enabled a swine/human/avian flu chimera to stalk the planet for the last 8 months. Should I trust such a company's laboratory protocols now that it has legal immunity and a mandate to mass produce the vaccine as quickly as possible? Happy happy!
New York State just rescinded its order mandating all heath care worker vaccinations due to significant pushback. Word of mouth around here leads me to believe similar pushback is likely if such a mandate arises, whether by company policy or state mandate. One doctor, asked informally and specifically whether or not he advised taking the new vaccine, answered, "I can't advise you on whether you should take it." I leave it to you to decide what that means. We are used to doctors talking more and more like lawyers lately, but this non-answer did not provide much encouragement to those present. Joy joy!
The unfortunate situation is that even if the above concerns turn out to be overblown and/or incorrect, enough people are spooked about it that the vaccination program itself is viewed with great skepticism among the very health care workers who stand on the front line. This will only magnify the impact of a wave of H1N1 patients when it hits if more health care workers are out of commission. Happy happy joy joy!
(And just what the hell is up with that broken captcha, ZH?)