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28. veebruar 2006

ettevõtete pandeemiajuhend (veel üks)

Mercer’s white paper The Emerging Global Pandemic: Human Resource Implications link
vt seal veidi allpool, pdf kujul, ainult 20 lk kokku :)

üks järjekordne ülevaade võimalikust pandeemiast, aga kirjutatud lihtsas (inglise :D) keeles ning suunatud ettevõtetele, mida peaks arvestama pandeemiaplaanide koostamisel
tundus enamvähem asjalik igatahes :)
kui oled ettevõtja/juhtivtöötaja ja sinu firma tooted/teenused on inimestele vajalikud,
palun, leia see viis minutit ja loe see jutt läbi, pliiz ..

teistele pakuks ehk huvi eeskätt lk 9-11, pandeemia mõjust majandusele - sh ka tarbijatele
kopida kahjuks ei õnnestunud

27. veebruar 2006

Sambucol - isetehtud versioon ja eestis müüdavad analoogid

Sambucol on USA linnugripifännide seas ülipopulaarne gripiprofülaktik
teaduslikud artiklid tõestuseks ja puha, loe sellest pikemalt: link

Sambucol on tegelikult leedrimarjaekstrakt :) koduleht: link

koostis: Ingredients: Each 2 teaspoons contains Elderberry Extract (berry) 3800mg. Other ingredients: sorbitol, purified water, raspberry extract (berry), citric acid, natural flavour. link

laste versioon - vt kodulehelt - sisaldab veel punase päevakübara ekstrakti ja propolist
Sambucol® For Kids Liquid Extract 120 ml - standardized Wild Black Elderberry extract; including the active ingredient AntiVirin®; with Propolis and organic Echinacea, and a tasty berry flavor. Especially developed for kindergarden and school-age children.

misasi on see kiidetud AntiVirin, ei ole õnnestunud välja selgitada :D - aga kuna seda tootekoostises eraldi loetletud ei ole, siis võib see vabalt ka mingi müügivärk olla, või siis vaarikaekstrakt :D:D

cureventsi foorumis on juttu, kuidas ise teha leedrimarjadest sarnast asja link
a kust te saate leedrimarju, seda ma ei tea, mul igatahes sügisel ei õnnestunud neid kuskilt leida :S
kui keegi teab, siis andke mullegi teada :)
mõte ikkagi selles, et kõik uuringud viitavad leedrimarjadele kui ravimitele, Sambucol on kaubamärk, mida eriti praeguses linnugripihirmus väga edukalt müüakse :D
eesti ravimtaimetarkustes on musta leedri marju ka kasutatud - kui meeles on, vaatan õhtul mõnest targast raamatust järele ..

noja seejärel sukeldusin kaubandusvõrku
Sambucolist ei ole keegi kuulnudki mõistagi, musta leedri marju ei leidnud, apteegis analooge ka ei leidnud
ainus koht, mille leidsin oli miskine uus võrkturustus(!) nimega Just/Vivasan
hästi segane värk, aga tooted on OK :)
(just eelmisel nädalal ostsin endale sealt kotitäie :p)

ja neil on kaks toodet, mis Sambucoli meenutavad:
1) musta leedri jook: link
koostis: musta leedri marjade mahlakontsentraat, õiesiirup, glükoossiirup, fruktoos, sidrunhape, leedripuu õite kuivekstrakt
hind: 500 ml - 376 kr
2) Immune Guard link,
koostis: musta leedri marjade mahl, purpursiilkübar, acerola ja askorbiinhape (C-vit)
hind: 175 ml - 309.60 kr

hind on kallis :S ja igati nutikas oleks ise see kokku keeta kui kuskilt marju leiab, nii must leeder kui purpur-siilkübar kasvavad eestis ju edukalt :)
aga kui keegi ikkagi osta tahab - siis meilige Pilleriinule: pilleriin@pilleriin.ee.

kui keegi originaali tahab, siis soomest leidsin ka veebipoe, kus toda "päris" sambucoli müüakse: link
seal oli hind siis (koos soomesisese transpordiga) 120 ml - 265 kr
võibolla saadavad eestisse ka kui kaubelda :)

WHO soovitused lindude gripi piirkonnas elavatele inimestele

ehee, mis ma leidsin :)
WHO soovitused aastast 2004, mida tuleks arvestada, kui sinu piirkonnast on avastatud linnugripp (lindudel)

varsti eestis aktuaalne teema, loe läbi :)

Advice for people living in areas affected by bird flu or avian influenza link
(pdf, sikuta arvutisse trükkimiseks või salvestamiseks)

How to use this guide Health officials who are alerted to a location where poultry (chicken, ducks and other farmed birds) have been found to be dying of bird flu or avian influenza (H5N1 virus) will need to take immediate steps to ensure that the disease does not spread. With a good plan, one that includes effective communication measures, the spread of bird flu can be successfully arrested. This simple guide provides key messages and information to achieve this goal.

The first objective is to identify the people and communities that are most at risk. This would constitute the primary audience.

The Food and Agriculture Organization estimates that 70% of poultry is raised in backyard farms. It is critical, therefore, that health authorities provide basic information on prevention and control of avian influenza to these people as they are at greatest risk of being exposed to the disease. It is also advisable that this information could be disseminated through other communication channels such as the media, community leaders, nongovernmental organizations and policy-makers. This would constitute the secondary audience.

The second objective is to adopt and adapt these key messages and information for local dissemination and use.
The third objective is to provide additional local information that will enable or reinforce positive or desired actions and behaviours of the target audience. Hotlines, referral numbers and names of key people who could provide help can be added by health officials to this guide.

Key steps to ensure the effective use of this guide:
• Identify audiences.
• Adopt, adapt and translate if necessary before dissemination.
• Add relevant information on local contact persons, hot lines, help centres, etc.

KEY MESSAGES AND ADVICE
The spread of bird flu in affected areas can normally be prevented.
• People should avoid contact with chickens, ducks or other poultry unless absolutely necessary. This is the best way to prevent infection with the bird flu virus.
• Children are at high risk because they may play where poultry are found. Teach your children the following basic
guidelines:
o Avoid contact with any birds, their feathers, faeces and other waste.
o Do not keep birds as pets.
o Wash hands with soap and water after any contact.
o Not to sleep near poultry.
• Do not transport live or dead chickens, ducks or other poultry from one place to another even if you think your birds are healthy.
• Handling of poultry in affected areas should be done within the area without transporting them to other areas.
• Do not prepare poultry from affected areas as food for your family or animals. The slaughter and preparation of such birds for food is dangerous.
• If you unintentionally come into contact with poultry in an affected area, such as touching the bird's body, touching its faeces or other animal dirt, or walking on soil contaminated with poultry faeces:
o wash your hands well with soap and water after each contact;
o remove your shoes outside the house and clean them of all dirt; and
o check your temperature for 7 days at least once daily. If you develop a high temperature (>37.5°C), visit a
doctor or the nearest health care facility immediately.

Proper handling of poultry that are ill, suspected of having bird flu or dead is an important control measure to
prevent the spread of the disease.
• Make sure to keep children away from dead or sick poultry.
• If you need to handle dead or sick poultry, make sure you are protected. Wear protective clothing such as a mask,
goggles, gown, rubber boots and gloves. If these are not available, cover your mouth with a piece of cloth, wear
glasses, use plastic bags to cover hands and shoes and fix these tightly around wrists and ankles with a rubber band or string. Wear overalls that can be washed.
• If you encounter sick and dead poultry for the first time and are unsure of the situation, inform the authorities
immediately and leave the handling of the poultry to experienced personnel (cullers, clean-up personnel, etc.).

Decontamination of the yard or chicken pen will help control the spread of the disease.• If possible, ask experienced personnel to help you decontaminate the yard or chicken pen.
• If this is not possible and you have to do it yourself, wear protective gear to protect your eyes, hands, feet and other exposed parts of your body as described above.
• Dead birds should be buried safely (see next section).
• Effective cleaning results in no visible feathers or faeces remaining in the shed.
• Influenza viruses can survive for some time in organic material, so thorough cleaning with detergents is an important step in decontamination. All organic matter must be removed from poultry houses as much as possible.
• As outdoor areas used by poultry can be difficult to clean or disinfect, poultry should be excluded from these areas for a minimum of 42 days to allow natural ultraviolet radiation to destroy any residual virus. The period of exclusion should be longer in cold weather.
• Spraying of disinfectants on vegetated outdoor areas or soil is of limited value due to the inactivation of these
chemicals by organic material. Removal of surface soil is not normally recommended unless it is heavily contaminated with faeces.

Dead birds and their faeces should be buried.• As much as possible, seek assistance from your local agriculture authority on how to bury dead animals safely.
• When burying dead birds or their faeces, try to avoid generating dust. Spraying or sprinkle water to dampen the area first. Bury bird carcass and faeces at a depth of at least 1 metre.
• When the dead birds and their faeces have been properly disposed, clean all areas very well with detergent and water. Influenza viruses are relatively susceptible to a variety of detergents and disinfectants.

Contaminated protective clothing should be properly handled or disposed.
• After the area has been cleaned, remove all the protective materials and wash your hands with soap and water.
• Wash clothes in hot or warm soapy water. Hang them in the sun to dry.
• Put used gloves and any other disposable materials in a plastic bag for safe disposal.
• Clean all reusable items such as rubber boots and glasses/goggles with water and detergent, but always remember to wash your hands after handling these items.
• Items that cannot be cleaned properly should be destroyed.
• Shower/wash body using soap and water. Wash your hair.
• Take care not to re-contaminate yourself or the cleaned area by avoiding contact with dirty, contaminated clothes and items.
• Most importantly, wash your hands every time after handling any contaminated items.

Footwear should also be decontaminated.• After walking around areas that may be contaminated (such as farms, markets or backyards with poultry), clean your shoes as carefully as possible with soap and water.
• When cleaning shoes, make sure that you do not flick any particles into your face or on your clothes. Wear a plastic bag over your hands, shield your eyes by wearing glasses or goggles, and cover your mouth and nose with a cloth.
• Leave dirty boots and shoes outside the home until they have been thoroughly cleaned.

People who have flu-like illness should take additional precautions.
• WHO believes it is very important to prevent human influenza from spreading in areas affected by bird flu. Where the avian influenza viruses and human influenza viruses come in contact with each other, there is a risk that genetic
material will be exchanged and a new virus could emerge.
• Anyone with flu-like illnesses should therefore be careful with secretions from the nose and mouth when around other people, especially small children, in order not to spread human influenza viruses.
• Cover your nose and mouth when coughing or sneezing. Use a tissue and throw it away once used. Teach children to do this as well.
• Always wash your hands with soap and water after any contact with secretions from nose or mouth as these can carry a virus.
• Children are especially prone to touching their face, eyes and mouth with unwashed hands. Teach children the
importance of hand washing after coughing, sneezing and touching dirty items.
• Inform the health authorities immediately and seek medical advice from a health professional if you develop signs of illness, such as fever and/or flu-like symptoms.

Precautions can be taken when visiting friends or relatives in health-care facilities.• If you visit a patient who has bird flu, follow the advice from the hospital staff to wear protective clothing, including a mask, gown, gloves and goggles.
• Such special protective clothing is required when you have direct contact with the patient and/or the patient's
environment.
• It is important that the protective mask fits properly. If it doesn't, seek advice from the hospital staff.
• When you leave the patient's room you must remove these items and wash your hands with soap and water.

In affected areas where the presence of bird flu has been confirmed, do not eat poultry meat that comes from
dead or sick animals.
• In affected areas it is advisable not to use dead and sick chicken or other poultry for preparing food for humans and/or animals. Even healthy-looking poultry of any kind from a bird-flu affected area should not be used for food.

In neighbouring areas (next to the bird-flu affected area) some precautions need to be taken.• In general, only apparently healthy poultry should be prepared for food.
• For killing, use a method that does not contaminate you or the environment of your household with blood, dust, faeces and other animal dirt. Seek advice from the agriculture authority about the proper procedure.
• For plucking, use a method that does not contaminate you or the environment of your household with dust, faeces and other animal dirt. It is best to put poultry in boiling water before plucking feathers.
• For degutting, use a method that does not contaminate you or the environment of your household with blood, dust,
faeces and other animal dirt.
• Do not touch other items or your face (e.g. rubbing your eyes) during the procedure, unless you have washed your hands with soap and water.

Take all precautionary measures to ensure that poultry and poultry products are properly prepared and safe to eat.• Chicken prepared hygienically and cooked thoroughly, i.e. no pink juices should be observed, can be considered safe to eat. However, remember, if the bird has a transmittable disease, such as bird flu, the person preparing the food is at risk of becoming infected and the environment may become contaminated.
• Eggs, too, may carry pathogens, such as the bird-flu virus inside or on their shells. Care must be taken in handling
raw eggs and shells. Wash shells in soapy water and wash hands afterwards. Eggs, cooked thoroughly (hard boiled, 5 minutes, 70oC) will not infect the consumer with bird flu.
• In general, all food should be thoroughly cooked to an internal temperature of 70°C or above.

tõsine medvarustus

näide, milline on ühe ameerika metsaselava endise meediku kodused ravimi- ja varustuse tagavarad :)
nb! ära proovi järele teha kui sul pole vastavat haridust :D
aga mingeid ideid ehk annab, mida võiks kodus varuks olla - eriti kui arstiabi kaugel (kasvõi sügaval metsas talus elades või üksikus kohas suvitades), rääkimata sellest juhtumist kui pandeemia peaks puhkema ja apteegid ravimitest lagedad

vt ka muid huvitavaid artikleid backwoodshome ajakirjast, mis on siis mõeldud sellistele vanamoodsalt elada armastavatele ameeriklastele :D link

Medical kits for self-reliant families link
by Jackie Clay

There may be a time, as close as tomorrow, when your loved ones need medication or medical treatment and there is no drug store open or doctor available. This may be as simple a situation as a head cold coming on during a weekend night, or more drastic, such as nothing available after a civil or natural disaster.
Family medical kits Here at home, we've always had a medical kit. Several, in fact. One is quite large, made up of a poly box, originally designed as a field box for trap and skeet shooters. This "drug store on wheels" is a well-packed medical utility box that will handle nearly everything from a cold to severe lacerations. This one we carry when traveling in remote locations.

But while it is loaded with most medical needs, far surpassing a first-aid "kit," it is heavy, weighing over 30 pounds, and it is not something we carry for short trips, pack in our canoe, or carry on horseback.

An intermediate kit is lighter and fits into a flat, moderate-sized fishing tackle box. While this does not contain such a wide variety of medical supplies and medications, it is a very well thought out first-aid-and then some-medical kit. This is light enough to pack in the canoe (if we don't foresee many lengthy portages, when every ounce counts), with camp supplies on a horse packing trip, or small enough to take up little room in the truck.

Besides this kit, we also carry a small first aid kit under the seat of the truck and Suburban, containing bandages, antibiotic ointment, burn medication, sterile gauze, tweezers, aspirin, sterile eye wash, and cold tablets for ourselves and our eight- year-old son, David. In the glove box is a smaller snap-open plastic box with Bob's oral diabetes medication, my blood pressure pills, and a few aspirin. This has come in handy many times when someone forgot to take prescribed daily medication or a headache suddenly popped up. As the glove box does get hot during the summer, this small stash of meds is rotated routinely to make sure the strength does not fade.
Learning to use your kit
No matter how comprehensive your medical kit is it can be useless or even harmful if you do not know how to use it safely. You don't have to have extensive medical treatment to handle most emergencies that occur in real life. Most of ours consist of splinters, minor cuts and scrapes, sprains, and an occasional head cold or the flu. While these are scarcely life-threatening, they are uncomfortable and the afflicted party sure appreciates quick, competent aid.

Our family is lucky; I have spent a lifetime as a veterinary field technician riding on calls and acting as an assistant on everything from broken legs to pneumonia. Bob is a Certified Nurses Assistant (CNA) with additional military medical training in Vietnam. But you'd be surprised at how much free medical training is out there for you to pick up. Many communities provide first-aid classes, including invaluable cardiopulmonary resuscitation (CPR) training.

During these classes, ask questions to boot up the amount of knowledge you receive. Attend volunteer firemen's training sessions, as available (again, ask around). Ask your veterinarian if you could accompany him/her on calls one or more days a week free in exchange for the knowledge you gain. Yep, I know, they're animals, not people, but basically, a mammal is a mammal, especially when it comes to shock, wounds, and common illnesses such as pneumonia.

Pick up a good first-aid manual (which should be in your large medical kit at all times) and a book or two from a preparedness company which details medical treatment when no doctor or dentist is available. Then read these manuals carefully. I know they're not great reading, but they can save someone's life. Share the reading with your spouse or older children, and even practice at home. It can be interesting, learning to suture gaping wounds on a piece of that chicken you're having for dinner. After it's butchered and ready to cook, of course. I'm not that morbid.
Real life medical treatment basics
While some survival first aid manuals assume your family's injuries will need treatment for nuclear blast and gaping wounds, in reality most will be of a much more mundane level no matter where you are, from arctic tundra to urban sprawl. They will consist of minor cuts, scrapes, slivers, blisters, the flu, colds, a fish hook in the skin, etc. We have lived for years in very remote locations and, although the worst injury any of us sustained was Bob's green stick fracture of his leg in a snowmobile accident, the most painful was my severely sprained ankle, suffered when I missed a step going downstairs in our farmhouse in "civilization."

Let's look at some real-life possibilities and what to do about them, assuming that there is no doctor or hospital available. Remember that if trained medical help is available, one should always consider this course first as many conditions can be made worse by incorrect diagnosis and treatment.

Hypothermia
Believe it or not, hypothermia (the condition where the body temperature is lowered below normal) kills more people in survival/stress situations than does gunfire, wild animal attacks, poisonous reptiles and spiders, wounds, or drowning.

Hypothermia has many causes, from shock following an accident to remaining outside in cold weather without adequate clothing or shelter to getting dunked in icy water-even for short periods of time. It is definitely something to watch for in any survival situation.

Identifying hypothermia can be a problem with the uninitiated, as it comes on slowly and the person still can walk and talk. But by paying careful attention, one can usually notice body shaking, paleness, and a tendency toward poor judgement and/or speech that doesn't make sense.

Taking the victim's temperature, you will quickly see that it is subnormal.

Hypothermia must be treated vigorously and immediately. Warmth is the key. As the body has lost it's ability to warm itself, simply putting a blanket around the person is not enough. Build a warm fire. If the victim is wet, get them into warm dry clothes quickly. Warm a blanket or sleeping bag, then wrap it around them while they sit or lie in front of the fire. If they are not too bad, a drink of warm coffee or tea often helps. But do not give anything to eat or drink to a victim that is dazed or unconscious.

If nothing else is available, have one or more persons crawl into a sleeping bag or blankets to provide bodily warmth to the victim. Then keep the person warm and dry until they are fully recovered. You don't have to be a mountaineer to suffer hypothermia. I have had several encounters: falling through thin ice while crossing a beaver dam, getting stuck out in an unexpected blizzard in June, and getting drenched in the rain while making a mile and a half canoe portage in Minnesota's Boundary Waters. Hypothermia can be just plain uncomfortably miserable, but it can also kill.
Wounds
Most wounds that folks suffer in a survival situation are relatively minor, and though they may be uncomfortable and even bleeding, they are not usually life-threatening. The thing is not to panic. A little blood looks like a lot, especially when it is on yourself or a loved one.

If the wound is combined with possible other injuries, such as following a tumble down a rocky slope, you have to first assess the possible damage.

Could there be a broken bone? A concussion? Internal injuries?

Don't panic. However, if you suspect such complications, do not move the injured party unless absolutely necessary, and then do it with great care.

Talk to the victim. He can usually tell you a lot about where he hurts and how much pain he is in. If the only injury seems to be the wound, reassure the victim and begin treatment.

Check the wound. Is it visibly dirty? Is the blood simply flowing from the wound or is it spurting? In survival situations, more people die from infected wounds than bleeding to death.

If the wound is relatively minor and the bleeding is minimal, you'll want to gently clean it before any attempt is made to bandage it. Nothing causes infection more than bandaging an unclean wound, even if it contains no visible dirt. Remember that deadly staph organisms are commonly found on human skin.

A good way to clean most wounds is to gently bathe the area with mild soap and water. Mop away from the wound, as one would sweep a floor, instead of scrubbing back and forth. The latter only moves bacteria around rather than removing it from the area. Rinse or soak the area well, removing any debris carefully with sterile tweezers.

When the area is clean, pat it dry with sterile gauze or air-dry it, then apply Betadine or antibiotic salve. We use Betadine for deeper wounds, and antibiotic salve for lesser injuries. Minor wounds seldom require bandaging, healing quicker by air exposure. Deeper wounds and ones in areas where they will be constantly irritated by clothing or work should be bandaged. A simple adhesive strip usually does the trick.

If the wound is bleeding quite a bit, simply applying pressure to the area with a sterile gauze pad will usually stop it within a few minutes. Where tourniquets were once advised, it has been found that more damage was done by the tourniquet than the bleeding would have caused in most instances. The application of firm pressure directly to the wound is very effective. After the severe bleeding has been stopped, gently clean the wound, but do not destroy the clot that has formed or bleeding will probably resume.

Should you be dealing with a more severe wound, covering it with a Betadine soaked (but not wet) sterile gauze, then a plain sterile gauze square, then adhesive tape is usually sufficient. If the edges of the wound gape or there is a flap of skin hanging down, either gently match the edges with butterfly adhesive strips or suture them, if you have the experience. Remember that most wounds will heal fine without suturing, especially with a little help from gentle butterfly adhesive strips. Sutures that are too tightly drawn will cause pain and scarring.

Never bandage a wound tightly with gauze bandage or anything else. This will restrict circulation and can cause pain and severe problems and even gangrene.

In the following days, keep the wound clean and dry. Change the dressing as needed, usually twice a day, leaving the dressing off and the area open to fresh air and sunlight as much as possible. This will greatly reduce the healing time and reduce chances of infection. Bacteria love damp, dark, warm areas, including a wound which is bandaged.

Watch for ugly redness or a fever in the patient, which would indicate infection in the wound. In this case, keep the area soaked in Betadine and give the patient antibiotics for 10 days, even if they seem better within a day or two. Immersing the infected wound in a hot Epsom salts solution also helps reduce pain and swelling along with cleansing the area.

Simple pain and swelling from the injury can be alleviated by plain aspirin, taken orally. Do not give aspirin immediately following an injury if there is a possibility of internal injuries, as aspirin may enhance hemorrhage. Do not give aspirin to young children. Use Ibuprofen instead.
Colds and flu
These common conditions are bad enough when things are fine, but are downright miserable in a survival situation. And remember that stress helps these overcome your body.

At the first sign of a cold or the flu, do those things your grandmother told you: keep warm and dry, rest, and drink plenty of fluids. Then add vitamin C and zinc lozenges, and most folks can overcome that mean cold or flu in a few days. If you need to alleviate symptoms, such as fever, runny nose, or coughing, take a cold/flu medication that covers your symptoms. By now, you probably know what works best for you and your children. The key is to have the medication on hand.

If the cold or flu lasts for longer than 10 days or seems to get worse, it may have turned into bronchitis or pneumonia, and antibiotics are necessary. Remember that home treatment is only for when no doctor or hospital is available.
Sprains
Believe it or not, sprains are one of the most common injuries in a survival situation. And often one of the most painful. The sprain can arise from walking over debris, logs, rocks, and even urban curbs. It can come from a fall or even an ankle turning over. (Your family will experience less sprains if they wear good, sturdy footwear, not flats or sandals. Ankle support is very important.)

When a sprain is new, immerse the affected part in cold water or apply ice packs to reduce pain and inflammation. I've found that when I take two plain aspirin immediately following such an injury that it greatly reduces both pain and inflammation later on.

If possible, rest the sprain, keeping it immobile and elevated for as long as reasonably possible. I continue taking the aspirin to keep down the inflammation. If you must move about, gently wrap the area with an elastic bandage to support it. Do not wrap area tightly or you will restrict circulation and make the pain much worse. Use a cane or crutches if the sprain is in a foot, ankle, or knee to reduce the amount of weight put on the injury. If the sprain is in the hand, wrist, elbow, or shoulder, keeping the arm in a sling will greatly reduce the pain and help it heal.

After a day, begin using hot Epsom salts soaks or packs to reduce the swelling and pain. And remember, the more you use a sprained joint, the longer it will take to heal and it may not ever heal completely if you persist using it before it heals. Rest is the key.
Slivers and spines

Getting a sliver or sticker of some kind is awfully common, especially in a survival situation, when one may be building a wood fire or foraging for food. Most of the time you can simply get hold of it and pull it out and be no worse for wear. But sometimes it is in too deep and painful and seemingly impossible to remove.

For relatively minor, but painful slivers, I use a sterile hypodermic needle, choosing the gauge (diameter/size) to fit the sliver size. Most smaller slivers are removed very easily with a 20-gauge needle. Now I use a hypodermic needle for several reasons, as opposed to using a sewing needle.

First, and most important, they are hollow. This allows one to slip them into the sliver track with little pain, as less bulk is pressing on that tender skin. They are also sharp, which lets me carefully pick away the skin layer above the sliver which has no feeling because there are no nerves, until the sliver is exposed and can be either snagged with the needle and drawn out or picked up with a pair of sterile tweezers and removed.

With larger slivers, I use an 18-gauge needle, which does the same thing but is a bit stronger. When the sliver is very painful, using a local anesthetic, such as oral medication or antibiotic ointment containing an anesthetic on the area about 10 minutes before the procedure, helps a lot.

The main thing is to keep the sliver aligned with its track, and not to pry it upright in removal, which is extremely painful.

Once the sliver is out, a little alcohol or Betadine will disinfect the area and let it heal quickly.

I've discovered a great treatment for small stickers and cactus thorns which break off when you try to remove them from tender skin. Should you or a family member fall into a cactus or other plant with fine stickers, simply coat the area with Shoe-Goo or Sportsman's-Goo, which is a clear silicone-type produce. Just a thin coat is fine. In about fifteen minutes it will be dry, and you can just peel it off, complete with all of the painful stickers.

Of course, there are many other possible injuries and illnesses. With a little advance preparation and study, you'll be surprised at what you can glide smoothly through. There is seldom any benefit to panic; a positive mental outlook can save lives.

SUGGESTIONS FOR YOUR MEDICAL KIT (LARGE)
ITEMS USES
thermometer detecting fever
aspirin/Tylenol fever/pain
zinc lozenges head off colds/flu
cough/throat lozenges comfort with colds
antifungal medication fungus infections of the skin
antibiotic ointment heal curs/abrasions
eye medication infections/irritations
oral expectorant clear lungs, reduce coughing
burn medication, such as Burn Free reduce severity and pain from burns
oral electrolytes treats dehydration
rolls of 2" sterile gauze covers wounds, control bleeding
several packs of 2" sterile pads covers wounds, gauze controls bleeding, holds medication in place
rolls of elastic leg wrap supports sprains, holds meds in place, controls bleeding, protects legs
rolls of sterile cotton cleaning area, controls bleeding, etc.
alcohol, soap, Betadine cleaning, disinfecting, wound healing
oral antidiarrheals treating moderate diarrhea
any family daily meds maintaining health
oral antibiotics/sulfas treating systemic or local infection
injectable antibiotics/sulfas treating systemic or local infection
injectable ephinephrine shock, as in drug allergy
injectable antihistamine allergies; bee sting
surgical instruments, such as forceps, needle holder, scalpel w/blades,scissors, etc. facilitate minor injury
assorted sizes suture material; absorbable allows suturing of gaping wounds
stethoscope monitoring vital signs
sterile needles and syringes giving injections
sterile IV kit (if experienced) makes IV injections possible for severe dehydration
IV electrolytes severe dehydration, shock
first-aid manual instructions

Of course, your family's personal medical kits (small, medium, and large) will probably contain different items, depending on your foreseeale needs, medical experience, and preferences. And you will probably think of many more items that would be provident to carry, especially in your large kit. There are no hard and fast rules, only suggestions. The main thing is to be prepared — and confident.

levinud vead toiduvarumisel

7 Mistakes of food storage link
by Vicki Tate

If you are going to store food, make sure that the food you store is adequate for the need you and your family anticipate. This may not be as easy as to achieve as many people think, because the facts are that most people make serious errors when storing food—errors that will come back to haunt them when the food they’ve stored is the only thing that stands between them and their empty, dissatisfied, bellies.

There are seven common mistakes people make when storing food. They are:

1. Variety

Most people don’t have enough variety in their storage. 95% of the people I’ve worked with have only stored four basic items: wheat, milk, honey, and salt. Statistics show most of us won’t survive on such a diet for several reasons.
a) Many people are allergic to wheat and may not be aware of it until they are eating it meal after meal.
b) Wheat is too harsh for young children. They can tolerate it in small amounts but not as their main staple.
c) We get tired of eating the same foods over and over and many times prefer to not eat, then to sample that particular food again. This is called appetite fatigue. Young children and older people are particularly susceptible to it. Store less wheat than is generally suggested and put the difference into a variety of other grains, particularly ones your family likes to eat. Also store a variety of beans, as this will add color, texture, and flavor. Variety is the key to a successful storage program. It is essential that you store flavorings such as tomato, bouillon, cheese, and onion.

Also, include a good supply of the spices you like to cook with. These flavorings and spices allow you to do many creative things with your grains and beans. Without them you are severely limited. One of the best suggestions I can give you is buy a good food storage cookbook, go through it, and see what your family would really eat. Notice the ingredients as you do it. This will help you more than anything else to know what items to store.

2. Extended staples

Never put all your eggs in one basket. Store dehydrated and/or freeze dried foods as well as home canned and “store bought” canned goods. Make sure you add cooking oil, shortening, baking powder, soda, yeast, and powdered eggs. You can’t cook even the most basic recipes without these items.

3. Vitamins

Vitamins are important, especially if you have children, since children do not store body reserves of nutrients as adults do. A good quality multi-vitamin and vitamin C are the most vital. Others might be added as your budget permits.

4. Quick and easy and “psychological foods”

Quick and easy foods help you through times when you are psychologically or physically unable to prepare your basic storage items. “No cook” foods such as freeze-dried are wonderful since they require little preparation, MREs (Meal Ready to Eat), such as many preparedness outlets carry, canned goods, etc. are also very good. “Psychological foods” are the goodies—Jello, pudding, candy, etc.—you should add to your storage. These may sound frivolous, but through the years I've talked with many people who have lived entirely on their storage for extended periods of time. Nearly all of them say these were the most helpful items in their storage to “normalize” their situations and make it more bearable. These are especially important if you have children.

5. Balance

Time and time again I’ve seen families buy all of their wheat, then buy all of another item and so on. Don’t do that. It’s important to keep well-balanced as you build your storage. Buy several items, rather than a large quantity of one item. If something happens and you have to live on your present storage, you’ll fare much better having a one month supply of a variety of items than a year’s supply of two or three items.

6. Containers

Always store your bulk foods in food storage containers. I have seen literally tons and tons of food thrown away because they were left in sacks, where they became highly susceptible to moisture, insects, and rodents. If you are using plastic buckets make sure they are lined with a food grade plastic liner available from companies that carry packaging supplies. Never use trash can liners as these are treated with pesticides. Don’t stack them too high. In an earthquake they may topple, the lids pop open, or they may crack. A better container is the #10 tin can which most preparedness companies use when they package their foods.

7. Use your storage

In all the years I’ve worked with preparedness one of the biggest problems I’ve seen is people storing food and not knowing what to do with it. It’s vital that you and your family become familiar with the things you are storing. You need to know how to prepare these foods. This is not something you want to have to learn under stress. Your family needs to be used to eating these foods. A stressful period is not a good time to totally change your diet. Get a good food storage cookbook and learn to use these foods! It’s better to find out the mistakes you’ll make now while there’s still time to make corrections.

It’s easy to take basic food storage and add the essentials that make it tasty, and it needs to be done. As I did the research for my cookbook, Cooking with Home Storage, I wanted to include recipes that gave help to families no matter what they had stored. As I put the material together it was fascinating to discover what the pioneers ate compared to the types of things we store. If you have stored only the basics, there’s very little you can do with it. By adding even just a few things, it greatly increases your options, and the prospect of your family surviving on it. As I studied how the pioneers lived and ate, my whole feeling for food storage changed. I realized our storage is what most of the world has always lived on. If it’s put together the right way we are returning to good basic food with a few goodies thrown in.

26. veebruar 2006

it's just matter of time

it's just matter of time link
üks 60 lk booklet pandeemiast ja ettevalmistustest, võib ju pilgu üle lasta :)
kohati veidi kummaline ja kõigega ma nõus ei oleks, aga ühtteist oli huvitavat ka - näiteks näidend, kuidas elavalt kirjeldada, miks on vaja ettevalmistusi teha - ja võimaliku pandeemiaaegse päeva kirjeldus :p
päris värske teine ka, 01.02.06 .. samuti meeldis mulle algus :D - et miks vahel on vaja häirekella lüüa mõõdukuse asemel :D :D :D

“Tell a man whose house is on fire to give a moderate alarm; tell him to moderately rescue his wife from the hands of the ravisher; tell the mother to gradually extricate her babe from the fire into which it has fallen; but urge me not to use moderation in a case like the present.” – William Lloyd Garrison

ettevalmistused infra katkestusteks

Flu WIki kogumik, millised elementaarsed ;) asjad võivad puududa äärmuslikes olukordades

WHEN SERVICES FAIL: link
elekter, valgus, sidesüsteemid, lõbustus, küte, vesi, toit, transport, isiklik hügieen

Electricity:
all else flows from electricity: heat, food preparation, communications, lighting, computing, entertainment
DC to AC inverter to use car as generator (not in a closed space: CO poisoning) as long as there is gasoline; have a self-contained jumpstarter on hand in case you run down your car battery
5 gallon (bright red) fuel can full, stabilized with Sta-Bil (a double dose keeps it fresh 2 years), stored carefully, protected, away from the house; date it
Consider a backup solar system with battery array

Lighting:
Battery-operated LED lanterns for ambient light
Solar battery charger (solar and LED gear: http://store.sundancesolar.com)
If you use candles or candle lantern, be careful as they are a fire hazard
Hand-crank or shake flashlights
LED lightbulbs (standard base) 2 or 4 watt, if you have limited backup electricity like solar/wind/batteries

Communications:
passive:
Radio: hand cranked or battery-powered, solar battery charger; XM satellite radio has a 24/7 emergency channel, consider getting a receiver
TV: small portable TV with multiple power options (assuming TV stations are up and running)

active: phones, internet, loud whistle
Roll of quarters, prepaid phone card for pay phones (locate them in your area)
Have at least one old-style low-power telephone (not cordless) that can function without electricity
Prepare and carry a laminated card with all important contact information
Obtain a cellphone if you don’t already have one; learn how to send/receive text messages on your cellphone; familiarize yourself with wireless data capabilities of phone
Manual cell phone charger like Sidewinder
For internet when there is no electricity: use battery-powered laptop; recharge via car/DC-AC inverter or portable solar panel

Entertainment:
Books, games, musical instruments
Battery-operated DVD and CD players

Natural gas:
Warmth:

Close off unused areas of house; seal off with plastic and duct tape; cover walls and floors with rugs and blankets;
Fireplace with reflector or wood stove; fleece clothing
Emergency heating: Coleman Catalytic Heater and lots of 1 lb propane canisters (3/day)

Cooking and hot water:
Barbecue with briquettes or coal (must be used with proper ventilation)
Jetboil or other camp stove such as Coleman, plus fuel cartridges
Solar cooker and solar water heater (Super solar shower, 4 gal capacity)
Grate for cooking on fireplace fire

Water:
Store about 50 gallons of potable water; consider obtaining a food grade 55 gallon water storage barrel, keep it fresh
Learn how to purify water (rolling boil for 10 minutes, use AquaPak solar sterilizer, filtration. chemical, etc) link
Obtain water purifier such as Exstream Orinoco or Exstream Mackenzie water bottle for small amounts; First Need Deluxe Portable water purifier/filter for groups (get spare cartridges)
Use swimming pool water for non-drinking uses such as washing
If water pressure drops, indicating failure, shut off master valve to avoid contamination to water in your system; then, water in hot water heater tanks can still be used

Food:
Dried and canned foods, rice and beans, food bars, trail mix, candy bars, etc
Staples such as sugar, flour, salt, pepper, spices, Parmalat or dried or canned milk
Plant fruit trees, vegetable garden
Food preservation: 5 day super-insulated coolers with wheels; unload the contents of your freezer into them as soon as power goes out; keep in cool place; consider getting a small car-sized 12 volt DC mini cooler if you have medicines requiring refrigeration

Transportation:
mobility may be restricted, mass transit could be hazardous, and fuel shortages are likely
Consider getting a bicycle
Safely store extra fuel (see above, under electricity)
Get car with highest MPG

Hygiene:
Laundry, dish washing, hand washing all need hot water (see above, under natural gas)
Human waste: porta-potty, bucket with lid, or use strong trash bags duct-taped into drained (shut off water to it and then flush until empty) toilet, seal completely and dispose of after use; there are digesting enzymes and deodorants for toilet bags; use bleach solution to sterilize
Trash: compost pile for non-meat organic waste; paper can be burned if trash and recycling pickups are interrupted
Baking soda and white vinegar can serve as cleaners and deodorizers for many purposes if you run out of detergents
Moist baby wipes (unscented), Purell waterless hand sanitizer (use one with ethanol), rubber gloves

eeldused oma plaanide koostamiseks

Flu Wiki - millised eeldused on mõtet aluseks võtta, kui oma pere pandeemiaplaani koostada link

Preliminary considerations:

There will most likely not be a targeted vaccine until about 6 months after pandemic has begun; any vaccine prepared ahead of the pandemic will likely confer only partial protection
There will most likely not be enough antivirals for treatment, let alone prophylactic use
Assume a quarter to a half of the public will become infected over a 3 month period (a flu wave, of which there usually are 3 — the worst being the 2nd — a few weeks or months apart) and 3/4 to a half staffing everywhere for various durations
Virus will be shed before symptoms appear (which can be 3 - 6, up to even 17 days) and after symptoms (21 days for children, 3–5 days for adults, longer for the immunocompromised)
Children and otherwise healthy young adults are disproportionately at risk
All bodily excreta will be very dangerous, especially feces and sputum/mucus; virus often multiplies in gut and diarrhea is often first symptom, preceding respiratory symptoms
We will probably need two or more times the hospital beds and ICU facilities
There will probably be mortality of at least an extra 50% beyond normal; a high percentage of these are likely to be under 65 years old, which comprise workers in essential services
Most patients should probably be treated in the home, or if more critical, in secondary ICU-like set ups in schools or other locations
Hospitals will need to continue their usual work and erect a firewall to protect vulnerable inmates from flu
Childcare and family nursing responsibilities will strain ability of healthcare workers and other essential infrastructure workers to provide services
Public services such as water, power, waste disposal, communications, and transportation will likely be intermittently interrupted
Deliveries of food and other essential commodities may be disrupted
There may be civil disorder due to shortages and desperation


miks on vaja koonduda

FluWiki väga kurb kirjeldus, kuidas üksi ja väga haigena hakkama saada :S
hea selgitus, et miks on kriisiolukorras väga mõistlik mitmekesi kokku kolida
ainuüksi mõte sellest, et oled voodis vägaväga haige ja mitte keegi ei too sulle klaasi vett ega tuleta meelde, et nüüd oleks vaja kraadida või rohtu võtta, tekitab minus õudusjudinaid :S

Home Alone link
by Lisa the GP, who is real author of this story

Years ago I had (human) influenza, and developed a secondary bacterial pneumonia. I live alone, and these are a few of the things that I wish I had done to make my stay in bed easier. When you start getting symptoms, before you go to bed,
1) Put a large water supply on one nightstand. Large as in one of those 10 gallon collapsable plastic water cubes with a spigot commonly used for camping. Put more than one unbreakable cup next to it. You may not want to reach down for one if you drop it, not for reasons of hygiene but because of the effort required. 2) Put two boxes of facial tissues on the other, with a big trash can beneath. 3) Consider putting a barf container next to the trash can. Use a plastic trash-can liner that you can tie shut after use to control odor. Put a couple of extra bags under the tissue boxes. Intestinal problems are not usual in influenza, but coughing fits can send you retching, and bird flu does have potential to cause gastrointestinal problems. 4) Put all your medications on the water table. Don’t forget the ones you may ordinarily take, such as medications for diabetes or blood pressure, in addition to any prescribed flu treatments. Also include over the counter medications for symptoms, such as ibuprofen, cough suppressant, etc. If there are any medications recommended by authorities during an epidemic, include those. (I can imagine that if the bird flu has a lot of gastrointestinal involvement then the health department might recommend ‘electrolyte replacement’ of the kind used to treat cholera, for example.) Include any vitamins you usually take. 5) Put a few cans of a meal replacement drink within reach. 6) Consider a container that may be used for human waste in case you are too weak to walk to the restroom. Use something that can be closed in case you do not have strength to empty it for a day or more. 7) If you have a walker or a cane, put it by the bedside so that you can use it if you feel weak. 8) If you have a tv in the room, put the controls within reach of the bed. Plus a few other mental distractions, like books or a game-boy, though you probably won’t be awake much to use them. 9) Have a working phone within reach. Do not rely on any telephone that requires a power adapter (something that plugs into the power outlet in the wall). If the power goes out your phone is useless. Every home should have at least one phone that only plugs into the telephone jack on your wall, a separate system from your power. I keep a backup phone that even has caller ID (operates off batteries) that plugs directly into the telephone jack. 10) Have extra blankets (in case of power outage) and pillows within reach. Pillows are key because if you develop pneumonia you will want to remain sitting up so that fluid collects in the lower part of your lungs and leaves the upper parts with less fluid so that you can still breathe. (Note that this is different from when people have difficulty breathing due to ARDS in the hospital, when they are on a respirator; with forced air the most important thing is to make all the airways of equal resistance and so in that situation people try to arrange patients to be flat and even prone part of the day.) 11) If you have sleep apnea and use a CPAP machine, talk to your doctor (by phone) about using it while awake or whether any settings need to be adjusted. In a hospital, CPAP is sometimes used for respiratory support short of an actual respirator (vent)—but with supplemental oxygen. 12) If you are female, put feminine protection products (pads) at hand, though your illness will probably throw your cycle off. 13) Have a clock in sight. Make sure the alarm is switched off. 14) I imagine during a pandemic that a battery-operated radio and flashlight within reach would be important in case the power cuts out. I hope you bought new batteries before the outbreak started!

While ill, you may try to do an ordinary activity (walk to the restroom) and suddenly find yourself out of breath as though you have run a sprint. This is a serious symptom that should at the least prompt a call to your doctor or other professional. Meanwhile remember that being out of breath is a combination of how much oxygen you get into your circulation and how quickly you use it up. Move slowly so that you do not exceed your ability to exchange oxygen. (Okay, technically, the sense of breathlessness comes from how much carbon dioxide accumulates, but this is close enough.) Sometimes an inability to catch your breath is due to an inability to exhale and make the lungs ready for the next breath; exhaling with your hand over your mouth creates something called ‘positive end expiratory pressure’ (PEEP) which can help keep inflamed airways open, allowing the lungs to exhale more completely (asthmatics and people with emphasema have this problem, which is why old smokers sometimes breathe through pursed lips). The important thing is to try not to panic, because panic will raise your use of oxygen and make the situation worse.

I’m giving this information as a stop-gap to use until you are able to talk to a professional, not as a substitute for that consultation. If you cannot take more than a few slow steps without being breathless then you are probably *well* past admittable to a hospital for oxygen and should go to one if there is space (call for a pick up). If no services are available then you will have to limit activity and do not lie flat—remain sitting when awake and asleep. Use the pillows to brace yourself.

Another cause of sudden breathlessness is that, when you are immobile for more than a day, you can develop blood clots in your legs that may break loose and lodge in your lungs. This is called a pulmonary embolus (PE), and it can range in severity from hardly noticable to instant death. Hence my advice to at least phone a professional if you become breathless from what should be ordinary exertion. You can reduce (not eliminate) your risk of a PE by getting up and moving for at least a few minutes every day, or by clenching the muscles of your legs in bed every time you are awake and think of it. However if you have pneumonia these actions may make you breathless by causing your activity to exceed your oxygen delivery. But you knew being sick sucks, right?

Good luck, and may you not have to be sick without help.

kohanemine pandeemiamõttega

Flu Wiki'st, emotsionaalsetest probleemidest
Adjustment Reactions during an Influenza Pandemic link
· sissejuhatus
· näited
· võimalused
· soovitused
· edasine lugemine

Introduction Just thinking about a pandemic may elicit an emotional reaction (if we are alive). Our reaction will be very personal, depending on our basic personality, on how we feel about other things, and on our particular circumstances. Our reaction will evolve if we think further, if we do something practical about it, or if the world changes around us. And all this is only because we’re imagining it! If or when there’s a real pandemic, many people (all people?) will go through their own “journey”.

We may try and categorize these inner and personal reactions into several “reaction situations”, which are of course rough simplifications. Let’s not call them “reaction stages” because they need not be sequential, and also because one is not necessarily “better” than the others.

We hope this page may be of help, but please realise it’s been written by fluwikie contributors who are not necessarily experts in psychology, counselling or anything of that sort. Just people talking to each other, looking at what they see, and trying to find ways forward. We recognize feelings for what they are, and at the same time we want to move forward. Patronizing or helplessness are not allowed here, thank you! :-)

Examples from other runs of life
A man has been diagnosed with a really bad case of cancer. His wife looks for other opinions, one doctor after another, and one therapy after another. She just can’t believe it’s happening.

A young girl finds out she’s pregnant. She didn’t expect it and she doesn’t like the news. She quits school and joins a circus.
… please add a few other examples for variety …

Several possibilities. Is “yours now” here? Add what you have felt or seen

Denial, disbelief
Helplessness
Anxiety
Useless action
Talk, talk, talk (to yourself or to others)
Blaming others (rightfully or not)
“I will survive”
(Please add your own!)

Suggestions for each situation
The same action can be taken at different situations. Help yourself to whichever suits you!

Work at things that improve the world in general, not just regarding a possible pandemic.
Work at things that are specific to a possible pandemic.
Enjoy life.
Get more information, either general or specific, either supporting what you believe or the oposite.
Anxiety. Your body is complaining and you are not getting enough sleep? Laugh a bit, go for a walk …
Go out and do some exercise.
Do something difficult so you must concentrate on that only.
Focused thinking (“divide and conquer” strategy).
Useful action (“one thing at a time” strategy).
Alerting others in “detached” mode.

Finally, there’s one piece of (self) advice, specially useful if we feel “blocked”. If someone punches you in the face, your reaction is going to be fast, and maybe not the best possible reaction. In a pandemic, and much more so before a pandemic, we can give ourselves time to think, time to explore things in sequence (say 5 minutes for each question, 25 minutes total, maybe in a family group):

What is going on right now?
What may happen in the future?
What good things do we have already?
What can we do?
How do we carry it out practically?

You may find that most of the times you do have 25 minutes! Or you may become good at it and run through those (or similar) questions in less time … Or you may teach others and maybe even “lead without leading”?

Further Reading
Peter Sandman, Adjustment Reactions: The Teachable Moment in Crisis Communication link
Dave Pollard, Spin, the Three P’s and the Politics of Learned Helplessness and Learned Optimism link

järjejutt pandeemiast (ajalugu ja praegu)

lisandus: pandemic planning, kuidas pandeemia võib alata

järjejutt 1918a pandeemiast ühes usa kohalikus ajalehes (nõuab registreerimist, aga tasuta ja läheb kiiresti)
ei midagi erilist neile, kes analoogseid jutte varem lugenud on :D
aga annab hea pildi, mismoodi kulges 1918a pandeemia ühes usa väikelinnas
4-5 osa on siis juba praegusest olukorrast ja tegevusest ..

INVISIBLE ENEMY
By Cheryl Welch
Chapter 1: Brink of Disaster link
Chapter 2: 'First Class Fright' link
Chapter 3: Panic Swirls link
Chapter 4: Burning Itself Out link
Chapter 5: Current concerns link
Chapter 6: Pandemic planning link


25. veebruar 2006

Virumaa Teataja: Dekameroniaeg

Juhtkiri: Dekameroniaeg link

Ühel kaunil suvepäeval aastal 1343 said Firenzes kokku kümme noort ilusat inimest - kolm noormeest ja seitse neidu – ning otsustasid linnamüüride vahel (ja kogu tuntud maailmas) võimutseva musta surma eest maale ühte linnalähedasse villasse pakku minna.
Nõnda alustas oma surematut “Dekameroni” kõigi aegade kõige paremate jutuvestjate hulka kuuluv Giovanni Boccaccio. Nüüd teame, et katkuepideemia, mis oma tohutu lõikuse tõttu sai nimeks must surm, vähendas Euroopa rahvastikku tervelt kolmandiku võrra.

Ka kõige pessimistlikumate prognooside järgi maailmal linnugripi ja sellega kaasneda võiva pandeemiga nii hullusti küll ei lähe, kuid õudne on selle taudi peale mõelda siiski.

Linnugripil ja võimalikul pandeemial on keskaja laastavate katkudega ja ka 1918. a pandeemiaga võrreldes kaks erinevust: linnugripil on pikk peiteaeg, keskmiselt nädal, aga on olnud ka kauem - ja sel ajal on inimene juba teistele nakkusallikaks; inimesed reisivad kohutavalt palju ringi, prognooside kohaselt levib praeguse transpordisüsteemi toimimisel tapjaviirus ööpäevaga üle kontinendi, kust alguse saab, ja kolme päevaga üle maailma.

Teisisõnu on esmaspäeval veel kõik korras, teisipäeval sünnib näiteks Hiinas tapjaviirus, reedeks on viirus levinud üle maailma ja järgmisel pühapäeval hakkavad inimesed surema. Aga kui suur suremus on, seda ei tea keegi. Venelased on välja käinud, et nende kalkulatsioonide kohaselt surevad sajad miljonid kuni miljard, seega 5-15% Maa elanikkonnast.

Samas ütles üks Dekameronimaa Itaalia jahimees, et linnugripp pole midagi uut, seda on läbi aegade alati olnud ja sel aastal pole mitte midagi teistmoodi, kui vaid see, et meedias on tekitatud kära ja inimestes hirmu. Mis puutub kanalihasse, siis see ilmselt pole kunagi nii kontrollitud olnud kui praegu.

Pead ei tohi aga jaanalinnu kombel liiva peita ning lootes parimat tuleb igal juhul mõelda, kuidas vältida halvimat.

Sest linnugripi eest ei leia varju ka kõige varjulisemas villas, kui sellist tihedasti asustatud maailmas veel leida on.

21. veebruar 2006

oled sa valmis pandeemiaks?

If a Pandemic Strikes, ARE YOU READY? link
By Anita Manning

If you had to be on your own, in your home, for two weeks or more, what would you need to have on hand to survive? That's the question Americans should consider now, before the next flu pandemic strikes, health experts say. "If we have a pandemic, stores are going to run out of food," says Arnold Monto, an epidemiology professor at the University of Michigan. "It would be a good idea to have things available."
Michael Bell of the Centers for Disease Control and Prevention advises families to talk about what they would need if they were told to avoid gatherings or the grocery store. "Ask 'What would we need?'" he says. "If you have a large number of children, make sure you have supplies for them on hand. If your school district decides to have people stay home from school, how is the family going to manage? Things like that are important to consider."

Kanada mõttekoja raport

Facing the Risks
Global Security Trends and Canada link
värske raport, koostatud veebruaris 2006, nõuab registreerimist lugejaks, aga tasuta ja aega kulub ehk 1 min

mõned pandeemiat puudutavad lõigud kopin allapoole

There is a growing consensus that a large-scale, and possibly catastrophic, flu epidemic is imminent. While it is not the only health crisis threatening world populations, it is the most menacing one.

This long-awaited flu virus is expected to be so contagious that any attempt to close off borders and control migration would be ineffective.The consequences of a flu epidemic would be devastating. Between 180 and 360 million people could perish. Aside from the sheer dent in the global workforce, an epidemic of medium proportions would break global production chains, shatter trade and impede the delivery of services involving human contact. A widespread flu pandemic would throw the world into a sudden and possibly dramatic global recession.

While the pandemic would spread throughout the world, the impact would be highly skewed. Asian and African countries would be the hardest hit. A pandemic would also feed on and heighten existing inequalities. It would not only kill millions of people, it would have the power to close borders, destabilize economies and topple unstable governments. It would elevate the more traditional security risks and help shape a world where other threats could blossom.

Canada will not escape the imminent pandemic, and unless the level of global preparedness improves, panic will reign. Estimates of the scale of fatalities vary widely, but in the worst-case scenario, an H5N1 avian flu epidemic could kill as many as 1.6 million Canadians.1 An epidemic such as this would paralyze our manufacturing sector. Border disruptions would shatter integrated production lines and could last more than a year. Direct medical costs could surpass hundreds of millions of dollars. Canadian businesses and business organizations must be prepared to deal with a major flu outbreak—to coordinate with government emergency agencies, reduce the risk of disease transmission in the workplace, and maintain essential business functions despite the potential for high employee absenteeism. The Conference Board is currently surveying Canadian private sector organizations to see how prepared they are for an influenza pandemic.


48 söögisooda kasutusvõimalust

48 võimalust söögisooda kasutamiseks link

Uses For Baking Soda

Bicarbonate of soda or baking soda has many different uses in the household. Although much more expensive products have been developed over the years to do the same jobs, baking soda can work for you just as well, if not better. Use it in the following ways:

1. To make your own baking powder, stir and sift together 2 parts of Cream of Tartar to 1 part baking soda and 1 part cornstarch.

2. Be sure to keep an extra box of baking soda by your stove in case of grease or electrical fire. Scatter the powder by the handful to safely put it out.

3. Keep a container of baking soda in your garage as well as in your car to put out a fire. It won't damage anything it touches.

4. Baking soda will also put out fires in clothing, fuel, wood, upholstery and rugs.

5. Clean vegetables and fruit with baking soda. Sprinkle in water, soak and rise the produce.

6. Wash garbage cans with baking soda.

7. Soak and wash diapers with baking soda.

8. Oil and grease - stained clothing washes out better with soda added to the washing water.

9. Clean your fridge and freezer with dry soda sprinkled on a damp cloth. rinse with clear water.

10. Deodorize your fridge and freezer by putting in an open container of baking soda to absorb odors. Stir and turn over the soda from time to time. Replace every 2 months.

11. Soda absorbs kitty litter odors. Cover the bottom of the kitty box with 1 part soda; then add a layer of 3 parts kitty litter on top.

12. Always add 1/2 cup soda to your washing machine load.

13. Clean combs and brushes in a soda solution.

14. Wash food and drink containers with soda and water.

15. Wash marble-topped furniture with a solution of 3 tablespoons of soda in 1 quart of warm water. Let stand awhile, then rinse.

16. Clean formica counter tops with baking soda on a damp sponge.

17. Wash out thermos bottles and cooling containers with soda and water to get rid of stale smells.

18. To remove stubborn stains from marble, formica or plastic surfaces, scour with a paste of soda and water.

19. Wash glass or stainless steel coffee pots (but not aluminum) in a soda solution ( 3 tbsp. soda to 1 quart water).

20. Run you coffee maker through its cycle with a soda solution. Rinse.

21. Give baby bottles a good cleaning with soda and hot water.

22. Sprinkle soda on barbecue grills, let soak, then rinse off.

23. Sprinkle soda on greasy garage floor. Let stand, scrub and
rinse.

24. Polish silverware with dry soda on a damp cloth. Rub, rinse and dry.

25. For silver pieces without raised patterns or cemented-on handles: place the silver on aluminum foil in an enamel pot. Add boiling water and 4 tbsp. baking soda. Let stand, rinse and dry.

26. Reduce odor build-up in your dishwasher by sprinkling some soda on the bottom.

27. Run your dishwasher through its cycle with soda in it instead of soap to give it a good cleaning.

28. To remove burned-on food from a pan: let the pan soak in soda and water for 10 minutes before washing. Or scrub the pot with dry soda and a moist scouring pad.

29. For a badly-burned pan with a thick layer of burned-on food: pour a thick layer of soda directly onto the bottom of the pan, then sprinkle on just enough water so as to moisten the soda. Leave the pot overnight, then scrub it clean next day.

30. Rub stainless steel and chrome with a moist cloth and dry baking soda to shine it up. Rinse and dry. On stainless steel, scrub in the direction of the grain.

31. Clean plastic, porcelain and glass with dry soda on a damp cloth. Rinse and dry.

32. Remove that bad smell from ashtrays with soda and water.

33. Sprinkle a bit of dry soda in your ashtrays to prevent smoldering and reduce odor.

34. Clean your bathroom with dry soda on a moist sponge - sink, tub, tiles, shower stall, etc.

35. Keep your drains clean and free-flowing by putting 4 tablespoons of soda in them each week. Flush the soda down with hot water.

36. Soak your shower curtains in water and soda to clean them.

37. Bee sting: use a poultice of baking soda and water.

38. Windburns: moisten some baking soda and apply directly.

39. Making Play Clay with baking soda: combine 1 1/4 cups water, 2 cups soda, 1 cup cornstarch.

40. Use soda as an underarm deodorant.

41. If your baby spits up on his shirt after feeding, moisten a cloth, dip it in baking soda and dab at the dribbled shirt. The odor will go away.

42. When scalding a chicken, add 1 tsp. of soda to the boiling water. The feathers will come off easier and flesh will be clean and white.

43. Repel rain from windshield. Put gobs of baking soda on a dampened cloth and wipe windows inside and out.

44. Add to water to soak dried beans to make them more digestible.

45. Add to water to remove the "gamey" taste from wild game.

46. Use to sweeten sour dishcloths.

47. Use dry with a small brush to rub canvas handbags clean.

48. Use to remove melted plastic bread wrapper from toaster. Dampen cloth and make a mild abrasive with baking soda.

Readers Tips:

Mix a pinch in with your regular hair shampoo, to rid your hair of buildup caused by styling products and the environment. It works great.


60 äädika kasutusvõimalust

kuuskümmend äädika kasutusvõimalust link

Sixty Uses Of Vinegar
1. Arthritis tonic and treatment; 2 spoonfuls of apple cider vinegar and honey in a glass of water several times daily.

2. Thirst-quenching drink: apple cider vinegar mixed with cold water.

3. Sagging cane chairs: sponge them with a hot solution of half vinegar and half water. Place the chairs out in the hot sun to dry.

4. Skin burns: apply ice cold vinegar right away for fast relief. Will prevent burn blisters.

5. Add a spoonful of vinegar to cooking water to make cauliflower white and clean.

6. Storing cheese: keep it fresh longer by wrapping it in a vinegar-soaked cloth and keeping it in a sealed container.

7. Remove stains from stainless steel and chrome with a vinegar-dampened cloth.

8. Rinse glasses and dishes in water and vinegar to remove spots and film.

9. Prevent grease build-up in your oven by frequently wiping it with vinegar.

10. Wipe jars of preserves and canned food with vinegar to prevent mold-producing bacteria.

11. To eliminate mildew, dust and odors, wipe down walls with vinegar-soaked cloth.

12. Clean windows with vinegar and water.

13. Hardened paint brushes: simmer in boiling vinegar and wash in hot soapy water.

14. Clean breadbox and food containers with vinegar-dampened cloth to keep fresh-smelling and clean.

15. Pour boiling vinegar down drains to unclog and clean them.

16. Clean fireplace bricks with undiluted vinegar.

17. An excellent all-purpose cleaner: vinegar mixed with salt. Cleans copper, bronze, brass, dishes, pots, pans, skillets, glasses, windows. Rinse well.

18. Make your catsup and other condiments last long by adding vinegar.

19. To clear up respiratory congestion, inhale a vapor mist from steaming pot containing water and several spoonfuls of vinegar.

20. Apple cider vinegar and honey as a cure-all: use to prevent apathy, obesity, hay fever, asthma, rashes, food poisoning, heartburn, sore throat, bad eyesight, dandruff, brittle nails and bad breath.

21. When boiling eggs, add some vinegar to the water to prevent white from leaking out of a cracked egg.

22. When poaching eggs, add a teaspoon of vinegar to the water to prevent separation.

23. Weight loss: vinegar helps prevent fat from accumulating in the body.

24. Canned fish and shrimp: to give it a freshly caught taste, soak in a mixture of sherry and 2 tablespoons of vinegar.

25. Add a spoonful of vinegar when cooking fruit to improve the flavor.

26. Soak fish in vinegar and water before cooking for a tender, sweeter taste.

27. Add vinegar to boiling ham to improve flavor and cut salty taste.

28. Improve the flavor of desserts by adding a touch of vinegar.

29. Add vinegar to your deep fryer to eliminate a greasy taste.

30. Add a tablespoon of vinegar to fruit gelatin to hold it firm.

31. Steep your favorite herb in vinegar until you have a pleasing taste and aroma.

32. Use vinegar instead of lemon on fried and broiled foods.

33. To remove lime coating on your tea kettle; add vinegar to the water and let stand overnight.

34. To make a good liniment: beat 1 whole egg, add 1 cup vinegar and 1 cup turpentine. Blend.

35. Apply vinegar to chapped, cracked skin for quick healing.

36. Vinegar promotes skin health: rub on tired, sore or swollen areas.

37. Reduce mineral deposits in pipes, radiators, kettles and tanks by adding vinegar into the system.

38. Rub vinegar on the cut end of uncooked ham to prevent mold.

39. Clean jars with vinegar and water to remove odor.

40. Avoid cabbage odor by adding vinegar to the cooking water.

41. Skunk odor: remove from pets by rubbing fur with vinegar.

42. Paint adheres better to galvanized metal that has been wiped with vinegar.

43. Pets' drinking water: add vinegar to eliminate odor and encourage shiny fur.

44. For fluffy meringue: beat 3 egg whites with a teaspoon of vinegar.

45. Pie crust: add 1 tablespoon vinegar to your pastry recipe for an exceptional crust.

46. Half a teaspoon per quart of patching plaster allows you more time to work the plaster before it hardens.

47. Prevent discoloration of peeled potatoes by adding a few drops of vinegar to water. They will keep fresh for days in fridge.

48. Poultry water: add vinegar to increase egg production and to produce tender meat.

49. Preserve peppers: put freshly picked peppers in a sterilized jar and finish filling with boiling vinegar.

50. Olives and pimentos will keep indefinitely if covered with vinegar and refrigerated.

51. Add 1 tsp. vinegar to cooking water for fluffier rice.

52. Add vinegar to laundry rinse water: removes all soap and prevents yellowing.

53. After shampoo hair rinse: 1 ounce apple cider vinegar in 1 quart of distilled water.

54. For a shiny crust on homemade bread and rolls: just before they have finished baking, take them out, brush crusts with vinegar, return to oven to finish baking.

55. Homemade sour cream: blend together 1 cup cottage cheese, 1/4 cup skim milk and 1 tsp. vinegar.

56. Boil vinegar and water in pots to remove stains.

57. Remove berry stains from hands with vinegar.

58. Prevent sugaring by mixing a drop of vinegar in the cake icing.

59. Cold vinegar relieves sunburn.

60.When boiling meat, add a spoonful of vinegar to the water to make it more tender.

Bonus:

61. Marinate tough meat in vinegar overnight to tenderize.

62. Douche: 2 to 4 ounces of vinegar in 2 quarts of warm water.

60 soola kasutusvõimalust

kuuskümmend soola kasutusvõimalust link

Sixty Uses Of Salt

Although you may not realize it, simple table salt has a great number of uses other than simply seasoning your food. The following list will give you sixty uses of salt, many of which you probably didn't realize:

1. Soak stained hankies in salt water before washing.

2. Sprinkle salt on your shelves to keep ants away.

3. Soak fish in salt water before descaling; the scales will come off easier.

4. Put a few grains of rice in your salt shaker for easier pouring.

5. Add salt to green salads to prevent wilting.

6. Test the freshness of eggs in a cup of salt water; fresh eggs sink; bad ones float.

7. Add a little salt to your boiling water when cooking eggs; a cracked egg will stay in its shell this way.

8. A tiny pinch of salt with egg whites makes them beat up fluffier.

9. Soak wrinkled apples in a mildly salted water solution to perk them up.

10. Rub salt on your pancake griddle and your flapjacks won't stick.

11. Soak toothbrushes in salt water before you first use them; they will last longer.

12. Use salt to clean your discolored coffee pot.

13. Mix salt with turpentine to whiten you bathtub and toilet bowl.

14. Soak your nuts in salt brine overnight and they will crack out of their shells whole. Just tap the end of the shell with a hammer to break it open easily.

15. Boil clothespins in salt water before using them and they will last longer.

16. Clean brass, copper and pewter with paste made of salt and vinegar, thickened with flour

17. Add a little salt to the water your cut flowers will stand in for a longer life.

18. Pour a mound of salt on an ink spot on your carpet; let the salt soak up the stain.

19. Clean you iron by rubbing some salt on the damp cloth on the ironing surface.

20. Adding a little salt to the water when cooking foods in a double boiler will make the food cook faster.

21. Use a mixture of salt and lemon juice to clean piano keys.

22. To fill plaster holes in your walls, use equal parts of salt and starch, with just enough water to make a stiff putty.

23. Rinse a sore eye with a little salt water.

24. Mildly salted water makes an effective mouthwash. Use it hot for a sore throat gargle.

25. Dry salt sprinkled on your toothbrush makes a good tooth polisher.

26. Use salt for killing weeds in your lawn.

27. Eliminate excess suds with a sprinkle of salt.

28. A dash of salt in warm milk makes a more relaxing beverage.

29. Before using new glasses, soak them in warm salty water for awhile.

30. A dash of salt enhances the taste of tea.

31. Salt improves the taste of cooking apples.

32. Soak your clothes line in salt water to prevent your clothes from freezing to the line; likewise, use salt in your final rinse to prevent the clothes from freezing.

33. Rub any wicker furniture you may have with salt water to prevent yellowing.

34. Freshen sponges by soaking them in salt water.

35. Add raw potatoes to stews and soups that are too salty.

36. Soak enamel pans in salt water overnight and boil salt water in them next day to remove burned-on stains.

37. Clean your greens in salt water for easier removal of dirt.

38. Gelatin sets more quickly when a dash of salt is added.

39. Fruits put in mildly salted water after peeling will not discolor.

40. Fabric colors hold fast in salty water wash.

41. Milk stays fresh longer when a little salt is added.

42. Use equal parts of salt and soda for brushing your teeth.

43. Sprinkle salt in your oven before scrubbing clean.

44. Soaked discolored glass in a salt and vinegar solution to remove stains.

45. Clean greasy pans with a paper towel and salt.

46. Salty water boils faster when cooking eggs.

47. Add a pinch of salt to whipping cream to make it whip more quickly.

48. Sprinkle salt in milk-scorched pans to remove odour.

49. A dash of salt improves the taste of coffee.

50. Boil mismatched hose in salty water and they will come out matched.

51. Salt and soda will sweeten the odor of your refrigerator.

52. Cover wine-stained fabric with salt; rinse in cool water later.

53. Remove offensive odors from stove with salt and cinnamon.

54. A pinch of salt improves the flavor of cocoa.

55. To remove grease stains in clothing, mix one part salt to four parts alcohol.

56. Salt and lemon juice removes mildew.

57. Sprinkle salt between sidewalk bricks where you don't want grass growing.

58. Polish your old kerosene lamp with salt for a brighter look.

59. Remove odors from sink drainpipes with a strong, hot solution of salt water.

60. If a pie bubbles over in your oven, put a handful of salt on top of the spilled juice. The mess won't smell and will bake into a dry, light crust which will wipe off easily when the oven has cooled.

kuidas vältida nakatumist?

cureventsi foorumisse pandi üles loetelu nakkuse saamise viisidest,
allikat ei ole märgitud, aga tundub mõistlik ja selge ülevaade - ja niipalju kui ma asjast jagan, siis õige ka :D
a) õhk
b) tatipritsmed,
c) füüsiline kontakt haige või reostunud pinnaga,
d) reostunud vee joomise kaudu (nb! ka ujumisel satub vett limaskestadele)
e) nakatunud linnuliha või munade söömisel (mitte läbiküpsetatuna) või toorena töötlemisel,
f) kanade ja nb! sigade farmides
g) teised linnud ja loomad
h) tuul (reostunud tolm, suled)

lisaks juttu siis desinfitseerimisest

Flu viruses can be transmitted through:

A) breathing in Bird Flu (Avian Influenza) contaminated airborne aerosols. These are very small particles of water in the air
that are contaminated by viruses. These very small aerosols can also enter the body through the eyes. For these reasons masks and goggles must be worn near infected patients. When patient infected with Bird Flu breathes out, coughs or sneezes airborne aerosols are scattered in the air. Leave windows open if possible to allow contaminated aerosols to disperse outside. Use a fan facing the open window to assist this dispersal. Infected people must be encouraged to cough into a tissue that is then carefully disposed of. Cover cuts and open sores. Do not touch your eyes, nose or mouth. In one hospital, the only hospital staff that were infected during the SARS outbreak were those that did not wear a mask.

B) droplets from coughs and body fluids. Fluids from the nose, mouth and eyes from a patient infected with Bird Flu will be contaminated with the H5N1 Bird Flu virus. Always use masks, goggles, gloves, gown and cap when near infected patients and always wash hands with alcohol afterwards (even light bleach followed by soap if no alcohol is available). Stay at least 1 to 2 metres away from a suspected infected person when talking.

C) contact with Bird Flu infected people or Bird Flu contaminated objects by small particles. 1gram of chicken
manure contains enough Bird Flu viruses to kill 1 million chickens. Infected animal and human fluids and wastes are just are deadly. Avoid unnecessary contact with Bird Flu infected animals or humans. Wear full protective equipment when cleaning suspected Bird Flu infected animal enclosures, particularly chicken pens.

D) water contaminated by the Bird Flu virus. Boil all suspected Bird Flu contaminated drinking water.
Water collected from house roofs or open ponds, lakes and rivers maybe infected from bird droppings. Do not bathe or swim in open ponds, lakes or rivers where waterbirds gather.

E) eating or handling infected chicken meat or eggs (or pigs) The H5N1 Bird Flu virus will be destroyed by
complete cooking. It will survive in undercooked meat and eggs. The surface of raw chicken meat and eggs may also be contaminated with small particles of chicken manure.

F) chicken and pig farms. Bird Flu contamination may occur on feed sacks, egg cartons, all associated animal equipment and transport vehicles. The H5N1 Bird Flu virus may also be found on feathers and dust
particles contaminated by chicken droppings. The H5N1 Bird Flu virus may also be transmitted by flies, beetles and other possible insect vectors found associated with farms.

G) other types of birds or animals. A large variety of both wild and domestic birds are susceptible to the H5N1 Bird Flu virus, especially turkeys, ducks, swans and geese. The H5N1 Bird Flu virus has also infected and killed tigers, leopards, cats, and pigs that have been given infected chicken meat to eat. There have been no official reports of other animals being infected. However, as mentioned earlier, it is possible that other animals (including family pets) or insects may act as carriers, transporting contaminated particles such as chicken droppings to other locations, birds, animals or people.

H ) wind. Contaminated dust and feather particles maybe blown by wind from infected chicken pens to people or water collecting and storage areas. Relocate pig, chicken and other bird pens downwind and well away from a house.

Practice extreme hygiene during a H5N1 Bird Flu virus outbreak. Wear masks, goggles, gloves, cap and gown in suspected infected areas or near infected people.

Always sterilise all clothing, linen and objects that have been in the same room or area as an infected person, bird or animal. Wear protective gloves when handling, washing and sterilising potentially infected material. Wash and disinfect hands often.

Boil drinking water if in doubt of it being contaminated.

Extreme hygiene is one of the best defences against infection. Always wash and disinfect hands thoroughly, especially before eating, if the H5N1 Bird Flu virus is about. Wash and disinfect hands frequently with 95% alcohol or with a light bleach solution and then with soap after possible contamination.

Encourage infected people to cough into a tissue and dispose of carefully.

Disinfecting
The H5N1 Bird Flu virus can be destroyed by:

Bleaches containing Chlorite (chlorine) diluted 1 part bleach to 5 parts water
95 % alcohol (eg. methylated spirits)
Disinfectants containing formalin or iodine
Acidic environments. During the SARS outbreak many people boiled vinegar 24 hours a day so
acidic vapours were always present. I do not know how effective or harmful this was. Vinegar might be suitable as a disinfectant.
Heat. Boiling water is an effective way to clean and sterilise contaminated equipment and
clothes. The virus can survive 4 days in water at 22 C and 30 days at 0 C. It can survive for 3 months in bird manure. The earlier strain of H5N1 Bird Flu virus could be destroyed in 30 minutes in hot water at 60 C.
It would be expected that the worst waves of a pandemic would occur in the colder autumn or winter seasons and only minor waves occurring during the hotter summer period. This was the case in America during the 1918 Spanish Flu.

Commercial Antivirals
Although antiviral drugs (especially Tamiflu) are being stockpiled in some countries, these will most likely be given to front line health workers and/or some infected individuals only. There is not enough for everyone. (Australia has 3.3 million doses for only 1 million people for 6 weeks) In any case there is evidence that stronger doses are needed for longer periods than is recommended. One strain of the H5N1 Bird Flu virus has already mutated to become resistant to Tamiflu. Under normal conditions Tamiflu only provides 70% protection. There is only one pharmaceutical company making Tamiflu and it is not possible for them to increase production significantly. For an excellent Tamiflu/Relenza alternative try some of the natural herbal antivirals listed here.

Relenza is another suitable antiviral but again production limitations exist.
It has been confirmed that another strain of H5N1 is already resistant to two other antiviral drugs but both of these antivirals have proven severe side effects.

Vaccines
The World Health Organisation (WHO) also admits that vaccines will not be of any help initially either. An influenza vaccine takes about 6 months just to develop from a known strain of the virus that is not mutating. It can take up to a year to reach full production. This H5N1 Bird Flu virus is still mutating into different strains. A vaccine developed from an earlier strain could very likely be useless for later mutated strains. There are several deadly strains of this H5N1 Bird Flu virus existing now that have only recently mutated, particularly in China. China is withholding samples of these strains from WHO. The present vaccines are based on samples of H5N1 Bird Flu virus obtained from Vietnam in April 2004. Recent research by WHO has found that some strains of H5N1 Bird Flu virus isolated in Vietnam in 2005 are significantly different from the 2004 strain, creating doubt about the current vaccine’s effectiveness.

It costs a fortune for pharmaceutical companies to mass produce a vaccine for a specific influenza virus. It is not good business sense to mass produce a vaccine that is useless and not wanted. The method of vaccine production has virtually not changed since 1957 and is based on egg incubation. It is expensive, time consuming, limited in production outputs and is prone to contamination. New and promising DNA based vaccines made from cultivated bacteria are still in the experimental stage and may take years to be available.

gripiravi, traditsiooniline ja alternatiiv

H5N1 Avian Flu Virus Therapy Conventional and Herbal Options: link
by Jonathan R. Byron

Flu Wiki: Complementary and Alternative Medicine, Holistic and Integrative Therapies link

Cureventsi foorumi teemakogud:
Antiviral medicines link

Master Flu Preps Thread link
pikk ja põhjalik vestlus koos viidetega allikatele, teemal: Mida Peaks Tegema&Varuma
soovitaks lugeda :)

ravimivarud

püüan kirjutada siis mingi jutu ravimivarude soetamisest .. pigem mõtete andmiseks kui konkreetseks ostunimekirjaks

ah et miks üldse ravimeid varuda? seetõttu, et eestis ravimeid eriti ei toodeta, ravimid on kallid ja laovarud minimaalsed
selles on kõik majandusanalüütikud ühel nõul, et apteekide varustatusega tekib olulisi probleeme

samas loodetavasti telefonikonsultatsioonivõimalus ikka olemas on, et kui sul on kodus karp purkidega (ja nimekiri), siis arst saab nõu anda, mida ja kuipalju ..

omapead ravimine on teadmiste mitteomamisel äärmiselt kahtlase väärtusega ettevõtmine :(

põhiliigid siis:
1) esmaabi
2) gripiravimid
3) krooniliste haiguste ravimid
4) tavaliste haiguste ravimid
5) vitamiinid

1) esmaabi
kui on eeldada, et võid jääda pikemaks ajaks nö oma ja saatuse hoolde, siis oleks igati nutikas soetada koju üks põhjalik esmaabikomplekt
seda on nii või naa mõistlik teha, aga antud situatsioonis on see eriti oluline
näiteks selline

samuti võiks läbida ühe esmaabikursuse (kui seda ei ole viimastel aastatel tehtud) ning soetada ühe korraliku esmaabiõpiku

2) gripiravimid
gripiravimitest loe pikemalt Woodsoni käsiraamatust
Preparing for the Coming Influenza Pandemic by Dr. Grattan Woodson link
kui vähegi inglise keelt jagad, trüki välja ja loe läbi

ma panen siia tema soovitatud ravimid ning nende analoogid eestis

mitteravimid, aga vajalikud:
Table salt: 1 lb - lauasool 0,5 kg
Table sugar: 10 lbs - suhkur 5 kg
Baking soda: 6 oz - söögisooda 180 g
Household bleach 1 gal - kloor, desinfitseerimiseks, meil lähim variant vabamüügis peaks olema ACE kõige lihtsam variant
Caffeinated tea, dry loose: 1 lb - pool kilo lahtist teed,
teed kasutatakse peavalu vähendamiseks, kurguvalu korral, köha leevendamiseks jne

vabamüügiravimid ühe inimese kohta:

Tums Ex: 500 tablets - antatsiid, kõhulahtisuse vastu, - kaltsiumkarbonaat, meie analoog: Rennie
Acetaminophen 500mg #100 tablets - palavikualandaja, valuvaigisti - paratsetamool: Paramax, Panadol
Ibuprofen 200mg # 100 tablets - valuvaigisti - ibuprofeen: Ibumetin, Ibumax
Diphenhydramine (Benadryl) 25mg capsules # 60: 1 tablet every 4 hours as needed for nasal congestion, allergy, or itching.- nohu ja allergia jaoks - nt Zyrtec

Promethazine (Phenergan) 25mg tablets # 60: take ½ to 1 tablet every 4 hrs as needed for nausea - allergilise nohu raviks - nt Actifed

Hydrocodone with acetaminophen (Lortab-5) # 60 (5mg/325mg): ½ to 1 tablet every 4 hrs as needed for cough or pain - kofeiiniga paratsetamool, vabamüügis peaks olema ainult Solpadeine (Paracetamolum+Codeinum+Coffeinum), enamus on retseptiga

pere peale
tavaline elavhõbedatermomeeter (2 tk, üks kasutusse ja teine tagavaraks)
vererõhumõõtja
märkmik
mõõduanum

Retseptiravimid:
Tamiflu, teoreetiliselt vist veel müügil, praktiliselt osta võimatu; venemaal on müügil nende oma gripiravum Arbidol, ei oska soovitada

Diazepam (Valium) rahustid on reeglina retseptiga ja neid niisama ei taheta kirjutada, asenduseks siis ehk mingi looduslik variant, kasvõi Une Mati, midagi mis aitab vajadusel rahuneda ja paremini uinuda), palderjanitilgad ..

sool, suhkur ja sooda on vajalikud taastuslahuse tegemiseks:
segu, mida antakse vedeliku taastamiseks gripihaigel
4 klaasi puhast vett
3 sl suhkrut
1/4 tl soola

(kõhulahtisuse korral vedelikukaotuse taastamisel asendada sool 1/2 tl soodaga)

sool on vajalik ka kurgu kuristamiseks kurguvalu korral (jõle, aga aitab, omal nahal proovitud)

3) krooniliste haiguste ravimid
erakordselt oluline!
kui oled diabeetik, allergik, vererõhuhaige jne, siis taga endale 2-3 kuu varud vähemalt, kui mitte kauemaks!
prognoositakse, et krooniliste haiguste raviks vajalike ravimite puudusesse sureb päris palju inimesi
ja ka siis, kui su elu ei sõltu ravimitest, tagad sellega endale veidi mugavama elu, kui tagavarad on olemas ..
samuti diabeetikutele mingid testrid jne, ise tead paremini, mida sa apteegist regulaarselt ostad :)

4) tavaliste haiguste ravimid
köha, nohu, kurguvalu, kõhukinnisus, kõhulahtisus, jne
igapäevased asjad, mille korral sa muidu apteeki tormaksid :)

5) vitamiinid
mõistlik oleks varuda multivitamiine, c-vitamiini, kaltsiumi
piiratud toidumenüü mõjub tervisele
samuti mingeid toonikuid taastumise tarbeks

no ja lõpuks - ravimteed ja loodusravimid
pärnaõietee, piparmünditee, kibuvitsatee, küüslaugutabletid, taruvaigutabletid, teepuuõli ..
nende kohta püüaks kunagi ka mingi jutu kirjutada


19. veebruar 2006

kuidas ennast kaitsta?

kirjutab cureventsi foorumis üks kogenud medõde, kes plaanib pandeemia ajal tööle minna,
milline on tema meelest mõistlik enesekaitseviis nakkuse vastu

This time, I'll wear a mask. N95 if I've got them, surgical masks if nothing else available. I'll wear latex gloves. If they are in short supply, I'll use alcohol sanitizers in between hand washings. And, of course, I'll put a mask on any patients I'm in close contact with.

To become infected with the flu, you need to be within `coughing distance' of an infected patient, or pick up the virus from a fomite, an inanimate object such as a door knob, telephone, or shopping cart handle.

Fomites can be disinfected by a 10:1 water/bleach solution, or by using lysol 3%. A 60% alcohol solution will also kill the flu virus.

The Flu virus does not remain airborne over long distances. It has never been shown to be carried thru ventilation systems, for instance. This is not a biosafety level 4 pathogen like ebola.

For most people, staying 10 to 20 feet away from an infected person is probably a safe distance. Indoors, sharing `common air' in a larger room, might entail some risk. But masks will greatly reduce the threat.

There is no such thing as a zero risk scenario. But by using proper infection control, the risks can be managed.

neli valdkonda ettevalmistusteks

There are four essential areas that you must address to prepare for the bird-flu pandemic: link
1) "social distancing";
2) commodities--including food,
3) personal protective equipment (PPE), and
4) financial preparation.

Social distancing refers to your living and work situations when the pandemic strikes. Without going to extremes, you want you and your family to be as far away from other people as possible. Bird flu is just like the regular seasonal flu in that you become infected from other people, not birds. (Although it might be possible to acquire the viral infection from birds, it is much more likely that, if you do become infected, you will have acquired the virus from another person, not a bird.)

The bird-flu virus is extremely contagious; it is transmitted though casual contact with a contagious person (who might not have any symptoms during the first 24 hours of infection), through touching contaminated objects, and through the air. Because of this, you want to stay away from people as much as possible, and that means spending more time at home. Your children will not be at school, they will be home. If your home is on the 73rd floor in an apartment building in New York City, how are you going to avoid other people? You might want to think of an alternative living situation for a few months.

The same principle applies to your work setting. If you can telecommute, that is the best scenario. If you don't telecommute now, but because of the type of work you do it might be a possibility, discuss it with your employer. If you will have to continue to work closely with others at your job site, what can be done there to help protect you and others from infection? How can policies and procedures be amended to minimize contact with coworkers or customers? Are there hand-washing stations available? What are your employer's plans for dealing with the coming pandemic? Discuss these and related issues with your employer and coworkers.

The second area that must be addressed is "commodities--including food."
There will be sporadic difficulties manufacturing or producing goods--because workers around the globe will be sick or otherwise absent from work. There also will be supply chain disruptions--both because workers will be sick or otherwise absent from work, and because of regional, national and/or international restrictions on travel. These problems will cause a decrease or the unavailability of most or all of the products we easily have access to now.
Commodities such as soap, toothpaste, toilet paper, and virtually everything you can buy at stores such as Wal-Mart will be difficult or impossible to obtain--for periods of weeks or months at a time. This includes the most important commodity--food. The federal government is always telling us to stock up on emergency supplies for three days. This will not be sufficient preparation for the coming deadly bird-flu pandemic. There will likely be limited food available in stores. In addition, stores are places you want to avoid anyway, because potentially contagious people might be there. Stock up now so that you have sufficient commodities, including food, for a period of months.

The third area to address is so-called personal protective equipment (PPE), which you will have to use, depending upon circumstances. PPE includes special face masks, called N95 respirators, which help prevent infection through inhalation of the virus. Remember that avian influenza ("bird flu") is a very contagious disease that can be transmitted through the air. The only way to counter this source of infection is through the use of special N95 respirators. These are disposable face masks that can be worn for up to eight hours.

N95 masks were the type of masks worn by hospital workers during the 2003 severe acute respiratory syndrome (SARS) pandemic that struck a number of cities around the world, including Toronto, Canada. Surgical masks or other common face masks, sometimes used when sanding or painting and so forth, are not effective.

Other elements of PPE include disposable latex or vinyl gloves, eye goggles or face shields, gowns impervious to liquids, and sometimes disposable booties or disposable head caps. Keep in mind that during the pandemic, most people who become infected will have to be cared for at home, not in crowded and overwhelmed hospitals. This means that caregivers taking care of loved ones at home need to be protected from the virus, just like hospital workers working in hospitals. The only way to be protected is to wear PPE. (Just washing your hands--the federal government's primary recommendation for caregivers at home--will not be enough.) Once the pandemic starts, demand for PPE will be huge and supplies will be in very short supply--or nonexistent. Buy now or suffer the consequences later.

The last area that must be addressed before the bird-flu pandemic strikes is personal finances. This is an area that governments at all levels have been mute on. However, preparing your finances to sustain yourself and your family during (and after) the pandemic could prove to be the most important area of preparation. Although the bird-flu virus is deadly and many of us will fall ill, most of us will not die from it--only one to two percent of the population will likely die. The vast majority will live--but under what circumstances?

Boccaccio: 1348 katkust

Giovanni Boccaccio lived through the plague as it ravaged the city of Florence in 1348.
Boccaccio wrote a graphic description of the effects of the epidemic on his city.

"The violence of this disease was such that the sick communicated it to the healthy who came near them, just as a fire catches anything dry or oily near it. And it even went further. To speak to or go near the sick brought infection and a common death to the living; and moreover, to touch the clothes or anything else the sick had touched or worn gave the disease to the person touching. "

"...Such fear and fanciful notions took possession of the living that almost all of them adopted the same cruel policy, which was entirely to avoid the sick and everything belonging to them. By so doing, each one thought he would secure his own safety.

Some thought that moderate living and the avoidance of all superfluity would preserve them from the epidemic. They formed small communities, living entirely separate from everybody else. They shut themselves up in houses where there were no sick, eating the finest food and drinking the best wine very temperately, avoiding all excess, allowing no news or discussion of death and sickness, and passing the time in music and suchlike pleasures. Others thought just the opposite. They thought the sure cure for the plague was to drink and be merry, to go about singing and amusing themselves, satisfying every appetite they could, laughing and jesting at what happened. They put their words into practice, spent day and night going from tavern to tavern, drinking immoderately, or went into other people's houses, doing only those things which pleased them. This they could easily do because everyone felt doomed and had abandoned his property, so that most houses became common property and any stranger who went in made use of them as if he had owned them. And with all this bestial behaviour, they avoided the sick as much as possible.

In this suffering and misery of our city, the authority of human and divine laws almost disappeared, for, like other men, the ministers and the executors of the laws were all dead or sick or shut up with their families, so that no duties were carried out. Every man was therefore able to do as he pleased.

Many others adopted a course of life midway between the two just described. They did not restrict their victuals so much as the former, nor allow themselves to be drunken and dissolute like the latter, but satisfied their appetites moderately. They did not shut themselves up, but went about, carrying flowers or scented herbs or perfumes in their hands, in the belief that it was an excellent thing to comfort the brain with such odours; for the whole air was infected with the smell of dead bodies, of sick persons and medicines.

Others again held a still more cruel opinion, which they thought would keep them safe. They said that the only medicine against the plague-stricken was to go right away from them. Men and women, convinced of this and caring about nothing but themselves, abandoned their own city, their own houses, their dwellings, their relatives, their property, and went abroad or at least to the country round Florence, as if God's wrath in punishing men's wickedness with this plague would not follow them but strike only those who remained within the walls of the city, or as if they thought nobody in the city would remain alive and that its last hour had come."


"One citizen avoided another, hardly any neighbour troubled about others, relatives never or hardly ever visited each other. Moreover, such terror was struck into the hearts of men and women by this calamity, that brother abandoned brother, and the uncle his nephew, and the sister her brother, and very often the wife her husband. What is even worse and nearly incredible is that fathers and mothers refused to see and tend their children, as if they had not been theirs.

Since the sick were thus abandoned by neighbours, relatives and friends, while servants were scarce, a habit sprang up which had never been heard of before. Beautiful and noble women, when they fell sick, did not scruple to take a young or old man-servant, whoever he might be, and with no sort of shame, expose every part of their bodies to these men as if they had been women, for they were compelled by the necessity of their sickness to do so. This, perhaps, was a cause of looser morals in those women who survived."

"Such was the multitude of corpses brought to the churches every day and almost every hour that there was not enough consecrated ground to give them burial, especially since they wanted to bury each person in the family grave, according to the old custom. Although the cemeteries were full they were forced to dig huge trenches, where they buried the bodies by hundreds. Here they stowed them away like bales in the hold of a ship and covered them with a little earth, until the whole trench was full."

pandeemia: minna tööle või jääda koju?

natuke mõtlemiseks :)
cureventsi foorumis kirjutab üks meedik järgmist:
(tegelikult väärib terve see arutelu lugemist: link)

Okay, let's play a little game. Let's assume that you guys are right, and it's just a little too risky for HCW's to report to work.

What happens then?

If HCW's are too afraid to work, then no one else will work either. Cops, firefighters, national guard, military, utility plant workers (water/sewer/elect), even the good folks who are hopefully working on a vaccine.

Food distribution stops. Oil refineries shut down. No gasoline. Maybe no natural gas. Certainly no propane deliveries for those in the northern states. Rx drugs aren't delivered. Factories shut down. Railroads, airplanes, trucks.

Everything stops. Except the virus.

People die in their homes. Or on the streets. Certainly all those in hospitals and nursing homes when it starts. After all, the staff is going to abandon ship, right?

Each year, roughly 2.5 million people die in this country. Add in the virus, and maybe we're up to 5 million.

But wait, there's more.

As the dead bodies pile up (nobody coming to pick them up, too scared, remember), so does the garbage. Sewers are backed up because the power's out. Water is contaminated because the checmicals needed to purify it ran out after the first week.

People start dieing in their homes of starvation. And of course, dysentery, typhoid, and cholera are on the plate as sanitary conditions deteriorate.

Some people manage to bury their dead in the back yard, but most are unable to, so they haul the dead to the street corners, and pray someone will pick them up. Maybe they dump some in the woods, or in the rivers and lakes. We're talking millions of dead bodies, accumulating at a rate of hundreds of thousands each month.

People release their dogs and cats, because they can't feed them. They feed on the dead. Rats begin to roam the streets, and with them, they bring the potential of bubonic plague. Far fetched? Not really, we see 10 to 15 cases of plague in this country each year. But we do a pretty good job of controling rats, so the last real outbreak was in Los Angeles in 1924. But it's still out there, waiting to make a comeback.

Hanta Virus, rare today, will become more prevalent. Suddenly, instead of a pandemic, we've unleashed a pandora's box of pathogens, because we've let our infrastructure whither and die.

The death toll mounts. Five Million? Ten Million?

And the problem only gets worse.

Hungry desperate people, abandoned by their communities, left to die in the streets, take to looting, raping, and pilaging. There's no law, remember?

People die by the millions during the winter from lack of heat. Starvation is rampant. You want an apocalypse? This is the perfect recipe.

By the time the first wave is over (if it ends), the ability to restart things has been lost. Vaccines won't be manufactured. Food won't be distributed. The utilities won't be restored. The downward spiral will simply continue, unabated.

When does it stop? Maybe after 18 months the virus is gone, but the plague, dysentary, and a host of other killers continue. The system, the infrastructure, is lost. It could take years, maybe decades, to restart.

Maybe you think you can hole up and withstand the ravages of this sort of social breakdown. If so, I wish you luck. I figure, my chances are a hell of a lot greater of dying from the collateral damage than they are from the virus.

So, call me crazy, but I'll go down fighting, thank you.

1918a numbrid

täpselt ei tea keegi, kui palju inimesi hispaania grippi suri, aasta oli 1918 ja sõda .. sõjaväelaste andmed on olemas ja arenenud maadest ka enamvähem, aasia kohta andmed puuduvad
prognooside kohaselt 50-100 miljonit inimest
tundub noh, mõõdukas arv, eksole :D sõjad jne
aga mõelge sellele, et tollal oli maailmas vaid üks miljard inimest, 50-100 miljonit võetuna suhtarvuna on 5-10%
praegu on ca kuus ja pool miljardit - ja vastavalt 5-10% sellest numbrist on 325-700 miljonit

üle poole inimestest elab praegu aasias, suhteliselt väikesel territooriumil tihedalt koos
erinevus elutingimustes aasia maapiirkondades ja aafrikas ei erine oluliselt 1918.aastast ilmselt

kaasaegne meditsiin? on arenenud, tõepoolest, eriti valges maailmas :)
aga tugineb eeskätt kaasaegsetele ravimitele, aparaatidele, kaitsevahenditele, materjalidele .. ja on väga kallis, seetõttu ära optimeeritud, üleliigseid varuressursse ei ole kellelgi (va ehk usa, venemaa, hiina sõjaväel),
see kehtib nii haiglavoodite arvu kui ravimivarude suhtes - kasutamata ressursi hoidmine on liiga kallis

Spanish flu link

The Spanish Flu Pandemic, also known as La Grippe Espagnole, or La Pesadilla, was an unusually severe and deadly strain of avian influenza, a viral infectious disease, that killed some 50 million to 100 million people worldwide over about a year in 1918 and 1919.

It is thought to have been one of the most deadly pandemics so far in human history.
jap, levinud väide :) aga - jäetakse täpsustamata, et inimohvrite absoluutarvult, mitte suhtarvult .. vt ka teisi maailma ajaloo pandeemiaid link

1918a gripipandeemiast edasi:

It was caused by the H1N1 type of influenza virus, which is similar to bird flu of today, mainly H5N1 and H5N2.

The Allies of World War I called it the "Spanish Flu". This was mainly because the pandemic received greater press attention in Spain than in the rest of the world, because Spain was not involved in the war and there was no wartime censorship. Although the virus certainly did not originate in Spain, the country did have one of the worst early outbreaks of the disease, with some 8 million people infected in May 1918. It was also described as "only the flu" or "the grippe" by public health officials seeking to prevent panic.

The Spanish flu might have contributed to the end of World War I. More people (20-40 million on both sides) died from the Spanish flu during World War I than were killed in the conflict.

18. veebruar 2006

toiduvarud

millised siis võiksid olla toiduvarud?
kui pikaks ajaks ja mida peaks ostma?

etapiviisilisest planeerimisest võib lugeda pikalt .. vaata link paremal, ettevalmistused ja seal allpool on level 0, 1, 2, 3 4&5, pikk ja inglisekeelne lugemine, aga huvitav, ja aitab süsteemi luua endale (kellele see meeldib)

kolm päeva, kaks nädalat, mitu kuud .. eks igaüks ise otsustab, kui pikaks ajaks :)
ma arvan, et kaks nädalat võiks olla miinimum ..

umbkaudsed kogused võiksid olla sellised - kahele inimesele kaheks nädalaks
korruta ja jaga ise sobivaks oma perele :)

kogused võivad tunduda suured, aga arvestage seda, et tavaoludes süüakse päris palju väljaspool kodu ..

1) teraviljatooted - süsivesikute allikas!
kokku: 16 kg, sh näiteks 4kg jahu , 4kg pastat, 5kg riisi, 1 kg kaerahelbeid, 2 kg maisihelbeid
jahud leiva/saia küpsetamiseks, riis ja pasta toiduvalmistamiseks, helbed hommikusöökideks
igasugused jahud - nisu, rukki, jne, tärklist ka ehk veidi, tatart ka

2) oad, herned, läätsed - proteiiniallikas! -kuivatatud kujul 1,5 kg

3) liha/kalakonservid - proteiiniallikas! - 7 konservikarpi,
täissuitsuvorst seisab ka kaua

4) piim - 14 purki kondenspiima (või siis piimapulbrit 1,2 kg) - kaltsium ja abi toiduvalmistusel ..

5) sool/suhkur - 2kg suhkrut, 0,2 kg soola

6) õli, rasvad - kalorid! - 1 kg (õli, margariin, või, searasv)

7) köögiviljad, puuviljad - 2 kg tomatikonserve/ketshupeid (aitab teha suvalisi toite söödavamaks :D), 3,5 kg ulatuses erinevaid köögiviljakonserve, 0,8 kg moose-mahlakontsentraate, kuivatatud puuvilju, puuviljakonserve, jõhvikaid

need on siis põhiliigid

lisaks: pärmi küpsetamiseks, küpsetuspulbrit,
pakisuppe, purgisuppe, purgikastmeid,
puljongipulbrit või kuubikuid, kastmepulbreid,
kuivikuid, näkileibasid,
küpsiseid, komme,
maitseaineid - pipart, kaneeli, vaniljesuhkrut,
teed, kohvi, kakaod,
mahlasid - eriti apelsinimahlapakke,
mandleid, pähkleid,
kuivatatud juustupulbrit (parmesan) - see on muide ketshupi kõrval teine asi, mis võimaldab lihtsat toitu söödavamaks teha :)
söögisoodat ja äädikat (100 ja 1 otstarvet mõlemal, odavad ja seisavad lõpmatuseni)
munapulbrit võiks ka ehk osta, aga seda jaekaubanduses ei leidu (sügisel oli võimalik osta firmast Eesti Munatooted, Talleggi juures)

abiks oleks varuda ka c-vitamiini ja multivitamiine, sest vitamiinivajadust katavad eeskätt värsked puu&köögiviljad, millega võib probleeme olla :(
kes idusid sööb, võiks idandamismaterjale varuda (munguba nt)

nb!
- ära osta neid toiduaineid, mida sa ei söö! - või alternatiiv - planeeri, mida teed jääkidega!
(mina annetan oma konservid ja piimapulbri ilmselt kunagi koerte varjupaigale :D)
- pea tabelit, mida oled ostnud - ja nende säilivustähtaegade kohta!
- kui oled saanud soovitud koguse kokku, siis hakka otsast tarvitama ja osta uuemaid juurde,
siis on sul pidevalt teatud perioodiks varu olemas :)

kust osta?
mugav on osta hulgiladudest (Kaupmees, Supernetto), kliendikaardi saad lihtsalt - vaja on suvalise firma andmeid (no kellelgi tuttavatest ikka üks väike firma olemas on), väikest rahasummat (50-100 kr), põhjenduseks sobib "klientide kostitamine" või "ürituste korraldamine" :p
kaart kehtib tähtajatult ja kui kaart on olemas, ei huvita rohkem kedagi, mida sa ostad
hulgiladudes on mugavam osta kolmel põhjusel: 1) odavam, 2) mugavam, ei pea käeotsast poest vedama (kui auto olemas), 3) ei vaata sind imelikult, kui ostad koti riisi ja kasti konserve :D

vabalt võib muidugi osta ka tavamarketitest, ma püüan iga kord kui poes käin kärusse visata täiendava paki riisi, pastat vms

kuhu panna?
kuni mahub, köögikappi :D
kui enam ei mahu - siis pappkasti, kastile silt peale, mis sees on - ja kast kapi otsa/kapi alla/riidekappi kuhu iganes, lähene loominguliselt :)
oluline et oleks normaalse temperatuuriga, kuiv ja pime

kui kaua säilivad? suurusjärgud:
originaalpoepakendis siis .. pasta ca 2a, riis ca 1a, õli 1a, piimapulber/kondenspiim 1a, konservid mitu a, suhkur-sool-sooda-äädikas lõpmatuseni


pandeemia mõju kaubandusele ja toiduainetetööstusele

An Analysis of the Potential Impact of the H5N1 Avian Flu Virus
- Wholesale and Retail Grocery and Foodservice Industry - link

kes peaks sellelt alalt olema, kas siis omanikuna või töötajana - lugege läbi!

kui keegi veel siiani on kahelnud, kas on mõtet mingeid varusid soetada, siis peale selle raporti läbilugemist ta selles ilmselt ei kahtle :DDD
teistele kopin allapoole mõned olulisemad lõigud, kui tarbijatele ..


selgitus - raportis on võetud valdkondade kaupa prognoosid ja soovitused,
kopeerin allapoole valikuliselt peamiselt prognoose, paar üksikut värvikamat soovitust ka

Vision:
The ramifications of a severe global pandemic are considerable.
Consumers will resist leaving the home.
Grocers will see their business shift to fewer visits with increased basket size.
Demand for Internet Shopping, self checkout and home delivery will spike.
Consumer demand will also shift away from perishable products towards prepackaged goods.
Poultry and pork demand should tank.
Consumers may also shy away from imported product and have greater interest in country-of-origin information.
Restaurants should expect to see their business evaporate.
Many food service customers will find it difficult to survive.
Employee response will be inconsistent, but our company will need to find a way to operate with significant staff shortages. Many part time and lower pay employees will abandon their jobs as they perceive the risk being greater than the compensation. We will face shortages in some positions with surpluses in others.
The demands placed on HR will be large as many policies and practices become instantly obsolete.

On the vendor side, disruptions to the supply chain and product shortages will become the norm. Non-product vendors will also struggle to provide their services. Initially, fuel shortages are probable. With a little time, fuel costs could actually drop due to the pandemic’s impact on China.
At a macro level, we should expect to see Wall Street tank. Likewise, some insurance companies could be in trouble. Banking institutions will seek to limit their risk.

MEDIA
Vision:
In the past 300 years there have been 10 documented pandemics. However, the H5N1 threat represents the first
pandemic since the advent of the 24 x 7 cable news network. There is no doubt it will result in an unparalleled feeding frenzy as the fatalities start to climb.
The result will be consumer panic. We will need to be prepared for both the reality of the situation as well as many false perceptions based on nonstop media hype. It is very important that we manage the media very well.

CONSUMERS
Vision:
Fed by massive media hype, we should anticipate overreaction and irrational behavior, especially in the first two or three months. Initially there will be overall panic. Thereafter, consumers will adjust to the new realities of life during a pandemic.
During the initial months we should anticipate a number of consumer behavioral shifts. Some of the key changes will
include:
�� Avoidance of dining out
�� Consolidate trips to the store by purchasing much larger quantities of product in fewer visits
�� Preference towards non-perishable and prepackaged goods
�� Preference towards buying in bulk
�� Desire to buy case quantities of certain items
�� Spike in demand for certain HBC/anti-bacterial products´(whether or not they are effective)
�� Demand for masks and gloves
�� Strong demand for Internet Shopping
�� Strong interest in home delivery
�� Strong demand for self-checkout
�� Avoidance of non-essential retail stores
�� Some consumers will attempt to stockpile product (similar to Y2K experience)
�� Strong desire to get accurate information
�� Demand to see employees wearing masks and gloves
�� Demand to see anti-bacterial wipes at check-out (whether or not they are effective)
�� Demand for country-of-origin information throughout the store
�� Avoidance of products made outside the United States
�� Demand for “USA Only” sections of the store
�� Demand that employees who survived the virus, and are “safe”, to be easily identifiable
�� As schools shut down, there will be a need for families to provide lunches for their children
�� Note that some consumers may conclude that certain large national chains may pose additional health risks
because they import many products from Southeast Asia.

Recommendations:
�� Prepare to ramp up Internet Shopping at all stores.
�� Prepare to scale up Internet Shopping operations. This includes consideration for both people and technology.
Note that less variety in the store may simplify the picking of orders.
�� Develop a detailed plan that identifies the product that should be carried during the pandemic. This should
include more pre-packaged goods and case quantity items.
�� Prepare to ramp up self check out.
�� Consider how current lanes could be modified to isolate the Consumer from the cashier.
�� Develop a program that would support an Internet Shopping program for independent grocers.
�� It may be necessary to support an Internet-Only model of operation in which consumers place orders via the
Internet and drive to the retail store for pickup.
�� Identify partners who can provide home delivery options as an extension to Internet Shopping.
�� It may be necessary to limit purchases of product.
�� It may be necessary to reduce hours of store operation.
�� Develop a plan to identify which foodservice should be moved to retail to meet the need for bulk buying.
�� With any noticeable action step we implement, consider the need to educate the consumer on why the change is
appropriate. Provide an up-to-date message for the consumer that answers the critical questions (for example, “What is your store doing to protect me?”).
�� Explore the potential impact as different types of people take on shopping duties (husbands shopping for sick
wives, shift to shoppers that are not in the target 18-40 age group, etc.).
�� Explore the possibility of working with other retail chains to provide the most accurate and consistent information to the consumer.

EMPLOYEES
Vision:
It is estimated that over 280 employees per 1,000 will become ill with the virus, and more than 28 will die. Approximately 40 immediate family members of employees will perish (per 1,000 employees)
Employees will face many needs to tend to themselves and their families. In addition to the illness itself, other factors
such as school closings will place additional demands and stress on many employees.

Although this will occur over a 12-18 month period, there will be peaks and it will probably be inconsistent. For planning purposes, we should assume that, at times, some departments may need to operate at a 50% staffing level.
We should expect to be particularly hard hit in part-time and lower pay positions. For example, it is reasonable to conclude that many two-income households will decide that the risk of exposure outweighs the incremental income. This could hit retail particularly hard.
Employees will face a natural conflict between the need to earn money and the need to protect themselves and their family. It is reasonable to conclude that employees will react to this in a wide variety of ways:
�� Some employees will refuse to show up.
�� Some employees will want to come to work and remain at work as a way to earn money, protect their family
from exposure and to serve the company.
�� Some employees will want to work even though they exhibit symptoms of the flu.
�� Some employees will exploit the situation and use the flu as a reason to avoid showing up.
�� Some employees will refuse to seek health care for fear of contracting the flu at the doctor’s office.
�� Some employees will expect the company to provide them with food.
�� Some employees will refuse to drive into certain geographies hard hit by the virus.


PRODUCT SUPPLIERS
Vision:
Upstream manufacturers and vendors will certainly be facing the same set of issues. Since it is reasonable to assume that many of our vendors have yet to address the H5N1 issue, we should be willing to provide assistance to them.
There will be significant disruptions to their production capabilities as well as their distribution network. It should be
noted that suppliers will face shortages from their suppliers as well. Even obscure shortages, such as packaging material, will negatively impact the suppliers’ ability to provide product.

SECURITY
Vision:
As the public panics and as shortages develop, the need for security will increase.

RETAIL STORES
Vision:
Consumer and employee reactions will have a strong impact on retail. Both groups will place new demands on the retail store.
Recommendations:
�� Develop plans to deal with consumer demands to see special precautions (masks, gloves, cleaning procedures,
etc.).

INDEPENDENT GROCERS
Vision:
Life will be especially tough for the independent will be facing most all of the same organization with far less resources at their cases, illness (or death) to one or two deliver a knock out punch to the store.


GOVERNMENT
Vision:
In a pandemic situation, the federal and state governmental agencies will have to take control. Typically slow-moving
bureaucracies will create conflicts with the demand to take some kind of knee jerk actions. At least initially, the result will probably be highly inconsistent. We should expect to see well intended but poorly conceived regulations only adding to the level of confusion. With a little time, the agencies will get their act together, but the first few months could be wild.

Sandman: ei ole vaja karta paanikat!

Peter Sandman on kõrgelt tunnustatud riskikommunikatsiooniekspert

ta kinnitas CIDRAPi äriliidritele korraldatul konverentsil, et riigijuhtidel ei ole mõtet karta paanikat, inimestele tõese info jagamine on vajalik, kuna ainult hirm on see, mis paneb inimesed tegema ettevalmistusi.

ma pean siinkohal tunnistama, et seda juttu oli väga hea lugeda :)
ma sain kinnitust sellele, et see infojagamine - ja ka mõõdukas hirmutamine :D -, millega ma olen viimased kuud tegelenud - on õige tegevus :)
eriti viimastel päevadel, kui selle blogi külastatavus on kasvanud, olen mõned korrad mõelnud, et järsku ma teen valesti .. järsku on see ikkagi vaid mõttetu hirmu külvamine .. aga tundub siiski, et ei ole :)

Fear can play role in pandemic readiness, speaker says link
Robert Roos News Editor

Feb 17, 2006 (CIDRAP News) – One expert's advice to leaders trying to prepare the world for an influenza pandemic: Don't be scared of scaring people.

Peter M. Sandman, PhD, a risk communication expert from Princeton, N.J., told those attending a Minneapolis conference on business planning for pandemic flu that fear is what motivates people to take sensible precautions in the face of a real threat.

The single most important thing I want to say to you is, don't worry so much about scaring people. People can take it," Sandman told the group of over 300 business leaders and others at the Minneapolis Convention Center on Feb 15. He made no apologies to Franklin W. ("The only thing we have to fear is fear itself") Roosevelt.

Leaders are often reluctant to tell the truth about dangers because they fear causing panic, Sandman said. "The notion that we will panic people if we frighten them is outright false," he said.

The mistaken fear of panic is compounded by other errors that get in the way of telling people the truth about threats, he said. These errors include "the failure to realize the positive value of fear" for stimulating appropriate action and "the mistaken judgment that fear can be avoided."

"There's no way to get people to take precautions without frightening them," Sandman said.

What is likely to lead to panic is giving false reassurance, he said. "When you mislead people, when you overreassure people, they feel abandoned—because they are," he said. That's what happened in the United States during the flu pandemic of 1918 and during the SARS (severe acute respiratory syndrome) outbreak in China in 2003, he added.
"People panicked because the government was telling them there was no SARS," he said.

"People are much better able to handle a crisis when they are told the truth" and "treated as adults."
However, there is danger in overplaying a threat as well as in false reassurance, Sandman said. He zeroed in on the oft-repeated statement, "A pandemic is not a matter of if, it's a matter of when."

"That's true of a pandemic; it's not true of a severe 1918-like pandemic," he said. "In that case, it's if."

He added, "Just as overreassuring people backfires, alarming people in ways that won't last, that won't stand up to investigation, backfires. There's an unknown probability of a pandemic of very high magnitude."

To say that a severe pandemic is inevitable is "dishonest," and it gives ammunition to those who argue that the threat is trivial, Sandman said.

In a similar vein, Sandman urged his audience to be frank about uncertainty. "People love certainty, but people punish fake certainty. The public is extremely capable of tolerating high levels of uncertainty."

When you are uncertain about a risk, he advised, "You need to be visibly, vividly, confidently uncertain."

But his primary message was that in the presence of a real threat that demands precautions, leaders should not be afraid of causing some fear.
Calling fear a "fungible" emotion, he said, "When you [preparedness advocates] frighten people, you are not making them more fearful people. You are competing for their fear with other interest groups. You are working to get your share of their fear. You only have so much fearfulness to go around. If you allocate more to terrorism, you have to allocate less to other things."

"We have to overcome our fear of fear, our 'panic panic,' so that we can do the job," he concluded.

Sandman was asked how to maintain the level of concern about pandemic flu long enough to ensure that preparations are adequate. Part of the answer, he said, is not to try to maintain exactly the same level of concern all the time, but rather to use opportune moments to boost concern.

"You pivot on the event," he said. For example, every time the H5N1 virus infects birds in another country, concern about a potential pandemic increases. The event doesn't necessarily mean much in relation to the actual threat of a pandemic, he said. "It is, however, a teachable moment."

Leavitt: gripipandeemia on vältimatu

Leavitt on siis USA kõrgeim tervishoiuboss

USA prognoos (1918a alusel): 300 miljonit elanikku, neist 90 miljonit (30%) haigestuvad, neist omakorda 45 miljonit (15%) vajavad arstiabi

eesti numbritesse üle viidud: 1,3 miljonit elanikku, neist 390 000 haigestuvad, ja neist omakorda 195 000 vajavad arstiabi
ülejäänud siis saavad kodus põetatud, eks selleks avaldatakse mingid juhised loodetavasti, mida teha ja mida mitte teha ..

surevuse kohta ei taha keegi eriti prognoose teha, neid on seinast seina, ja reaalselt selgub see siis kui pandeemia kohale jõuab, mitte enne

karm on see, et paljudel puudub tänapäeval üldse raske haiguse koduspõetamise kogemus ju, rääkimata sellest, et tänapäeval ei sure keegi praktiliselt enam kodudes
psühholoogiliselt saab see päris räige olema kindlasti :(

Flu pandemic deemed inevitable link
Communities will be on their own in crisis, top federal official says
By JIM PROVANCE
BLADE COLUMBUS BUREAU
Saturday, February 18, 2006

COLUMBUS - An influenza pandemic is inevitable and local communities will be on their own when it hits because federal and state governments will have their hands full, U.S. Health and Human Services Secretary Mike Leavitt warned yesterday.
The worst-case scenario suggests as many as 2 million Americans could die.

Whether it's the so-called bird flu or a virus not yet on the radar screen, Mr. Leavitt urged more than 500 health officials, doctors, nurses, law enforcement officers, and others attending Ohio's first flu pandemic summit to start the "buzz" now to prepare for what will surely come.
"Pandemics happen," he said. "They've been happening for centuries. There's no reason to believe the 21st century will be markedly different."

There were three global pandemics in the 20th century, the worst in 1918, killing an estimated 500,000 Americans. The last, in 1968, was tame by 1918 standards.

"If we were to have a pandemic of equal proportion to the one that happened in this country in 1918, we would see 90 million Americans contract the disease," said Mr. Leavitt, a former Utah governor.

"We would see half of them, over 45 million people, who would become sick enough that they would require serious medical attention," he said. "Regrettably, if we have a pandemic of similar proportion as in 1918, nearly 2 million of our citizens will die."

Mr. Leavitt came with the promise of $3.2 million in federal aid for Ohio to help state and local planning efforts, part of $100 million that has been appropriated nationwide by Congress from $350 million President Bush has requested.

Similar summits are happening in states across the nation.

Lucas County Deputy Health Commissioner Larry Vasko, who attended the summit, said he has never seen as much government money reaching local efforts for planning.
But he said he understands Mr. Leavitt's point about local communities being largely on their own in a worst-case scenario in which the number of deaths could be "staggering."

"If everybody is struggling with the same crisis, natural or man-made, they're aren't enough people to go around," he said. "That's a major concern, but you've got no other choice. When you look at some of what we've done over the last four or five years, whether its with hurricanes, anthrax, or smallpox, it shows that it's important to have a good public health infrastructure."

Some of those in attendance, however, questioned government's commitment.

"We're talking about having more surveillance, but at the same time they're not giving the local school boards and districts the support they need to be able to keep their school nurse staffing levels," said Deborah Strouse, central Ohio representative for the Ohio Association of School Nurses.

"You can expect the highest incidents to be in school-age children, and that will probably be at a rate of about 40 percent, and we're usually going to see them before they're sick enough to go to the hospital," she said.

The Ohio Department of Health adopted a Pandemic Flu Preparedness Study two years ago and has since updated it. The 59-page document provides instructions on such things as communications during a crisis and how to prioritize who gets a newly created vaccine while it remains in short supply.

Families are encouraged to keep a stock of food, water, and other supplies in case they have to quarantine themselves for perhaps weeks at a time.
Marjorie Broadhead, Seneca County's health commissioner, said Ohio is probably better prepared than most states.

But even as it prepares for a pandemic threat for which there may be no vaccine, she said the federal government could do a better job encouraging for the elderly to take pneumococcal vaccine now to reduce the chances of a fatal secondary infection attacking weakened flu victims.

"This is something that we can physically do for preparation, because so many times people die of the secondary infection, which is pneumonia from flu," she said. "If we can immunize people against pneumonia, doesn't it make sense to do that? We have that vaccine now."

lindude gripi infovoldik, eestikeelne

veterinaaramet on andnud välja infovoldiku linnugripi kohta (kiitus!)

asub aadressil: link

pdf kujul, sikuta oma arvutisse ja trüki välja :)

17. veebruar 2006

Soome ostis endale koha vaktsiinijärjekorras

Suomi varautuu influenssapandemiaan link

Kansanterveyslaitos on 20.12.2005 allekirjoittanut täsmärokotetta koskevan viisivuotisen ennakkovaraussopimuksen hollantilaisen influenssarokotevalmistajan Solvay Pharmaceuticals B.V:n kanssa. Sopimuksella hollantilainen valmistaja sitoutuu toimittamaan Suomeen 5,5 miljoonaa annosta pandemiavirusta vastaan suunnattua täsmärokotetta sopimusjärjestyksessä sitä mukaa kuin rokotetuotanto etenee. Suomi on neljäntenä jonossa. Varausmaksu on 550 000 euroa vuodessa.

millal kahtlustada linnugrippi vol 2

Kuulo Kutsari artikkel 2005.a. oktoobri Lege Artises
Suure patogeensusega A(H5N1)-linnugripi viirusnakkuse epideemiatõrje korraldamine
(linki panna ei saa, ei ole veebis juurdepääsetav)

linnugripi haigusnähud inimesel ja millal kahtlustada, samuti kuidas pindasid desinfitseerida, nakkustõrjejuhised

A(H5N1)-linnugripi haigusnähud inimesel on:

a) palavik >38 ºC,
b) köha,
c) kurguvalu,
d) nohu,
e) lihasevalu,
f) konjunktiviit,
g) vesivedel kõhulahtisus ja
h) ebaselge põhjusega raskekujuline respiratoorne haigus.

Kui palavikku pole, siis ei ole suure tõenäosusega tegemist linnugripiga. Surmaga lõppenud juhtudel domineerivad suure patogeensusega linnugripi viirusnakkuse kliinilistest nähtudest inimestel samuti tüüpilised gripinähud ning viiruspneumoonia ja sekundaarne hingamispuudulikkus. Lõimetusperioodi kestus A(H5N1)-gripi viirusnakkuse korral on kolm päeva, varieerudes kahest nelja päevani.

A(H5N1)-gripikahtlane haigusjuht

1. Haigusnähud: kahtluse püstitamiseks piisab, kui tüüpilistest haigusnähtudest a-f esineb kaks sümptomit.

2. Epidemioloogilised kriteeriumid:

a) Anamneesis on viibimine linnugripi riskipiirkonnas ja lähikokkupuude nakatunud lindudega – haige viibis seitse päeva enne haigusnähtude tekkimist linnugripi riskipiirkonnas, kus ta puutus kokku elus või surnud kodu- või metslindudega või sigadega.
b) Anamneesis on kokkupuude ägedate respiratoorsete nähtudega haigega või selliste nähtudega surnud isikuga riskipiirkonnas.
c) Anamneesis on andmed selle kohta, et haigestunu töötab tervishoiuasutuses, kus on esinenud ebaselge etioloogiaga rühmaviisilised respiratoorse nakkuse juhud.
d) Anamneesis on andmed, et haigestunu on A(H5N1)-gripiviiruse kokkupuute võimalusega laboritöötaja.
3. Kliinilised (labori)uuringud: röntgeniuuring, vereuuring lümfopeenia suhtes ja maksa funktsionaaltestid on negatiivsed või piiripealsed.

A(H5N1)-gripi tõenäoline haigusjuht
1. Haigusnähud: palavik >38 ºC ja teised gripitaolised haigusnähud.
2. Laboridiagnostika kriteeriumid:
a) kliiniliste laboritestide positiivsed tulemused,
b) viroloogilise testi positiivne tulemus, ilma gripiviiruse antigeense struktuuri määramiseta,
c) positiivne H5-antikehade leid ägeda staadiumi vereseerumis.
3. Epidemioloogilised kriteeriumid:
a) patsient (sealhulgas tervishoiutöötaja) puutus kokku kinnitatud gripidiagnoosiga haigega 7 päeva enne haigusnähtude tekkimist,
b) patsient puutus kokku haigete/surnud lindudega 7 päeva enne haigusnähtude tekkimist,
c) patsient töötas 7 päeva enne haigusnähtude tekkimist laboris, kus uuriti suure patogeensusega gripiviirusnakkuse kahtlusega haigete inimeste või lindude proove.

Surmajuhu korral:
a) surm saabus ebaselge põhjusega ägeda respiratoorse nakkuse tagajärjel,
b) surnud haige elas/viibis piirkonnas, kus oli levinud kinnitatud või kahtlane suure patogeensusega gripiviirusnakkus,
c) surnud haige puutus kokku kinnitatud gripidiagnoosiga haigega 7 päeva enne haigusnähtude tekkimist.

A/H5N1)-gripiviirusega saastunud pindade desinfitseerimine• haige vere ja kehavedelikega saastunud esemed ja pinnad – 1% Na-hüpokloriid (5% Na-hüpokloriidi lahus lahjendatuna veega 1 : 4) • tualettruum – kloorlubja lahus 7 g/l • lauapinnad, metallpinnad jm pinnad, kus kloorlubjalahust ei või kasutada – 70% etanool, metanool, isopropüül (lasta kuivada) • pesta käsi pärast haige või haiguskahtlase isikuga või tema ümbruse saastunud või potentsiaalselt saastunud pindadega kokku puutumist • tuba/korterit ei desinfitseerita • ruumi õhku ei desinfitseerita • põetusruumist väljunud isik ei pea desinfitseerima riideid, jalatseid, tarbeesemeid ning temale ei pea tegema sanitaartöötlust juhul, kui ei ole ilmset saastumist
Nakkusohutuse soovitused tervishoiutöötajatele, kes ei puutu vahetult kokku haigega • Vältige linnufarmide, -kasvatuste, -tapamajade jm kohtade külastamist, kus võiksite kokku puutuda linnugripiga. • Juhul kui külastasite teadmatult linnugripi kahtlusega farmi jm kohti või puutusite kokku haige/surnud kodu- või veelindudega, peske hoolikalt käsi ning kontrollige oma kehatemperatuuri seitsme päeva jooksul; >38 ºC palaviku korral pöörduge kohe arsti poole viirusevastase ravimennetuse alustamise eesmärgil. • Juhul kui puutusite kokku linnugripikahtlase kodu- või metslinnuga või nende väljaheitega, kontrollige oma terviseseisundit seitsme päeva jooksul ning gripinähtude ilmumisel pöörduge kohe arsti poole.
Nakkusohutuse soovitused A(H5N1)-gripihaige lähikontaktsetele/pereliikmetele • Hoiduge kokkupuutest haigega nakkusohtliku perioodi jooksul (täiskasvanud haige 7 päeva, kuni 12-aastane haige laps 21 päeva alates haigestumise algusest). • Juhul kui peate vältimatult kokku puutuma A(H5N1)-gripihaigega või teda hooldama, kandke maski/respiraatorit, kitlit, kaitseprille ja kindaid. • Pärast haigeruumist väljumist võtke ära individuaalsed kaitsevahendid ja peske hoolikalt käsi. • Juhul kui puutusite kokku haigega nakkusohtliku perioodi jooksul, jälgige oma terviseseisundit 7 päeva ning gripi haigusnähtude ja kõrge palaviku tekkimise korral pöörduge kohe arsti poole ja teatage, et puutusite kokku A(H5N1) gripihaigega.
Nakkustõrjesoovitused isikutele, kes puutusid kokku (gripi)haigete lindudega • Juhul kui te teadmatult puutusite kokku (gripi)haigete lindudega, peske hoolikalt käsi ja jälgige oma terviseseisundit 7 päeva; gripinähtude ja kõrge palaviku tekkimise korral pöörduge kohe arsti poole viirusvastase ravimprofülaktika alustamise eesmärgil. • Juhul kui puutusite kokku oletatavalt linnugrippi surnud linnuga või tema väljaheitega, pöörduge kohe arsti poole viirusevastase ravimprofülaktika alustamise eesmärgil. • Juhul kui teie kodulinnud ootamatult haigestusid ja surid, tuleb lindla kahjutustada/desinfitseerida järgmiselt: 1) kandke individuaalseid kaitsevahendeid või vähemalt kindaid ja näokaitset/prille, 2) põletage surnud linnud või matke 2,5 m sügavusele ja eemale veevõtukohast, 3) puhastage lindla ja kohad, kus linnud liikusid, nende väljaheidetest, matke need 2,5 m sügavusele, 4) kui soovite linnupuure edaspidi kasutada, peske need vee ja pesuvahendiga ning seejärel desinfitseerige.

millal kahtlustada inimesel linnugrippi?

soome tervisekaitseameti kodulehel link
oli hea juhend, milliste tunnuste alusel võib kahtlustada inimesel linnugrippi ja peaks tegema täiendavaid uuringuid

kui on täidetud korraga kolm kriteeriumi:

1. palavik >38°C
JA
2. Üks või rohkem järgmistest: köha, kurguvalu, hingamisraskused
JA
3. 10 ööpäeva jooksul enne haigustunnuste ilmnemist lähedane (<1 m) kokkupuude kodulindudega (elamine linnukasvatustalus või selle külastamine, linnuturul viibimine)
või
lähedane kokkupuude (otsene kontakt või viibimine kõnekaugusel) linnugrippi põdeva või linnugripikahtlusega inimesega

eelnevad siis maades, kus on kinnitatud linnugripi olemasolu lindudel ja/või inimestel

www.ktl.fi on ka muud infot linnugripi kohta, kes soome keelt valdavad - need lugegu

Barry: mida võiks õppida ajaloost?

Barry on siis raamatu The great influenza autor.
kui keegi vajab veenmist, et linnugripp on reaalne oht ja on võimeline inglise keeles raamatuid lugema, siis kinkige talle see raamat :D

mis puutub lainetesse, siis kuigi Barry arvab, et ka uus pandeemia võib tulla lainetena - siis selles osas on nii mõnigi erineval arvamusel, kuna tänapäeval toimub inimeste liikumine märkimisväärse kiirusega üle maailma

oluline on artikli lõpp, kus rõhutatakse, et inimestele õigeaegse ja õige info andmine väldib paanikat ja võimaldab inimestel teha vajalikke ettevalmistusi ..

Author Barry says pandemic planners should expect waves link
Robert Roos News Editor

Feb 16, 2006 (CIDRAP News) – If the next influenza pandemic imitates past ones and plays out in waves, the first wave might serve as a warning that gives the world a little time to prepare for the worst, a leading expert on the pandemic of 1918 told business leaders at a Minneapolis meeting this week.
John M. Barry, author of the 2004 book The Great Influenza, an account of the 1918 pandemic, said the first phase of that pandemic, in early 1918, was mild. The disease didn't strike with full ferocity until the second wave about 6 months later, in September and October.

"The first wave was so mild that you could read in a scientific journal article that this disease looked like influenza and acted like influenza but it can't be influenza because it was, so far, absent the usual complications of influenza," Barry, told a luncheon audience on the first day of the "Business Planning for Pandemic Influenza" meeting at the Minneapolis Convention Center.

"At first it wasn't great at infecting people in large numbers," he said. "Over a period of about 6 months, it was becoming more and more and more efficient, and then suddenly seemed to erupt simultaneously all over the world on three continents."

On the basis of pandemic planning meetings he has attended, Barry said planners don't seem to be figuring on "the wave phenomenon." "I think it's important to take that into consideration, because you may well have 6 to 8 months after the first identified human [case], before the worst phase hits," he said. "There may be an opportunity there."

The 1918 pandemic had three waves, as Barry recounts in his book. The last wave, in the winter of 1918-19, was milder than the second, though still much worse than the first.

Barry said that in the pandemic of 1889, which also was severe, the third wave was the most lethal. If that happened in the next pandemic, "it would be good news for us, because by that time we would be fully protected by vaccine," he said. Once a pandemic flu virus emerges, it is expected to take at least 6 months to develop and begin producing a vaccine precisely matched to the virus.

US Army data make clear how fast the 1918 virus evolved in the course of the pandemic, according to Barry. At the first five major army camps affected, 20% of the troops who caught the flu suffered pneumonia, and 37% of the pneumonia patients died. At the last five camps hit by the virus, an average of just 3 weeks after the first five, only 7% of flu patients had pneumonia, and 17% of them died.

"You have to understand that this is going to be a constantly changing enemy," Barry said.

If Barry sounded faintly reassuring on the subject of pandemic phases, he was the opposite on other points.

He cited the prediction of other experts at the 2-day meeting that even if the next pandemic is severe, about 98% of people will survive. Though he didn't take issue with that overall, he said the toll could be much worse in certain places or among certain groups. In 1918, about a third of the populations of Alaska and Labrador perished, and in Western Samoa the toll was 22%. In Fiji, 16% of the people died in just 2 weeks. And among young adults in general—the hardest hit group—an estimated 4% to 8% succumbed.

In addition, today's population is "clinically more vulnerable" to flu than the population in 1918, Barry said. The reason is the many people with weakened immune systems, including the elderly, HIV/AIDS patients, and cancer patients.

To drive home the importance of preparedness, Barry talked about the widespread failure of public officials in 1918 to level with the public about the influenza threat. In an atmosphere of rigid wartime censorship, enforced by laws that "make the Patriot Act look like a resolution of the ACLU," any utterance that could have been construed as harmful to public morale was punishable, he explained.

Hence, public officials mostly downplayed or lied about the pandemic, saying things like, "This is ordinary influenza by another name," Barry said. Rather than allaying fear and panic, this approach increased them.

But there were a few places "that sort of did prepare and did tell the truth from the beginning," he said. "In San Francisco, the city from day 1 told the truth about the disease." As a result, "you didn't get the panic and social breakdown that you got elsewhere."
The lesson is that when people are told the truth about a danger, they can prepare and deal with it, he said. "So preparation does make a difference."
Barry, of Washington, DC, is a distinguished visiting scholar at Tulane University in New Orleans.


küüslauk

kirjutab üks cureventsi foorumis küüslaugust ja selle viirusevastasest toimest
seda teemat võiks lausa lähemalt studeerida ..
panen selle siia rohkem selleks et ise ära ei unustaks uurimast, aga vbolla kedagi huvitab ka :)

Let me tell you why the garlic preparation for the enema is so important...it has to be uncooked because an important enzyme is killed that is very potent against virus. I am allergic to most antibiotics and I have had pneumonia a few times along with pleurisy. I tried everything under the sun to get rid of it including a plaque formula that was guaranteed to get rid of pneumonia. When two bottles of that didn't work, I was told there was only one way left and that was garlic. I said I had taken bottles of garlic but it was the fresh that had to be used because of this enzyme that dies so easily in decoctions or dried capsule form.

I processed five cloves, put honey on it and swallowed it. It worked. My son got pneumonia last month and he was smart enough to put it in a little fresh lemon and maple syrup and a very little water, (it needs to be undiluted as much as possible for a knockout punch) and it went down easily. He had to do it a second time but was well in three days.

So, for the enema, the garlic must not be prepared as decoction, (hot water poured over for tea). I mince the garlic and put it in warm water for a few hours, strain and use. My doctor told me the kidneys suck it up from the enema and it is put right into the bloodstream like a shot of anti-viral.

During the BF, I plan on using the enema if any in my family get it but I also plan on us making suntea sweetened with honey daily. I gave this to my babies who had ear infections with great results and with honey it doesn't taste bad at all. No, really...honest.

Also, I will not trust to the masks outside. We will all put a tiny sliver of it between gum and cheek. You have probably all heard the stories about people wearing a necklace of garlic during the black plaque with great results. So, yeah, if everyone does it, you don't notice the loverly aroma.

16. veebruar 2006

kas linnugrippi võib nakatuda linnusita kaudu?

Küsimus: link

Kas linnugrippi võib nakatuda ka nii, et astud jalanõuga haige linnu väljaheitesse ning siis puutud kokku selle jalanõuga või vaibaga, kuhu oled astunud?

Vastus:
Haige linnu väljaheitest nakatumine on võimalik – vaibale sattunud väljaheide kuivab kiiresti ja tolmuga võib viirusi sisse hingata. Samal põhjusel ei soovitatagi (eriti lastel) viibida linnutoitmise kohtades, kus on nii väljaheiteid kui ka tolmu – väike laps on ninaga ohule vähemalt 1 meeter lähemal kui temast pikem täiskasvanu.

Kui tuppa tulles on jalanõud saastunud, siis tuleb need (ja ka vaip) vee-seebiga puhastada ja pärast seda käed hoolega puhtaks pesta. Käte pesemine on päästva toimega ka paljudest teistest haigustekitajatest lahti saamiseks ja enda kaitsmiseks. Seda teadmist peaks lastele varakult sisendama hakkama.


Juhis vigastatud või surnud lindudest teatamise puhuks

Juhis vigastatud või surnud lindudest teatamise puhuks link

Kuna looduses elavatel veelindudel kulgeb linnugripp sageli ilma selgete väliste haigustunnusteta, siis häirekeskuse või muu sarnase telefoni operaator peaks välja selgitama järgmised asjaolud:

* Kas lind on kodulind (põllumajanduslind või kodus lemmikloomana peetav lind), linnalind (tuvi, varblane), veelind (part, hani, luik), või muu metsalind.
* Elus või surnud?
* Kas on näha vigastusi, nagu murtud tiib või muud traumale viitavat?
* Kas on näha midagi muud ebaharilikku või tähelepanuväärivat?
* Kas lind leiti maanteelt, elektriliinide lähistelt, tuulegeneraatorite lähistelt, linna lähistelt, loomapidamishoonete lähistelt, asustamata kohas, asulas.
* Kas leitud linde on 1, 2–10, rohkem kui 10, massiliselt.

Üksiku surnud linnu leidmisel pole üldjuhul vajadust pöörduda veterinaarteenistuse poole – info edastada vastavasse omavalitsusse (korraldab surnud lindude koristamist). Veterinaar- ja Toiduameti riskianalüüsi põhjal ei kujuta endast inimesele ohtu lind, kellel ei ole lindude gripile iseloomulikke tunnuseid.

Info leitud linnu kohta soovitame edastada linnu asu(leiu)kohajärgsesse veterinaarkeskusesse juhul, kui lind on leitud lasteasutuse territooriumilt.

Kui pole viiteid traumale ega muid arusaadavaid põhjusi rändelise eluviisiga veelinnu ebaharilikuks käitumiseks või hukkumiseks, peab vastav info minema linnu asukohajärgsesse veterinaarkeskusesse, kus siis otsustatakse edasine tegevus (vajadusel proovivõtt jne).

Teade kodulindude massilisest haigestumisest või suremusest tuleb edastada lindude asukohajärgsesse veterinaarkeskusesse või piirkonda teenindavale veterinaararstile (volitatud veterinaararst).

Juhised isikutele, kes puutusid kokku (gripi)haigete lindudega

Üldised nakkustõrje juhised isikutele, kes puutusid kokku (gripi)haigete lindudega link

* Juhul, kui teadmatult puutusite kokku (gripi)haigete lindudega, siis peske hoolikalt käsi ja jälgige oma terviseseisundit 7 päeva; gripinähtude ja kõrge palaviku tekkimisel pöörduge kohe arsti poole viirusvastase ravimprofülaktika alustamise eesmärgil.
* Juhul, kui puutusite kokku oletatavalt linnugrippi surnud linnuga või selle väljaheitega, pöörduge kohe arsti poole viirusvastase ravimprofülaktika alustamise eesmärgil.
* Juhul, kui teie kodulinnud ootamatult haigestusid ja surid, teavitage sellest kohalikku veterinaarteenistust.
* Sisenedes eluslindude ruumi kandke kaitsemaski/respiraatorit, kitlit, kaitseprille ja kindaid.
* Lindla kahjutustamisel/desinfitserimisel kandke kaitsemaski/respiraatorit, kitlit, kaitseprille ja kindaid.

Lindude gripi tõrje eeskiri

BC saatis lingid:
Lindude gripi tõrje eeskiri: link

Lindude gripi inkubatsiooniaeg kestab sõltuvalt linnu liigist ja vanusest ning haigustekitaja patogeensusest 3–21 päeva.

Lindude gripp levib peamiselt otsekontakti teel ja inimtegevuse vahendusel, samuti õhu kaudu ja transovariaalselt. Erandjuhul võib nakkus üle kanduda inimesele.

Lindude gripi looduslikuks reservuaariks on rändavad mets- ja veelinnud.

Lindude grippi iseloomustavad patoloogilis-anatoomilised muutused linnu kudedes ja organites, näiteks täppverevalumid serooskestadel;
verevalumid ja nekroosikolded siseorganitel;
limane eritis hingamisteedes;
tursed ja verevalumid pea ja kaela piirkonnas ning lihastes ja silma sidekestal.
Äkksurma korral võivad iseloomulikud linnu organite patoloogilis-anatoomilised muutused puududa.


15. veebruar 2006

kuhu matta oma surnud?

Preparing for pandemic: know how to bury your dead link
Wed Feb 15, 2006 3:39 PM ET
By Andrew Stern

MINNEAPOLIS, Feb 15 (Reuters) - When burying a body in the backyard, don't put it too close to the septic system. That was one piece of advice offered on Wednesday to a business conference on preparing for a potentially lethal bird flu andemic.
Preparations for a global flu pandemic, which many experts believe is overdue, have begun but the grisly details are horrific and the number of sick could quickly overwhelm the health care system.

Needed supplies of even common medical supplies such as surgical masks and gloves are in doubt, not to mention the syringes needed for an as-yet undeveloped vaccine and costly mechanical ventilators.

The H5N1 avian flu virus that has infected flocks on at least three continents and killed 91 people could be the virus that experts fear will mutate into a highly pathogenic form that kills hundreds of millions of people in a matter of weeks or months.

In Seattle, public health officials are weighing the ramifications of hospitals overwhelmed by hundreds of thousands of sick people and the need for thousands of body bags.

"We talk about how people should bury their dead in their backyards, how far from the septic systems," said Dorothy Teeter, director of the King County public health department in Seattle. "In case you're wondering, it's $20 apiece for high-quality body bags. In New Orleans (after Hurricane Katrina) they had to double-bag bodies."

Refrigerated trucks will be needed to ship and store food and medicines and will not be available for corpses, a mistake made by federal authorities who commandeered trucks after Katrina, said James Caverly of the U.S. Department of Homeland Security.

Communicating the truth will be important to deter civil unrest, several experts told the conference. Up until six months ago, the Department of Health and Human Services was planning privately for a pandemic but saying little publicly, said communications consultant Peter Sandman.

The shift may be due to President George W. Bush reading John Barry's "The Great Influenza," an account of the 1918 influenza pandemic during which government assured the public that it was just another seasonal flu outbreak, Sandman said. At the time, Barry said many communities were brought to a near standstill, with people afraid to talk to each other or care for the sick.

"When you mislead people, when you over-reassure people ... they feel less trusting, and they behave much worse," Sandman said.

Conference participants from corporations, interest groups, and government met to discuss revising just-in-time supply concepts in order to stockpile, shutting down and restarting facilities in pandemic-hit countries, and cross-training employees and bringing back retirees to replace a significant portion of their employees that might become sick, decide not to come to work, or die.

inimestele tõe ütlemine väldib hiljem rahutusi

Public not ready for grim realities of health-care in a flu pandemic: experts

MINNEAPOLIS (CP) - Health-care delivery during a flu pandemic won't be remotely like current standards of care - and the public isn't prepared for that fact, leaders from the health-care sector warned Wednesday at a conference on business continuity planning for a pandemic.
Supplies of medical gloves, masks and other standard items will run out, several speakers bluntly predicted. So too will hospital beds and respirators. Tough choices may have to be made over the use of simple items such as syringes.

"We are going to run out of things we're not used to running out of," said Stewart Simonson, assistant secretary for public health and emergency preparedness in the U.S. Department of Health and Human Services.

Asked if he felt members of the public were aware of what health care might actually entail during a pandemic, Simonson was frank: "My sense is no."

He said the U.S. government is currently funding a project designed to see if disposable hospital masks can be reused, or if there is some safe way to use them for a longer period of time.

Another part of the project is looking at what might fill the gap should the supply of masks dry up, including "good, old-fashioned muslin" and other, newer fabrics, Simonson said in an interview.

"There's no percentage in not doing this work," he said, noting if a severe and prolonged flu pandemic occurred, global supplies of hospital goods would dry up. "Now is the time to figure all that out."

Simonson was speaking at a two-day meeting on pandemic planning for businesses staged by the University of Minnesota's Center for Infectious Disease Research and Policy.

Dorothy Teeter, interim director of the public health department for Seattle, Wash., said hospitals typically have on hand three to five days' worth of medical supplies. Hospitals in Seattle - considered one of the leaders in pandemic planning in the U.S. - are looking at stockpiling some basic medical supplies, things like IV (intravenous) tubes and syringes.

"If it's three days' worth of supplies, that's not enough," she said.

Teeter said in Seattle, where planning work has been ongoing for the past two years, there are 3,500 licensed hospital beds. The mathematical modelling the public health department is relying on suggests 57,000 people in the city may need hospital care during a pandemic - and that's in addition to those who would normally need hospital care for non-pandemic related illnesses.

"The hospital capacity is simply flat out not the answer. So people are going to have to understand there will be a very different system in place," she said.

"And we have to plan it now so we can educate the public. They become more resilient, they understand what that looks like. You as businesses can tell your employees 'Here's what you can expect,' and we go forwards.

"If you don't tell that truth, I think we'll have a social unrest problem that we perhaps could avoid if we did tell the truth."

14. veebruar 2006

vastutus oma pere ees

üks osa pikemast artiklist

News of avian flu may be buried in the back of newspapers, but prepare for the possibility that it will become front-page news link

Meanwhile, one wonders how many Canadians will actually prepare themselves an emergency survival kit. Allison Stuart, director of the Emergency Management Unit of the ministry of health, thinks you should. "We know, based on history, going back centuries, things can happen. We owe it to ourselves to be ready. We have got to be ready." The province of Ontario is ready -- at least as ready as you can be. In the past our government has done a great job of responding to things like the ice storm, massive floods, the Walkerton nightmare, the giant power outage and, of course, the SARS situation. "It's about making plans," said Michael Morton, assistant chief of training and education for Emergency Management Ontario. "In reality, an emergency could happen a minute from now, a year from now or never."

But when it comes to a pandemic, he says, it's only wise to be prepared.

"Ontario is the safest place in the world to live and yet we have seen we can be affected." He and his wife have an emergency kit in both their home and in their car. Morton suggests you do the same. "I think it's so important for every member of the public to prepare a personal emergency kit," he said.

LIMITED MOBILITY

This would include water, food, money, medical supplies, batteries, a flashlight, a battery-less radio and other items.

Morton says if there ever is a pandemic people will be glad they did it because in such a situation it could be difficult to go outside, go to the bank or get supplies. If you are fully stocked, a person could get their family in their homes and be able to sustain themselves until the situation is stabilized. "Having a kit at the minimum will make life more pleasant," Morton said, adding it also puts less strain on the system, which would be taxed in such a reality.


UK haigla pandeemiaplaanid

Bird flu warning link

A QUARTER of doctors and nurses in Barnsley are expected to fall ill, throwing Barnsley's health service into chaos, if a bird flu pandemic sweeps the borough, health chiefs have warned. At the same time more than 11,000 extra patients would be likely to call on GPs for an appointment - most of them home visits - during the expected eight-week course of any outbreak.
Now Barnsley Primary Care Trust has published its plan for coping with the disease in the wake of concern over the lethal H5N1 flu strain which has spread to Europe from its original hotspot in south-east Asia. A report backed by Paul Redgrave, the borough's director of public health and 'flu co-ordinator', outlines strict infection control methods including gloves, aprons and face masks to be worn by all health care workers in close contact with patients. Barnsley Hospital is expected to be working at maximum capacity for a long period, with a predicted 355 extra admissions, and extra mortuary space would be prepared to cope with a predicted 230 deaths from flu. Social Services would also be on high alert to help care for vulnerable people left without essential care if their health worker falls ill. The report states family, friends and neighbours would be asked to pitch in as informal carers in the event of a shortage of workers. And recently-retired and part-time staff could be asked to return full-time. In the community, school closures would be expected and up to a quarter of all public sector workers would be likely to be off work for up to eight days. Dr Redgrave said: "The virus has not acquired the ability to pass easily from person to person. Should it be able to H5N1 would be meet all the criteria of a pandemic flu strain. "An influenza pandemic will cause widespread social and economic disruption. Emergency planning is an ongoing process. A considerable amount of work is still required, particularly related to anti-viral distribution and continuity in Primary Care." Dr Kevin Perret, Barnsley's consultant in communicable diseases, said it was inevitable a new strain would strike at some point. He added: "A pandemic is not likely soon, but it is inevitable and it will have major consequences. Life will go on but it would be very disruptive. We will all have to work together. "All public institutions have contingency plans for dealing with a crisis, including coping with high levels of staff absence." 14 February 2006

üheskoos on kergem

suurepärane jutt!

"It's no news" is bad news link

It's not news any longer that there is bird flu all over the place: asia, southeast asia, Russia, Turkey, Iraq, Saudi Arabia, Azerbaijan, Bulgaria, Croatia, Slovenia, Greece, Italy, Nigeria -- where did I miss? Nevermind. Mainly in birds, of course, but enough humans to give us pause. This virus is still experimenting and looking for new hosts to use for its only purpose in life -- make copies of itself. Maybe it will find humans or cats or dogs or all of the above good factories. Maybe not. But pretty much we are now at the mercy of the virus's biology as to what it will do. There is little at the moment we can do to affect that.

This is not true for managing the consequences of what it might or will do, however. There we still have a chance to affect the course of events. We don't have to fatalistically submit to whatever the virus has in store. Since on any given day about half our readers are first time visitors, we'll repeat here what we have been saying for the last year or more. We can get ready for this and we can do it despite the yawning public health and governmental leadership void. In a pandemic every community will have to depend on its own resources anyway, as the need will be so huge that no outside source will be able to satisfy it.

Our interests here and at The Flu Wiki are what can be done as a community, not as individuals. There is no shortage of sites with individually-oriented survivalist strategies and we wouldn't discourage anyone who felt the need to do whatever they feel is necessary for themselves and their families. But if we are going to get through this with minimum pain we will, above all, need to help each other. The more prepared we are as communities the more likely we will see neighbor helping neighbor instead of neighbor fleeing neighbor. In essence this is a task at community mobilization and the closer a pandemic seems, the easier it will be to mobilize the community. So we should be thinking about it and doing it, even if in the past it was hard to get attention. Perceptions change and with them, willingness to take action.

We are not just talking about public health measures. In a way, they will more likely take care of themselves because that seems to be the only thing state and local governments are thinking about. The big issues will be those loosely called social services:
* how to care for the many people who will need care despite no money, family or social support;
* how to ration scarce resources of all kinds;
* how to cope with a prolonged 30% to 40% absenteeism that can cripple essential services like food supply, pharmacies, water, power;
* how to provide for the dead and comfort their survivors.

All of these things can be done by schools, businesses and agencies thinking ahead and putting in place some rudimentary planning.
Who are the key people in your business and what would you do if they were out sick?
What if power was off for a week or ten days?
When do you close your school and what do you do about childcare if school is closed?

These are hard questions but it won't do any good waiting for someone else to give you the answer. No one knows what to do. But you can start thinking about it. There is an impressive amount of raw brain power in our communities and we have no doubt some innovative solutions will be found -- sooner or later.

kui tuttavad hakkavad surema

Northcom branches out to fight flu link

Peterson Air Force Base - Military commanders called together government emergency-response officials recently for a brainstorming session at this Cold War base turned headquarters for homeland defense. But rather than dirty bombs or suicide attacks, they wanted to talk flu.

Convinced that pandemic influenza inevitably will strike inside the United States, military leaders contend the failure of civilian agencies after Hurricane Katrina could happen again. It's an example of how U.S. Northern Command military forces charged with homeland defense quietly are assuming broader, non-traditional roles.

Those perched around conference room tables here knew the latest worst-case scenario assessments too well: pandemic flu could kill as many as 2 million Americans.

The recent spread of the H5N1 bird-flu virus to birds in Africa and southeastern Europe, just as birds begin seasonal migrations, has piqued concerns the virus could mutate to spread from birds to humans and among humans. Experts say that could touch off a global pandemic.

At the meeting here, civilian officials could only dream of acquiring the beds, vaccines, ventilators and worldwide outbreak-detection data available in the military system. Health and Human Services officials say these military assets could more than double the national capacity of 970,000 staffed beds and 100,000 ventilators.

But Northcom chiefs emphasized: the military system would treat soldiers, veterans and their families first.

Northcom spokesman Lt. Cmdr. Sean Kelly said military capacity figures "aren't available yet, but we do not believe we'd be able to double the national capacity."

Yet, spurred by President Bush during his recent visit here, Northcom officials are preparing to:
* Share early-warning data on outbreaks with civilian health authorities.
* Inspect passengers at airports and seaports for signs of flu.
* Slow travel and help police communities short of attempting fullblown quarantines.
* Move medicines to hard-hit areas and victims to clinics for treatment.
* Back up civilian doctors by working shifts at overloaded hospitals.
* Possibly share vaccines, beds, and ventilators.

"This thing could hit next week, for all we know," said Col. Joseph Bassani, Northcom's chief of planning.

While defense once meant mobilizing armed forces to confront foreign armies and control turf, homeland defense forces over the past year participated in activities ranging from border control to firefighting.

On Monday, Northcom convened military and National Guard leaders to talk about how to handle hurricanes this year.

Bush has said the military would play an important role in responding to pandemic flu. Bush also said that "the best way to deal with a pandemic is to isolate it in the region in which it begins," and suggested Congress debate quarantines.

Civilian response leaders here - representing diplomatic, environmental protection, emergency management and transportation agencies - welcomed the prospect of military support.

Military forces "have assets we don't have. They move tons of equipment every day. They're also the best at planning," said Lynn Slepski of the U.S. Public Health Service, now serving as a senior health advisor in the Department of Homeland Security.

Compared with civilian hospitals that often are hard-pressed to meet non-crisis needs, the military's medical system can treat thousands of soldiers in critical condition at once. Fixed and mobile clinics give a "surge capacity" that civilian health officials in cities such as Denver are struggling to arrange.

After Hurricane Katrina, military doctors and nurses treated hundreds of victims. Helicopters evacuated victims to the 500-bed USS Bataan floating hospital.

Military medical teams track disease outbreaks by testing tissue and blood samples at surveillance centers in Egypt, Kenya, Indonesia, Thailand and Peru.
Meanwhile, civilian hospital emergency rooms turn away as many as 500,000 people a year, according to recent studies.

The new defense budget includes millions of dollars to prepare for pandemic flu, including streamlined vaccine production.

If pandemic influenza strikes, the military likely will be needed to stabilize communities and enable an effective response, said Colorado College professor Andrew Price-Smith, author of "The Health of Nations," an authority on pandemic threats to the economy and security.

U.S. communities aren't as cohesive as in the past, and "the fragmentation in the government response evident in Katrina is, unfortunately, likely to be replicated during a pandemic," Price-Smith said. "Do we rely on the military to make up for the diminished capacity in various states? Unfortunately, we are going to need their resources. The question is: How much can the military assist?"

Government worst-case scenarios suggest pandemic flu could infect 90 million Americans, with half needing medical treatment. Up to 40 percent of workers would stay home, and the economic impact could match that of a major recession, according to a new Congressional Budget Office assessment.

The pandemic flu in 1918-19 killed more than 500,000 Americans and 50 million worldwide.

The problem, military leaders told civilians here, is that military facilities likely would be overwhelmed, too.

These exist primarily to serve soldiers and their families, and they'd be treated first in a pandemic, said Navy Adm. Timothy Keating, chief of Northern Command, in an interview.

"Our job in the Department of Defense is principally to fight and win the nation's wars," Keating said. Tens of thousands of soldiers deployed in Iraq and Afghanistan "need to know that their families are being taken care of. That's a significant effort." But "simultaneously, or as soon as we can," military forces would mobilize "to stabilize and ease human suffering," Keating said.

Military planners said soldiers would not attempt large-scale quarantines. Quarantine "really isn't effective with influenza, because influenza is so contagious," said Dr. Tanis Batsel, Northcom's chief of preventative medicine.

Americans likely would stay home anyway, she said. "Most convincing will be that people are going to be dying. Everybody will know somebody."
Soldiers instead would screen travelers at airports, and perhaps restrict movements of those who are infected.

Homeland defense officials also plan an aggressive public information campaign: Vaccinate. Follow cough etiquette. Wash hands. Avoid large groups. Reach out to the homeless and infirm.

By calling civilian emergency planners together, Northcom hoped to encourage agencies "to come up with requests for assistance" as soon as possible, Batsel said.

Then military chiefs can review them and "give a reality check."

13. veebruar 2006

linnugripikogemused

Linnugripp A(H5N1) inimesel – mis on teada senisest kogemusest link
Autor: Mari Järvelaid
Ilmunud: © Moodne Meditsiin, detsember 2005.
Väljaandja: Eesti Ekspressi Kirjastuse AS

Maailma Terviseorganisatsiooni selle aasta mais Hanois peetud kohtumisel tõdeti, et enneolematu loomataud – linnugripp A (H5N1), mis on väga patogeenne, on ületanud liikidevahelise barjääri Aasias, põhjustanud inimeste hulgas fataalseid juhte ja suurendanud ohutunnet, et läheneda võib pandeemia.

Senine esinemissagedus

Inimeste haigestumine A (H5N1) grippi Kagu-Aasias on olnud samaaegne kanade rühmaviisilise haigestumisega linnugrippi A (H5N1), kuigi 2004. a ja 2005. a linnugripi epideemiatega kaasnesid vaid üksikud inimeste haigestumisjuhud. Suurim arv inimeste haigestumisi on registreeritud Vietnamis, seda eriti kolmanda, hetkel toimuva haigestumiste laine ajal, ja esimesest inimese fataalsest haigestumisest A (H5N1) teatati hiljuti ka Indoneesiast. Registreeritud ei ole inimeste tegeliku nakatumise sagedust, teada on ainult haiglasse pöördunute arv. Sel aastal on linnugripi A (H5N1) viirustüve geograafiline leviala laienenud Kasahstani, Mongooliasse ja Venemaale.


Linnugripi ülekandeteed

Inimeste hulgas levib gripiviirus piisknakkusena ja piisktuumadena, otseses kontaktis ja kaudses kontaktis nakkusallikaga, ise kätega nakkustekitaja konjunktiivide limaskestale või ülemistesse hingamisteedesse viies. Täna on linnugrippi A(H5N1) nakatumine teada nii linnult inimesele kui võimalikuna keskkonnast inimesele, ja teada on piiratud arvul juhte, kus nakkus levis inimeselt inimesele.


Loomalt inimesele

Aastal 1997, kui A (H5N1) esimest korda isoleeriti grippi surnud lapselt Hongkongis, peeti nakatumist võimalikuks, kui inimene oli nädal enne haigestumist viibinud kanalas, ohutuks peeti aga kanatoodete söömist ja kanast söögi valmistamist ning võimatuks peeti A (H5N1) nakatunud isikult nakkuse saamist. Haigete lindudega kokkupuutes olnud isikutel leiti seropositiivsus A (H5N1) gripitüvele ja kõik haigestunud olid kanadega kokku puutunud.

Nakatumised olid aset leidnud kas siis haigestunud linde sulgedest puhtaks kitkudes või kanu tükeldades, tegeledes võitluskukkedega, mängides lindude hulgas, seda eriti sageli asümptoomsete partide hulgas, partide toorest verd juues või pooltoorest kana süües. Tais registreeriti ka tiigrite ja leopardide nakatumine, kui neile anti loomaaedades söögiks kanu. Kodukasside nakatumine linnugripiviirusega leidis tõestust kassidega tehtud eksperimendi käigus. Gripiviirus nakatas nii farüngeaalsel kui gastroenteraalsel viiruse ekspositsioonil.


Inimeselt inimesele

Mitmel juhul on inimeselt inimesele nakatumist dokumenteeritud perekonna piires, ühel juhul nakatas ema tema laps. Senini pole tõendeid, et nakatumine oleks toimunud aerosoolina leviva viirusega sotsiaalsete kontaktide ajal. Ei ole registreeritud ühtki arsti nakatumist.

Patsientide kontaktsete intensiivne jälgimine RT-PCR (reverse-transcriptase-polymerase-chain-reaction) on võimaldanud ka kergete haigusnähtudega nakatunud isikute kindlakstegemist, näidates, et enam on nakatunuid pereliikmete ja vanemaealiste hulgas. Need leiud viitavad, et viirustüvi on kohanemas inimestega. Seni on haiglanakkusoht tervishoiutöötajatele olnud väga väike, isegi juhul, kui ettevaatusabinõud on jäetud rakendamata. Dokumenteeritud on Vietnamis ühe patsiendi eest hoolitsenud meditsiiniõe raskekujuline haigestumine A (H5N1) gripitüvest.


Keskkonnast inimesele

Keskkonna kaudu on teoreetiliselt võima­lik nakatumine mitmel viisil. Kontamineeritud vee allaneelamine ujumise ajal või otse intranasaalselt või konjunktiividel, samuti saastunud käte kaudu.


Avaldumine

Haigusnähtude kirjeldus põhineb nendel haigusjuhtudel, mida on ravitud haiglas. Kergemakujulisi haigestumisi, subkliinilisi ja atüüpilisi haigusjuhtusid (nt entsefalopaatia ja gastroenteriit) ei ole uuritud, kuid teavitatud juhud viitavad nende võimalikkusele. Enamik haigestnutest on olnud terved väikelapsed või täiskasvanud.


Inkubatsiooniperiood

Inkubatsiooniperiood A (H5N1) ­gripi korral võib olla pikem kui seniteatud gripitüvedega nakatumisel. 1997. a haigestuti valdavalt 2 kuni 4 päeva pärast ekspositsiooni, hiljutised juhud näitavad enamasti sama ajaperioodi, kuid mõnel juhul kuni 8päevast ajavahemikku. Peresiseste puhangute korral on üldiselt inkubatsiooniperiood 2 kuni 5 päeva, kuid on olnud ka 8 kuni 17 päeva, seda eriti pärast võimalikku kontakti keskkonnateguritega või nakatunud loomaga.


Esimesed haigusnähud

Esimesteks haigusnähtudeks on enamikul patsientidest olnud kehatemperatuuri tõus üle 38 ºC ja samal ajal alumiste hingamisteede sümptomid. Ülemiste hingamisteede haigusnähud on esinenud vaid mõnel üksikul juhul. Erinevalt A (H7) linnugripi viirustüvest esineb A (H5) korral konjunktiviiti harva. Varajases haigusstaadiumis on patsientidel haigusnähtudeks nii diarröa, oksendamine, kõhuvalu, pleuravalu, ninaverejooks kui igemete veritsemine. Vesine diarröa ilma vere või põletikuliste muutusteta, millele on eelnenud respiratoorse haigestumise nähud ühe nädala jooksul, on enam iseloomulik tavalisele sesoonselt esinevale inimesegripile. Ühes raportis kirjeldatakse ka kaht A (H5N1) patsienti, kel esines entsefalopaatia ja diarröa ilma respiratoorsete haigusnähtudeta.


Kliiniline kulg

Alumiste hingamisteede haigusnähtude manifesteerumine leiab aset juba varases haigusstaadiumis. Düspnoe teke on registreeritud keskmiselt 5 päeva pärast haigestumist (kõikudes 1 kuni 16 päevani). Tavalised on respiratoorne distress, tahhüpnoe ja inspiratoorsed räginad. Rögaeritus on varieeruv ja röga võib olla ka verine. Pea kõikidel patsientidel on 7 päeva pärast palaviku tõusu diagnoositud pneumoonia, mis röntgeniülesvõttel on nähtav difuussete, multifokaalsete muutuste või infiltraatidena, samuti interstitsiaalsete infiltraatidena. Need mõned mikrobioloogilised uuringud, mis on seni tehtud, on näidanud primaarset viiruspneumooniat, tavaliselt ilma bakteriaalse superinfektsioonita.

Respiratoorne häire manifesteerub ägeda respiratoorse distress-sündroomina. Tais registreeritud haigestumiste korral on ägeda respiratoorse distress-sündroomi väljakujunemise aja mediaan alates haigestumisest olnud 6 päeva, jäädes vahemikku 4 kuni 13 päeva. Tavaline on ka mitme organi samaaegne kahjustus (neeru- ja südamepuudulikkus, sh südame dilatatsioon ja supraventrikulaarsed tahhükardiad). Muude tüsistustena on esinenud kopsu­verejooks, pneumotooraks, pantsütopeenia, Reye sündroom ja sepsis ilma dokumenteeritud baktereemiata.


Suremus

Haiglaravil olnud patsientide suremus on olnud suur, siiski võib arvata, et üldine suremus on oluliselt väiksem. Erinevalt 1997. a registreeritud surmadest, mis enamikus olid vanemate kui 13aastaste hulgas, on viimasel ajal suremus suur laste seas. Nii on Tais registreeritud surmajuhtudest 89% olnud alla 15aastaste hulgas. Surmani kulus haigusnähtude väljakujunemisest keskmiselt 9 kuni 10 päeva (vahemikus 6 kuni 30 päeva) ja valdavalt oli surma põhjuseks ­progresseeruv hingamispuudulikkus.


Laboratoorsed leiud

Tavaline leid on leukopeenia, eriti lümfopeenia, kerge kuni mõõdukas trombotsütopeenia, veidi kuni mõõdukalt tõusnud transferaasid. Tais ­registreeritud surmajuhtude korral on suurem suremus olnud nende hulgas, kellel pärast haiglasse saabumist tehtud vereanalüüsis oli leukotsüütide hulk kahanenud, seda eriti lümfotsüütide osas.


Viroloogiline diagnoos

Ante mortem diagnoosi kinnitab A (H5N1) viiruse isoleerimine, H5-­spetsiifilise RNA leid või mõlemad korraga. ­Linnugripi
A (H5N1) korral on kõrgemat viiruse RNA taset leitud kurgus, võrreldes ninast võetud analüüsidega. ­Vietnamis kulus 2 kuni 15 päeva haigestumise algusest, kuni leiti viiruse RNA kurgust võetud analüüsides (mediaan 5,5 päeva). Kurgust võetud analüüsides oli A (H5N1) nakkusega patsientidel ­viiruskoormus
4 kuni 8 päeva pärast haigestumist vähemalt 10 korda suurem kui A (H3N2) või A (H1N1) nakkusega isikutel. Kiired antigeeni testid on osutunud vähetundlikuks võrreldes RT-PCR-meetodiga. Tais tehtud uuringus osutus kiirtest positiivseks vaid neljal A (H5N1) patsiendil üheteistkümnest.


Ravivajadus

Enamik hospitaliseeritud A (H5N1) patsientidest on vajanud 48 tundi pärast haiglasse saabumist ­hingamisaparaadi abi, samuti intensiivravi multiorganpuudulikkuse ja hüpotensiooni tõttu. Lisaks empiirilisele ravile laia spektriga antibiootikumidega on enamikku patsiente ravitud viirusevastaste ravimitega ja kortikosteroididega. Kõige parem tulemus on olnud varajasel ravi alustamisel viirusevastaste ravimitega. Nendel haigestunutel, kes jäid ellu, paranes seisund kahe-kolme päeva jooksul pärast ravi alustamist oseltamiviiriga. Letaalse kuluga juhtudel on hoolimata varajasest ravi alustamisest oseltamiviiriga haigusnähud süvenenud ja kurgust võetud analüüsis pole viiruskoormus alanenud.


Viiruse replikatsioon

Haiglaravil olnud patsientide uuring on näidanud, et A (H5N1) viiruse repli­katsioon on pikemaajalisem kui inimesegripiviirusel, nii oli Tais intervall haigestumisest kuni positiivse viirusleiuni 3 kuni 16 päeva. Võrreldes inimesegripiga toimub viiruste replikatsioon vähem naso­farüngeaalpiirkonnas, pigem eelistab viirus replikatsioonikohana alumisi hingamisteid. Samuti on olnud viiruse leid sage roojaanalüüsis, alati negatiivne aga uriinianalüüsis. Sage diarröa esinemine ja viiruse leid roojas viitavad sellele, et viirus paljuneb maosooletraktis. Seda arvamust on kinnitanud ka üks autopsia leid.

Lindudel on leitud viiruse vistseraal­set disseminatsiooni, imetajatel aga on dokumenteeritud invasiivset nakkust ja inimestel on kuuest uuritud seerumist kõik kuus olnud positiivsed viiruse RNA-le neli kuni üheksa päeva pärast haigestumist. Viirust ja tema RNAd on leitud nii veres kui tserebrospinaalvedelikus.


Immuunvastus

A (H5N1) gripitüvest surnud isikutel on leitud kõrgem põletikumediaatorite tase (interleukiin-6, interleukiin-8, interleukiin-1â, monotsüüte keemiliselt ligitõmbav proteiin) kui ellujäänutel. Plasma interferoon-á tase on linnugrippi surnud isikutel olnud umbes kolm korda kõrgem, võrreldes tervete kontrollrühmaga. Sarnane immuunvastus on osalt ka sepsise sündroomi korral, ägeda respiratoorse distress-sündroomi korral ja multiorganpuudulikkusega patsientidel.


Viirusevastaste ravimite kasutamine

Varajane ravi alustamine on parima kliinilise tulemuse tagatis. Oseltamiviiri ja zanamiviiriga tehtud platseebo-kontrollitud katsed on andnud mõlema ravimi sarnase tõhususe.

Oseltamiviiri soovituslikud annused (kaks korda päevas viie päeva jooksul 75 mg täiskasvanutele ja 30 mg kuni 15 kg kehakaaluga lastele üle aasta vanuses, 45 mg 15 kuni 23 kg kaaluvatele, 60 mg 23 kuni 40 kg kaaluvatele ja 75 mg üle 40 kg kaaluvatele) sobivad varajase, kergekujulise A (H5N1) gripi raviks, suuremaid annuseid (150 mg kaks korda päevas täiskasvanutele) 7 kuni 10 päeva jooksul tuleb kasutada siis, kui haigusnähud on rasked.

Raviks ei sobi M2 inhibiitorid amanta­diin ja rimantadiin, milledele A (H5N1) gripiviirus on resistentne, kuid ravimid, mida hetkel võib soovitada lisaks oseltamiviirile, on peramiviir, pikatoimelised toopilised neuraminidaasi inhibiitorid, ribaviriin ja võimalik et ka alfa-interferoon.


A (H5N1) kui võimaliku hospitaalnakkuse kontroll

Gripp on tuntud nosokomiaalne patogeen. Siintoodud soovitused põhinevad kogemusel, mis saadi SARSipuhangu ajal.

Teada on, et kirurgimaskide, isegi mitmekordsete, tõhusus on väiksem kui N-95 maskidel. Seega tuleb eelistada ühekordseid N-95 näomaske ja alati tuleb näomaski ettepanemisel kontrollida, kas seda on tehtud nii, et kogu sissehingatav õhk läbiks maski.

Isikud, kes on olnud kontaktis A (H5N1) gripi kahtlusega patsiendiga, peaksid profülaktiliselt üks kord päevas võtma 75 mg oseltamiviiri. Kokkupuute eelset profülaktikat tuleks rakendada juhul, kui on olnud võimalus suure riskiga ekspositsiooniks.


Kodused ja lähedased kontaktid A (H5N1) gripis isikuga

Kodustele kontaktsetele tuleb rakendada kontaktijärgset kemoprofülaktikat. Lähedasi jälgitakse. Kuigi inimeselt inimesele ülekanne on harv, tuleks kontaktset jälgida ühe nädala jooksul. Kui on märke, et lähedased võivad olla nakatunud, tuleks rakendada karantiini.


Refereeritud:

The Writing Committee of the World Health Organization (WHO) Consultation on Human Influenza A/H5. Avian Influenza A (H5N1) Infection in Humans. The New England Journal of Medicine. 2005; 353: 1374–1385.

Ncholson, K. G., Wood, J. M., Zambon, M. Influenza. The Lancet. 2003; 362: 1733–1745.

The World Organization Global Influenza Program Surveillance Network. Evolution of H5N1 avian influenza viruses in Asia. Emerging Infectious Diseases. 2005; 11: 1515–1521.


Linnugripp A (H5N1) leviku ennetamise strateegia


Isoleerimine

· Patsienti A (H5N1) gripiga tuleb kohelda standardseid kontakt- ja piisknakkuse ning õhu teel leviva nakkuse ennetamise reegleid kohaldades. Peab arvestama, et nooremad kui 12aastased lapsed võivad eritada viirusi kuni 21 päeva ja seetõttu tuleb ennetusabi­nõu­sid rakendada vähemalt 7 päeva pärast palaviku langemist ja võimaluse korral kuni 21 päeva.

· Võimaluse korral isoleerida patsient negatiivse rõhuga suletud uksega ruumi, võimalusel üks patsient ühe ruumi kohta.

· Kui patsientide ühekaupa isoleerimise võimalus puudub, peab voodite vahe olema vähemalt 1 meeter ja nad tuleb üksteisest eraldada barjääriga.

· Tervishoiutöötaja, kes siseneb ruumi, peab kandma suure tõhususega maski (N-95 ehk respiraator, mis on 95% tõhususega keskmiselt 3 µm diameetriga osakeste filtreerimisel), kaitsekitlit, näomaski või prille ja kindaid.

· Patsiendi eest hoolitsevate tervishoiutöötajate arv tuleb hoida minimaalne. Võimaluse korral A (H5N1) gripiga patsientidega kokkupuutuvad tervishoiutöötajad ei hoolitse teiste patsientide eest.

· Külastajate arv viiakse miinimumini. Kõik nad tuleb varustada kaitsevahenditega ja õpetusega, kuidas kaitsevahendeid kasutada.


Kontaktsed tervishoiutöötajad

· Need, kes hoolitsevad A (H5N1) gripiga patsientide eest, peavad kaks korda päevas mõõtma endal kehatemperatuuri ja kandma näidud vastavasse žurnaali. Kui kehatemperatuur tõuseb üle 38 ºC, tuleb teha vastavad diagnostilised testid. Kui mõnd muud haigestumise põhjust kindlaks ei tehta, tuleb kohe alustada ravi oseltamiviiriga.

· Nendele tervishoiutöötajatele, kel on olnud ekspositsiooni võimalus A (H5N1) gripiga patsiendi aerosoolile, sekreetidele või teistele kehavedelikele, kuna nad eksisid aseptika nõuete vastu, tuleb kohaldada ekspositsioonijärgset kemoprofülaktikat oseltamiviiriga soovitatavalt annuses 75 mg üks kord päevas 7 kuni 10 päeva jooksul.

· Suure ekspositsiooniriskiga protseduure sooritavatele tervishoiutöötajatele tuleb kohaldada ekspositsioonieelset kemoprofülaktikat.


Kodused kontaktsed

· Kõik kodused peavad pesema regulaarselt käsi (iga kätepesu vähemalt 20 sekundit sooja vee ja seebiga), vältima ühiste sööginõude kasutamist, lähedast kontakti (1 meeter), kasutama suure tõhususega maski ja silmade kaitset.

· Samas ruumis pikemalt koos viibinud isikud peavad 7 päeva jooksul pärast viimast kontakti mõõtma oma kehatemperatuuri kaks korda päevas.

· Kontaktsetele on soovitatav kemoprofülaktika 75 mg oseltamiviiri üks kord päevas 7 kuni 10 päeva jooksul.

· Kontaktsetel, kel tõuseb palavik > 38 ºC ja kes köhivad, kel on diarröa või teised tüüpilised haigusnähud, tuleb teha diagnostilised testid.


Riskipiirkondadesse reisijad

· Soovitatavalt vähemalt kaks nädalat enne reisi tuleb lasta end vaktsineerida kolmevalentse sesoonse gripivaktsiiniga.

· Riskipiirkonnas viibides tuleb vältida otsekontakti lindudega, sh kanapojad, pardid ja haned, eluslindudega kauplemise kohti, pindade puudutamist, mis on olnud kontaktis lindudega.

· Reisi ajal tuleb sageli pesta käsi või kasutada käte puhastamiseks alkoholiga geele. Tooreste ja pooltooreste munade ja kanalihatoodete söömist tuleb vältida.

· Juhul kui 10 päeva jooksul pärast riskipiirkonnast lahkumist tekivad ägeda respiratoorse nakkuse sümptomid ja palavik, tuleb konsulteerida arstiga, kindlasti teavitades arsti oma eelnevast viibimisest riskipiirkonnas.

Linnugripi kahtlusega juht

Linnugripi A (H5N1) võimalust tuleb kahtlustada kõikidel raske ägeda hingamisteede nakkusega patsientidel, kes on viibinud piirkonnas, kus esineb loomataudina A (H5N1), ja eriti neil, kes on seal kokku puutunud lindudega. On teada, et mõned loomataudi puhangud on avastatud alles pärast seal viibinud inimeste nakatumist. Lisaks peab A (H5N1) peale mõtlema, kui tegemist on seletamatu etiopatogeneesiga raske haigestumisega (entsefalopaatia või diarröa) viibimisel piirkonnas, kus on teada A (H5N1) levik.

Diagnoosimisel tuleb eelistada kurgust võetud analüüse. Laboratoorne A (H5N1) kinnitus vajab vähemalt kas viiruse kultuuri positiivset leidu, PCR positiivset leidu A (H5N1) RNA-le, positiivset antigeeni immunofluorestsents-testi, kasutades monoklonaalset H5 vastast antikeha, või vähemalt neljakordset H5-spetsiifilise antikeha tiitri tõusu paarisseerumis.


Selgemaks on saanud loomulik viirustevastase immuunkaitse mehhanism

Nature Immunology 11. septembri numbris ilmus artikkel, mis kirjeldab Leonid Tšerno­mordiku juhtimise all tehtud uuringut, milles avastati uued viirustevastast loomulikku kaitset vahendavad peptiidid defensiinid. Selgemaks sai mehhanism, kuidas saab takistada selliste inimesele ohtlike viiruste nagu gripiviirus ja HIV sisenemist rakku. Samuti annab see teadmine võimaluse viirushaiguste ennetamise uue strateegia loomiseks.

Nimelt on viiruste rakku tungimine kaheastmeline protsess. Esiteks, viiruse välismembraan või ümbris peab end siduma rünnatava raku välismembraaniga. Pärast kontakti rakukestaga sulatab viirus rakumembraani ning viiruse geneetiline materjal siseneb rakku.

Peptiidid on oligomeersed biomolekulid. Inimese organismis on rohkesti bioaktiivseid peptiidmolekule. Avastatud defensiinid on peptiidid, mis kaitsevad inimese rakke mikroorganismide eest. Teeta-defensiin retrotsükliin-2 (RC-2) pärsib gripiviiruse nakkuse, blokeerides viiruse hemaglutiniini poolt tekitatavat rakumembraani “sulatamist”.

Meie immuunsüsteemil on seega olemas paljude multivalentsete lektiinide kujul mehhanism, mis annab meile loomupärase laiaspektrilise kaitse viiruste eest.

Lektiine toodavad rakud, millega viirus kõige esmalt kokku puutub, nagu leukotsüüdid ja epiteelirakud, mis katavad paljude organite ja kudede pindasid.

Uuring, mis tehti dr Leonid Tšernomordiku juhtimisel kopsude sisepinna epiteeli rakkudega, näitas, et lektiinid blokeerivad gripiviiruse rakku sisenemise, ennetades viiruse ja rakumembraanide ühtesulandumist. Uuriti kahe peptiidi, teeta-defensiini ja beeta-defensiini toimemehhanisme. Rakkude välismembraanid ja paljud viiruseliigid on väljastpoolt kaetud molekulide kihiga, mida kutsutakse glükoproteiinideks. Need glükoproteiinid ulatuvad esile membraani pinnalt, sarnaselt nagu juukseharja piid. RC-2 on multivalentne lektiin, mis ennetab hemaglutiniini poolt vahendatud rakumembraani sulatamist, ehitades kaitseks raku pinnaglükoproteiinidest püsiva kaitsevõrgustiku. Nii blokeerivad defensiinid viiruste ühinemise rakumembraaniga, sidudes pinnavalke omavahel, ning moodustub rakumembraani kaitsev liikumatu barrikaad. Kui viirus läheneb rakule, eenduvad nii viiruse kui raku pinnal glükoproteiinid. Selleks et jõuda rakumembraanini, peavad viiruse pinnal asuvad glükoproteiinidest piid sobituma raku pinnal asuvate glükoproteiinide vahele, sarnaselt nagu juuksehari toimib juukseid kammides. Ainult siis, kui viiruse ümbris ja rakukest kokku puutuvad, saab toimuda fusioon ja viiruse geneetilise materjali tungimine rakku. Defensiinid, mille uurijad avastasid, seovad glükoproteiinid omavahel nii, et viiruse ja raku glükoproteiinid ei saa omavahel sobituda. Kasutades juukseharja näidet, on see sama, kui juuksed on omavahel juuksekummidega kokku seotud ja neid ei saa enam kammida.

Avastatud defensiinid ei tapa viirust, kuid ei lase viirusel rakku tungida ja annavad nii immuunsüsteemile võimaluse viirus hävitada.

Nüüd tuleb teadlastel teada saada, miks ühed inimesed on suutelised tootma enam defensiine kui teised, olles sellega paremini kaitstud viirusnakkuste eest. Saades enam teada sellest, kuidas defensiinid seovad pinna glükoproteiine, võib osutuda võimalikuks töötada välja sellised ravimid, mis kaitsevad rakke viiruste sissetungi eest.

Refereeritud:

Leikina, E. et al. Carbohydrate-binding molecules inhibit viral fusion and entry by crosslinking membrane glycoproteins. Nature Immunology. 2005; 6: 995–1001.

Zilmer, M., Karelson, E., Vihalemm, T. Meditsiiniline biokeemia I. Tartu 2001.

Küsimused-vastused linnugripi, gripi ja pandeemia kohta

aitäh Epule viitamast! panen selle eraldi teemana tõesti välja :)

Küsimused-vastused linnugripi, gripi ja pandeemia kohta link
Koostanud Tervisekaitseinspektsioon

Mis on linnugripp?
Linnugripp, mille põhjustajaks on viirustüvi A/H5N1, on lindude jaoks eriti nakkav, ägedalt kulgev ja ravimatu haigus, millega kaasneb lindude massiline haigestumine ja suremus.

Linnugripp ohustab eelkõige linde, kuid sellesse võivad nakatuda ka inimesed. Maailma Terviseorganisatsiooni (WHO) andmetel on 2006. aasta alguse seisuga inimestel registreeritud linnugripijuhte seitsmes riigis: Vietnamis, Tais, Indoneesias, Hiinas, Kambodžas, Türgis ja Iraagis. Kokku on haigestunud üle 160 inimese, neist ligi 90 on surnud. (Värsked andmed vt www.tervisekaitse.ee)

Ka inimeste jaoks on linnugripp raske nakkushaigus, mis võib lõppeda surmaga.

Miks linnugripp on nüüd järsku inimestele ohtlik?
Maailma Terviseorganisatsiooni hinnangul on viimase kaheksa aastaga linnugripi viirustüved muutunud tunduvalt agressiivsemaks, nii et nad ei piirdu ainult lindude ja loomade nakatamisega, vaid on hakanud ohustama ka inimesi.

Kas kõik linnugripiviirused on inimestele ohtlikud?
Inimestele on kõige ohtlikum H5N1, kuid haigust võivad tekitada ka H7N2, H9N2 ja H7N7 viiruse alamtüübid. Kuid vaatamata sellele, missugune gripiviirus nakatab linde, tuleb haiguse levikule kiiresti piir panna, sest ka madala ohuga gripiviirused võivad muutuda inimestele ohtlikeks.

Kuidas linnugripp levib?
Linnugripiviiruse kandjaks ja levitajaks looduses on veelinnud, kellelt võivad nakkuse saada kodu- ja muud metslinnud. Kodulindudest haigestuvad esmajoones samuti veelinnud (haned, pardid), kuid ka kanad, kalkunid, faasanid jne. Rändlindudega võib haigus levida pikkade vahemaade taha.

Haigustekitaja levib eelkõige haige linnu kaudu. Ka inimeste nakatumine linnugrippi on senistel andmetel toimunud (tihedal) kokkupuutel haigestunud lindude ja nende eritistega. Kuid pole välistatud võimalus, et piiratud ulatuses võib kõrgelt patogeenne ehk väga nakkav ja suure hävitusvõimega linnugripi viirus A/H5N1 levida ka inimeselt inimesele. Ametlikku kinnitust sellele veel pole.

Veterinaaride andmetel Eestis praegu linnugrippi ei esine, seega ei ole siin võimalik lindudelt seda nakkust saada.

Kas linnugrippi võib nakatuda reisil olles?
Reisil nakatumise oht on olemas juhul, kui reisitakse linnugripi ohtlikku piirkonda. Tervisekaitseinspektsioon soovitab:

Mitte külastada selliseid piirkondi, kus seda haigust esineb.
Kui sõit on siiski vajalik, siis on esmaseks nakatumise vältimise meetmeks hügieeninõuetest kinnipidamine. Tuleb pesta tihti käsi, juua vaid ohutut (pudeli- või keedetud) vett, söömiseks valida kuumtöödeldud toite jne.
Samuti on soovitatav mitte külastada linnu/loomaturge ja -farme ning hoiduda kokkupuutest kodu- ja metslindudega.
Inimeste jaoks võivad ohtlikuks osutuda ka kohad, kus on viibinud nakatunud linnud, sest linnugripi tekitaja säilib keskkonnas kaua, näiteks sõnnikus kolm kuud, jahedas vees kuu aega.
On soovitatav vähemalt kaks nädalat enne riskipiirkonda sõitu vaktsineerida end tavagripi vastu. Linnugripi vastu see küll ei kaitse, kuid vaktsineerimine väldib organismis uue, ohtliku viirusetüve tekkimise juhul, kui inimene peaks korraga nakatuma nii tava- kui ka linnugripi viirusega.

Kas linnugrippi võib nakatuda ka nii, et astud näiteks linnu väljaheitesse või puutud muudmoodi kokku saastunud jalanõu või vaibaga?
Haige linnu eritistest nakatumine on võimalik, näiteks vaibale või maapinnale sattunud väljaheide kuivab ja võib tolmuga kanduda hingamisteedesse. Seepärast ei soovitata (eriti lastel, kes on ninaga ohule lähemal) viibida lindude toitmis- ja elukohtades.

Kui tuppa tulles on jalanõud saastunud, siis tuleb need korralikult puhastada ja pärast seda ka käed hoolega puhtaks pesta. Käte pesemine aitab lahti saada ka paljudest teistest haigustekitajatest.

Kas nakkuse võib saada ka linnulihast, munadest, sulgedest?
Kokkupuutel haigestunud linnu liha, munade või sulgedega võib nakatuda linnugrippi.

Kuidas linnugripiviirus hävib?
Lindude gripi viirus säilib kaua elujõulisena just madalal temperatuuril. Lindude väljaheidetes võib viirus temperatuuril 4°C püsida nakatumisvõimelisena vähemalt 35 päeva, 37°C juures aga kuus päeva. Kõrgetel temperatuuridel viirus hävib, näiteks 60°C juures 30 minutiga ning 75°C juures mõne minutiga. Seega muudab liha ja mune ohutuks kuumutamine.

Viirus on tundlik ka enamlevinud desinfitseerivate vahendite suhtes nagu jodiidiühendid, formaliin, seebikivi jne.

Missugused on linnugripi haigusnähud inimesel?
Need on tüüpilised gripinähud:

järsk enesetunde halvenemine koos kõrge palavikuga (alates 38 kraadist),
pea-, lihas- ja kurguvalu,
köha ja nohu, hingamisraskused,
silma sidekesta põletik.
Raskem haigusega kaasnev tüsistus on kopsupõletik, mis võib esile kutsuda hingamispuudulikkuse, kuid esineda võivad ka südame-, lihas- ja kesknärvisüsteemi kahjustused.

Kas linnugrippi inimesel saab ravida?
Maailma Terviseorganisatsioon on tunnustanud linnugripi raviks inimestel kahte viirusevastase toimega ravimit: oseltamiviri ehk Tamiflud ja zanamiviri ehk Relenzat.

Mõlemad on retseptiravimid, saadaval apteekides ja neid kirjutavad perearstid tavagripi raviks ka praegu välja.

Kas linnugripp võib muutuda epideemiaks või pandeemiaks?
Epideemia (piirkonniti, näiteks riigiti leviv haigestumine) või pandeemia (kogu maailmas leviv haigestumine) võib puhkeda juhul, kui tekib uus, kõrge patogeensusega ehk suure haigusttekitava võimega gripiviirustüvi, mis hakkab kiiresti levima inimeselt inimesele. Kuna pandeemilise toimega gripiviirus ilmub tavaliselt ootamatult, puudub epideemia või pandeemia alguses uue viiruse vastu vaktsiin. Ka inimesed pole uue tüve vastu immuunsed.

Uus pandeemiline gripiviirus võib tekkida linnugripi baasil, kuid selle aluseks võib olla ka mõni muu gripiviirus, sest gripiviirus (eriti A-viirus) on väga muutuv.

Kust inimesed teavad, et pandeemia on alanud?
Gripipandeemia algusest annab teada Maailma Terviseorganisatsioon, kes kogub kogu maailmast grippi haigestumise andmeid ja analüüsib neid. Kui diagnoositakse uut tüüpi gripiviirus, mis on mingis piirkonnas hakanud kiiresti nakatama paljusid inimesi, siis võib seda suure tõenäosusega pidada pandeemia alguseks.

Kuidas Eestis saab teada esimesest linnugrippi haigestunust?
Linnugrippi haigestunust saab elanikkonda teavitada alles pärast seda, kui linnugripi diagnoos on laboris kinnitatud. Kuid kindlasti antakse üldsusele kiiresti teada juba sellestki, kui arstid on Eestis tuvastanud esimese linnugripikahtlusega haige.

Kas riik on teinud gripipandeemia puhkemiseks ettevalmistusi?
Sotsiaalministeeriumi eestvedamisel on kokku pandud riiklik gripipandeemiaks valmisoleku plaan, kus on kirjas erinevate ametkondade tegevused juhuks, kui korraga peaks haigestuma palju inimesi. Kuid vajalikke ettevalmistusi tuleb teha ka igal maakonnal, haiglal ja teistel asutustel, näiteks panna kokku tegutsemiskava ja siis korraldada õppusi.

Kuidas ennast ise kaitsta, kui pandeemia Eestisse jõuab?
Kui pandeemia peaks Eestisse jõudma, kehtestatakse epideemiatõrje meetmed, näiteks:

keelatakse massüritused,
suletakse lasteasutused,
piiratakse inimeste liikumist,
isoleeritakse nakatunud jne.
Haiguse leviku tõkestamiseks on oluline vältida:

lähikontakti haigega (gripiviirus levib ruumis köhapiiskadega kuni 1,5 m kaugusele),
kokkupuutumist haigestunu rögaga/ninaeritisega või sellega saastunud pindadega. Seepärast tuleks hoiduda rahvarohketest kohtadest ja võimalusel isegi ühistranspordivahendite kasutamisest.
Väga tähtis on käte pesemine, eeskätt pärast haige lähikonnas viibimist ja muidugi pärast tualeti kasutamist, enne sööki jne.
Gripihaigel ei ole soovitatav minna arsti juurde, arst tuleks koju kutsuda või küsida temalt ravisoovitusi.
Ööpäevaringselt saab nõu küsida ka üleriigiliselt perearsti telefonilt 1220.
Arvestada tuleb sellega, et täiskasvanu võib olla nakkusohtlik kuni 7 päeva ja laps kuni 21 päeva.

Mis saab siis, kui perest keegi haigestub?

· Gripihaige tuleb kohe paigutada eraldi ruumi ja piirduda tema hooldamisel 1–2 inimesega.

· Tuleb vältida lähikontakti haigega (gripiviirus levib ruumis köhapiiskadega kuni 1,5 m kaugusele) ning kokkupuutumist tema rögaga/ninaeritisega või sellega saastunud pindadega.

· Haigega suhtlemisel/tema hooldamisel tuleb kanda kaitsevahendeid: kindaid, kaitseprille, maski. (Maskideks sobivad apteekides müüdavad nn protseduurimaskid.)

· Kui tekib vajadus haiget ühest ruumist teise viia või kaugemale transportida, tuleb ka talle mask ette panna.

· Väga tähtis on käte pesemine, eeskätt pärast haige lähikonnas viibimist või pärast haige hooldamist.

· Haigena ei peaks ise arsti juurde minema, vaid ravijuhiste saamiseks tuleks arstiga ühendust võtta.

Ööpäevaringselt saab nõu küsida ka üleriigiliselt perearsti telefonilt 1220.

Kas pandeemia ajal tuleks tänaval liikudes kanda maski?

Tänaval maski kandmise efektiivsuse kohta tõendid puuduvad. Kindlasti aga tuleb mask ette panna juhul, kui on kokkupuude haigestunutega või kui haigestunu ise peab mingil põhjusel tänaval liikuma.

Aevastades ja köhides tuleb suu käega katta ning nuuskamisel on soovitatav kasutada ühekordseid pabertaskurätikuid. Ülimalt oluline on kinni pidada teistestki hügieenireeglitest, näiteks pesta tihti ja korralikult käsi.

Kas uus inimeselt inimesele leviv pandeemiline gripiviirus on juba tekkinud?
Maailma Terviseorganisatsiooni andmetel uut pandeemiliselt levida võivat gripiviirust tekkinud ei ole. Praegu käib põhiline jutt kahest erinevast gripist:

linnugripp, mis levib üldjuhul ainult lindude hulgas, kuid nakatunud on ka inimesi, kes puutusid kokku haigete lindudega;
n-ö tavaline, hooajaline gripp, mida on juba Eestiski sel talvel diagnoositud.

Mida tähendab tavaline, hooajaline gripp?
Gripp (influenza) on äge, aastast aastasse korduv nakkushaigus, mille tekitajateks on A-, B- ja C- gripiviirus.

A-gripiviirus on kõige ohtlikum, sest levib kiiresti ja muutub pidevalt, mistõttu inimesed on iga uue A-gripilaine suhtes vastuvõtlikud. A-gripp suudab põhjustada ülemaailmseid pandeemiaid, ka praegu inimesi ohustav linnugripiviirus H5N1 on A-tüvega.

B-gripiviirust iseloomustab suhteliselt paikne levik – tal ei ole omadust palju muutuda ning seetõttu ei põhjusta B-gripp ka laialdasi haigestumisi.

C-gripiviirus on harva esinev ning haigestumises olulist osa ei etenda.

Gripi tundemärgid on haiguse äge algus, palavik (üle 38°C), kuiv köha ja/või nohu ja vähemalt üks järgmistest üldnähtudest: halb enesetunne, peavalu, lihase ja/või liigesevalu, iiveldus.

Grippi ei saa lõplikult diagnoosida ilma labori analüüsideta.

Gripp on aastast aastasse korduv ehk hooajati esinev, ja kuna gripiviiruse tüvi on muutlik, siis tuleb end selle haiguse vastu igal aastal uuesti vaktsineerida. Igaks hooajaks annab vaktsiini koostise soovituse Maailma Terviseorganisatsioon, arvestades eelnenud aastail ringelnud gripiviiruse tüvesid.

Keda hooajaline gripp enim ohustab?
Gripi tüsistused ja surmaga lõppevad haigusjuhud tekivad peamiselt väikelastel, üle 65-aastastel inimestel ja immuunpuudulikkusega inimestel. Ohustatud on ka tervishoiutöötajad ja teised haigetega kokku puutuvad inimesed. Kuid hoida tasuks ennast ka kõigil neil, kes enimohustatud gruppi ei kuulu.

Mis vahe on linnugripil ja nn tavalisel gripil?
Kõige suurem vahe on see, et nn tavaline gripp levib juba praegu inimeselt inimesele, kuid linnugripi levikut inimeselt inimesele praegu veel täheldatud pole.

Kuidas vältida linnugrippi lindudel?
Linnugripi vältimiseks lindudel on Veterinaar- ja Toiduamet andnud rea soovitusi, näiteks:

pidada oma kodulinde suletud hoonetes, et takistada nende kokkupuudet nakkust kanda võivate lindudega,
tuleb kaitsta (katta) kodulindude söötmispaiku,
mitte lubada lindlasse võõraid,
farmis töötades kanda kaitseriietust,
pidada puhtust, paigaldada sisse- ja väljapääsude ette desomatid jne.
Koos teiste EL riikidega on Eesti keelanud ka eluslindude, linnutoodete ja -sulgede sisseveo linnugripi riskipiirkondadest.

Kas linnugrippi põdev inimene võib nakatada kodulinde või –loomi?
Tervisekaitseinspektsioonile ja Veterinaar- ja Toiduametile teadaolevalt ei ole selliseid juhtumeid maailmas tuvastatud.

Kas varem on esinenud gripipandeemiaid?
WHO andmetel on teada kolm tõsisemat gripipandeemiat:

1918.–1919. aastal nn Hispaania gripp H1N1 (põhjustas ca 40 mln inimese surma),
1957.–1958. aastal nn Aasia gripp H2N2 (ca 2 mln surnut),
1968.–1969. aastal nn Hongkongi gripp H3N2 (ca 1 mln surnut).
WHO arvestuste järgi võib puhkeda võiv gripipandeemia kogu maailmas põhjustada 2 mln kuni 7,4 miljoni inimese surma.

Gripipandeemia oletatav kestus on kuni kaks kuud.


Materjal on koostatud seisuga 13.02.2006

Soome uuendab oma valmisolekuplaane

Finland fears aquatic birds may bring bird flu link
13.2.2006 at 13:40

Finland's Ministry of Agriculture and Forestry said Monday that the risk of avian influenza spreading to Finland would increase with the spring migration of aquatic birds.

However, most of Finland's aquatic birds winter in Denmark and Britain, countries where bird flu has not yet been found.

"Small groups of birds come from other parts of the world, but it is not known whether these birds are susceptible to carrying the bird flu virus, nor if they could make it to Finland with the virus," said Matti Aho, a director general at the ministry.

The ministry has updated its readiness plan to take into account the bird flu risk.

tapvad tervitused

eilne new york times
Greetings Kill: Primer for a Pandemic linkin

By DONALD G. McNEIL Jr.
Published: February 12, 2006

TO the pantheon of social arbiters who came up with the firm handshake, the formal bow and the air kiss, get ready to add a new fashion god: the World Health Organization, chief advocate of the "elbow bump."

If the avian flu goes pandemic while Tamiflu and vaccines are still in short supply, experts say, the only protection most Americans will have is "social distancing," which is the new politically correct way of saying "quarantine."

But distancing also encompasses less drastic measures, like wearing face masks, staying out of elevators — and the bump. Such stratagems, those experts say, will rewrite the ways we interact, at least during the weeks when the waves of influenza are washing over us.

It has happened before, and not just in medieval Europe, where plague killed a third of the continent's serfs, creating labor shortages that shook the social order. In the United States, the norms of casual sex, which loosened considerably in the 1960's with penicillin and the pill, tightened up again in the 1980's after AIDS raised the penalty.

But influenza is more easily transmitted than AIDS, SARS or even bubonic plague, so the social revolution is likely to focus on the most basic goal of all: keeping other people's cooties at arm's length. The bump, a simple touching of elbows, is a substitute for the filthy practice of shaking hands, in which a person who has politely sneezed into a palm then passes a virus to other hands, whose owners then put a finger in an eye or a pen in a mouth. The bump breaks that chain. Only a contortionist can sneeze on his elbow.

Dr. Michael Bell, associate director for infection control at the federal Centers for Disease Control and Prevention, has done the bump a few times already. When Ebola breaks out in Africa, he's usually on the team sent to fight it.

"I'll arrive on the tarmac and stick out a hand to say hello," Dr. Bell said, "and someone from the W.H.O. team will say: 'No, no, no, we don't do that. We do the elbow bump now.' "

In truth, he said, they do it mostly to set a good example. To stop an Ebola outbreak, visiting doctors must persuade villagers in Angola or the Congo basin to refrain from washing dead bodies and using their bare hands when nursing family members dying of hemorrhagic bleeding.

Those distancing measures would be easy to enforce in a pandemic in New York City. But other likely steps will strike at things New Yorkers are loath to give up. Dr. Isaac Weisfuse, the deputy city health commissioner in charge of avian flu preparation, said his first move would probably be to ban Major League Baseball games, Broadway shows, movies, parades and other large gatherings.

Closing schools or shutting the subways might be even more effective, because children are much more efficient than adults at spreading flu, and subways are enclosed spaces where sneezes linger in the air — but doing that would be harder to pull off, Dr. Weisfuse said. "People talk about 'flu days' like snow days," he said, "and if it was just days or a week, that would be simple. But if it's weeks or months, that becomes another matter." Without mass transit, no one gets to work and the economy collapses, he pointed out, and many poor children depend on the free breakfasts and lunches they get at school.

An alternative is to limit people to necessary travel and to have them wear masks — a tricky thing.

Getting people to don masks in Asia is relatively simple, Dr. Bell said. Particularly in Japan, it is considered polite for anyone going to work with a cold to wear one. And in Asian cities full of soot and diesel exhaust, people often wear gauze masks on the street.

But in the United States, "we don't have a culture of courtesy mask use," he said, and people may feel foolish wearing them.

The government of Taiwan faced that problem three years ago during the SARS epidemic. It ordered everyone who had a cough or fever, or who cared for a family member or patients who did, to wear a mask if they ventured outdoors. The head of Taiwan's version of the Centers for Disease Control correctly noted that studies showed that masks do much more good if the sick wear them, keeping sneeze droplets in, than if the healthy do.

But masks were rare on the streets, and the mayor of Taipei, the capital city, decided to ignore the data and pay more attention to the psychology. The sick and exposed would never wear masks, he reasoned, if it marked them as disease carriers. So he simply issued a mayoral order: no one without a mask could ride the subway. The next day, everyone in Taipei was wearing them. Within a week, they had become a fashion item, printed with logos like the Nike swoosh, the Burberry plaid and the Paul Frank monkey.

Pictures of the 1918 flu epidemic include much evidence of that sort of mass psychology. In a photograph of ranks of Seattle police officers, all are wearing masks; in one of 45 Philadelphia gravediggers digging trenches for the dead, none wear them. In a photograph of dozens of beds in a military field hospital, almost all of the patients, doctors and nurses seem to have masks — but most in the foreground have pulled them down for the photographers. People act as the group acts.

When a disease seems far away, as avian flu still does, notions like mask fashion and elbow bumping sound like jokes. But when people start dying, panic ensues, and nothing seems too far-fetched to try. In the 1918 epidemic, Prescott, Ariz., outlawed handshaking. Some small towns tried to close themselves off, barricading their streets against outsiders and telling any citizen who left not to plan on coming back. In factories, common drinking cups gave way to a new invention: the paper cup.

Under pressure, people don't adopt only sensible precautions, they overreact, said Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. During the anthrax scare of 2001, he said, nervous citizens submitted 600,000 specimens of white powder to public laboratories. The samples included brownies with powdered sugar. Dr. Osterholm said he feared that public reactions would be out of sync with any epidemic; that people would get scared too early, then say the fear was overblown and dismiss it. Then, if a pandemic lasts for weeks, fatigue will set in. "We tend to be a just-in-time, crisis-oriented population," he said.

It is all in the timing, said Dr. Harvey V. Fineberg, president of the Institute of Medicine, the medical arm of the National Academy of Sciences. "In the middle of a major pandemic, with people dying, we're likely to see people hungry for clear instructions," he said. "What would backfire would be for you to say, 'Start bumping elbows now.' People would look at you as if you were from Mars."

12. veebruar 2006

Tervishoiuteenuste osutajate valmisolekust nakkushaiguste raviks


MATRA projekt MAT03/ES/9/1 - Nakkushaiguste tõrje suutlikkuse tõstmine Eestis, konverents 15.12.05
Tervishoiusüsteemi valmisolekust, Dr. Mihkel Tamme, Tervishoiuamet link

Raviasutuste nakkussuutlikkus:
Voodeid kokku 6798

Nakkusosakonnad :
AS LTKH –85+15
SA TÜK-8
SA Pärnu Haigla-18(20)
AS Ida-Viru Keskhaigla-12
Narva Haigla SA-20

Infektsioniste – 43
Anestesiolooge – 275
Erakorralise meditsiini arste - 118

Intensiivravi voodid:
Kokku: 619; I-II aste – 496 ;III aste – 123
SA PERH - 174 (127+47)
AS ITKH - 82 (72+10)
AS LTKH - 46 (44+2)
SA TLH - 48 (36+12)
SA TÜK - 152 (98+54)
SA Pärnu Haigla - 36 (32+4)
SA Ida-Viru Keskhaigla - 21 (18+3)
SA Narva Haigla -10 (7+3)
Nakkusosakondades intensiivravi voodeid ei ole, välja arvatud SA Pärnu Haigla-2)

pandeemiarisk kasvab linnugripi levides

Pandemic risk rises as bird flu spreads link
By Elisabeth Rosenthal and Donald G. McNeil Jr. The New York Times
SUNDAY, FEBRUARY 12, 2006

paar lõiku:

The arrival of bird flu in Italy, and in the European Union, had been predicted for some months, as the virus has marched steadily from eastern Asia, to Russia, to the Balkans and, in the last week, to West Africa. Experts say the virus is being carried by migrating birds, so all countries on their flight paths are vulnerable.

World health officials say they have not had the cooperation they need from many poor countries, even those on the flight paths of migrating birds known to carry flu. Because of poor surveillance and rudimentary laboratory capabilities, they often received lab samples for testing weeks or months after problems begin - and for that reason, they worry that the disease is already much more widespread than they can prove.
"We are fighting the good fight, but to win it we'll need a lot more proactive surveillance and prevention," said Juan Lubroth, a senior veterinarian at the UN Food and Agriculture Organization, in Rome. There was strong evidence that bird flu took root in Nigeria "a few months ago," Lubroth said, even though it was only confirmed last week, after Nigerian veterinary officials had said last Monday that bird flu was not in the country.

There may be more unreported outbreaks in Africa and the Caucasus region, he said. "We've been repeating over and over to countries that they have to be vigilant, but in most countries, it's business as usual. They say, 'Avian influenza isn't here now. We'll deal with it when it arrives.' But then it's too late." Maria Cheng, a spokeswoman for the World Health Organization, said the agency suspected there might be human cases of bird flu in Africa, but had no way to confirm that yet. "We're getting a team ready to go," she said, "but we're waiting to get the invitation from Nigeria."
But Africa also has the worst AIDS epidemic in the world; in some countries nearly a third of the adult population is infected. In the initial stages, having a depressed immune system could have a protective effect, said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, because virulent flus set off a powerful immune reaction that can drown the lungs in fluid. However, he added, it would probably hurt patients trying to fight off secondary immune reactions. But HIV-infected people who managed to fight off bird flu would become ideal crucibles in which the H5N1 virus could exchange genes with other viruses, dramatically increasing the likelihood of a bird flu strain that could readily infect humans. "If H5N1 gets into people with AIDS it would likely persist and throw off mutants left, right and center," Oxford said. If bird flu takes root in Africa - or if has already done so, undetected - it could prove disastrous not just for that continent, but for Europe as well, experts say, since the northern migration of birds begins next month. "The prospects are not good," said Oxford. "Soon they'll be coming back over Europe and why wouldn't it cause a great danger?" As a virologist, Oxford said that he could only assume that Nigeria was just the "red light we could see," but that there were similar bird flu problems in many other places.

11. veebruar 2006

WHO nõuab EU-lt aktiivset võitlust linnugripiga

WHO urges stronger response as bird flu hits EU link

ZURICH, Feb 11 (Reuters) - The World Health Organisation (WHO) called on Saturday for stronger surveillance and response after the first reported outbreak of the H5N1 bird flu virus in the European Union.

However, the Geneva-based U.N. health agency said it saw no reason to escalate its pandemic alert level.
"Surveillance and response of H5N1 in both animals and humans needs to be strengthened in all regions bordering countries where outbreaks have been identified," said WHO spokesman Dick Thompson.

Earlier on Saturday, Greece and Italy said they had found dead swans with the H5N1 bird flu virus, the first known cases in the European Union of wild birds with the deadly strain of the disease.

Intensified surveillance meant alerting hospitals to be on the lookout for patients arriving with flu symptoms and to ask whether they had any contact with sick birds. It also meant speeding up official reporting to health and veterinary officials of sudden deaths among birds, Thompson said.

"At this point it is still an animal disease and does not transmit very easily to humans," he told Reuters by telephone. "Even more rare is that it would transmit from one human to another."

However, he urged caution when dealing with sick or dead animals.

"It is important that people understand that they do not handle sick animals," he said. "We believe it has the potential to evolve into a pandemic virus."

Italy said wild swans found in the island of Sicily and the mainland regions of Puglia and Calabria had tested positive for the highly pathogenic version of the H5N1 strain.

Nigeria started testing people who had fallen ill close to where the virus was found in birds, in Africa's first outbreak of the disease.

"When the virus shows up in a new country, it doesn't mean that the pandemic has started, it means that the animal disease has spread," Thompson said.

"The animal disease is spreading and if we get the alert out now to humans we can lower the risk," he said.

The virus has killed at least 84 people in Asia since early 2003 and forced affected nations to cull millions of domestic fowl. Indonesia reported on Saturday that a 27-year-old woman had died of the disease, the second in two days.

9. veebruar 2006

luuletus

Bonemani luuletus cureventsist :)
natuke nalja ka sellel halval päeval

We're going die, We're going to die!
From demons in the sky!
What are we to do!
When we're hit with bird poo!

Hide under a wide brim hat!
Can't even be there for my cat!
Just hide out with my stuff!
I think I've had enough!

kuhu paigutada toiduvarud korteris?

cureventsis seda arutati, link
mõned kommentaarid sealt:

I bought those bed risers for all of the beds in the house. I t really increased the amount of storage.

We have placed 2 or more buckets on each other and then topped with a round of plywood for end tables, stacked them in a large closet to the ceiling, we have underbedd storage containers also full of needed items,and we are thinking about replacing the kitchen table legs with buckets.

We got rid of our bed, built a higher platform and use the space under the bed. We can fit 3 cases of #10 cans high. There is quite a lot of space under there! You can also make a kitchen table, coffee table, end tables out of stacked cases of food, just throw a nice tablecloth over it, and it looks fine.

Do you have high ceilings? If so, consider dropping them a bit with a false ceiling and store things up there.

The first thing to do is to step back and really look at your rooms. Think wall shelves, corner shelves, clear plastic boxes stacked for toys, etc., and/or baskets, boxes, netting, and so on. There is always lost space at the top of closets; room for a shelf or two. There is also often wasted space at the bottom of closets.
The space saving organization of current possessions will help free up space and make way for creative storage ideas for Preps.

A member a while ago, suggested creating storage space along a living room wall by putting several rows of 10 inch or so, shelving along the wall, pushing the couch, etc. up against it, and adding pictures, vases, and decorative items to the top shelf. The shelving unit can be made out of easy to use, items like bricks and boards and covered with burlap, bamboo, or fabric to cover up the design, if desired. For the loss of 10-12 inches in a room, you get a lot of additional storage space.

I got rid of a foot stool and bought a large heavy duty plastic tub with a lid. I got a large plush pillow to fit the lid and then threw a colorful afghan over the whole thing. I now have extra storage sitting right out in the middle of the living room plus a comfy foot-stool.

I've found that during my initial preps, I found a lot of very old stuff that I was able to simply throw away, making quite a bit more space.

Extend your curtain rods beyond the width of the windows, and add floor-length curtain panels on either side. Stack canned goods on the floor behind the curtains. This is also a good place to store tall items like rolls of wrapping paper.

8. veebruar 2006

kuidas öelda EI soovimatutele öömajaotsijatele

cureventsis käis arutelu, et kuidas selgeks teha ämmale vm kaugematele sugulastele, et sa ei taha neid oma koju kui pandeemia peaks käivituma

Jonesie kirjutas järgmist:

I have had friends want to come to my place after 9/11 in case of a terrorist attack.
I told them, fine. "But all my kids and their friends will be staying with me also. And my 3 cousins and an old aunt...and 3 babies. I just don't have the heart to turn anyone away for any reason.
So please bring all the food in your freezer, your canned goods and money, your bedding and mattress. The couch will be used by my 90 year old auntie. She is incontinent, so there will always be her undies hanging in the bathroom drying out. Baby diapers too. Hope you don't mind sleeping on the floor. It will be wall to wall sleeping arrangements. Probably will be upwards to 35 people on any given weekend. 15 or 20 during the week. Bring a carboard box to keep all your toiletries and other things in. Write your name on it. We will stack boxes along one wall.
There will be a 5 minute limit in the shower. And everyone draws numbers for the toilet."
Funny thing, every one of my friends said they always had another place to go to. And nobdy came to visit after that either.

:DDD

ühelt poolt on mõistlik muidugi grupeeruda, teiselt poolt tuleb ka see enda jaoks läbi mõelda, keda sa oleksid nõus oma katuse alla võtma ja kellega oma varusid jagada

7. veebruar 2006

1918: nälgivad koerad

cureventsis üks trükkis lõigu sisse Barry raamatust, peab tõdema, et see jäi mulle ka lugedes silma :S

From John Barry's: The Great Influenza: The Epic Story of the Deadliest Plague In History (The Story of the 1918 Influenza Pandemic.)

One of the most chilling portions of that book IMO (Chapter Title: Tolling of the Bell; pp 361-362):

"On the opposite edge of the continent the story was the same. In Labrador man clung to existence with tenacity but not much more permanency than seaweed drying on a rock, vulnerable to the crash of surf at high tide. The Reverend Henry Gordon left the village of Cartwright in late October and returned a few days later, on October 30. He found "not a soul to be seen anywhere, and a strange, unusual silence." Heading home, be met a Hundson's Bay Company man who told him "sickness...has struck the place like a cyclone, two days after the Mail boat had left." Gordon went from house to house. "Whole households lay inanimate on their kitchen floors, unable even to feed themselves or look after the fire."

Twenty-six of one hundred souls had died. Further up the coast it was worse.

Of 220 people at Hebron, 150 died. The weather was already bitter cold. The dead lay in their beds, sweat having frozen their bedclothes to them. Gordon and some others from Cartwright made no effort to dig graves, consigning the bodies to the sea. He wrote "A feeling of intense resentment at the callousness of the authorities, who sent us the disease by mail-boat, and then left us to sink or swim, filled one's heart almost to the exclusion of all else...."

Then there was Okak. Two hundred sixty-six people had lived in Okak, and many dogs, dogs nearly wild. When the virus came it struck so hard so fast people could not care for themselves or feed the dogs. The dogs grew hungry, crazed with hunger, devoured each other, and then wildly smashed through windows and doors, and fed. The Reverend Andrew Asboe survived with his rifle beside him; he personally killed over one hundred dogs.

When the Reverend Walter Perret arrived, only fifty-nine people out of 266 still lived. ...

In all of Labrador, at least one-third the total population died."

mida võiks teada pandeemiast

üks kena ratsionaalne selgitus :) - selline võiks meie ajakirjanduses ka olla ;)
San Juani saared asuvad Washingoni lähedal

What you should know about pandemic flu link
By Dr. Frank James San Juan County Health Officer
and Brendan Cowan Director, Department of Emergency Management

What would a "pandemic" mean for San Juan County? Predicting the results of a pandemic is as much art as science. We use past flu outbreaks (like the ones in 1918 and 1957) to guide us. Current thinking suggests that somewhere between 3,500 and 4,500 islanders would become infected. Of those sick, there could be up to 500 deaths, but perhaps 120 fatalities is a more realistic figure.
Pandemics typically come in two to three waves of active infection. Each wave would last six to eight weeks and would be repeated after an interim period of little or no disease in the community. All schools, daycares and public gathering spots will likely be closed for the duration of each wave.

Can we isolate the islands early on and prevent the spread of disease here?
This is an appealing idea, but impractical and perhaps illegal. People are contagious with the flu before they show symptoms, so it is impossible to screen arrivals to the islands.

The logistics of restricting all arrivals would take more manpower than we have locally, and the reality is that in the past this type of isolation has been ineffective in stopping the spread of disease. A more effective approach is to aggressively close public gatherings of all kinds, and to strongly encourage residents to stay home and minimize exposure.


If I am sick, will I be confined to my house?
People with fever and cough will be strongly encouraged to stay at home. A phone triage system will be established to evaluate whether a patient needs more advanced care.

Forced isolation could be used in the case of a contagious individual who purposefully put others at risk, but it will truly be in everyone’s best interest to minimize their own exposure, and once sick to avoid spreading the illness to friends, co-workers, neighbors and other islanders.

During each active phase of the pandemic, upwards of 30 percent of the workforce is likely to be staying home, either because they are sick, are taking care of someone who is, or are caring for children who are out of school.

Because a pandemic will affect communities across the globe, food, fuel, access to mainland healthcare, and other services and supplies we’ve come to count on may be in short supply.

What do I need to do to prepare?
As with all disasters, being able to keep you and your family warm, fed, hydrated and supplied with vital medications is critical. If islanders are prepared individually, the islands will survive collectively. During a pandemic, power, water and other essential services will likely continue without interruption, but access to food, fuel and routine healthcare may be limited.
Having a supply of three to five “N-95” masks for each of your family members is a very inexpensive and simple step toward protecting yourself. Talk to your local pharmacist about how to obtain them, or look on the Internet.

It makes sense to stockpile a supply of food. Build up a surplus, rotate through what you’ve stored, and make sure you replace what you use. In addition to weathering shortages, if you and your family can take care of yourselves from home without frequent trips out, you’ll minimize your chances of interacting with contagious islanders. For information on what and how to stockpile, go to www.sanjuandem.net.

Perhaps the hardest but most critical step to prepare is to truly understand that in the event of a pandemic, the world will be a different place. Routine services will be limited and much that we take for granted in our regular lives will be unavailable or stopped. To survive the challenge will take preparation, patience and perseverance. It won’t be easy and there will be no magic solution.


linnugripihirmu mõju aktsiaturgudele

Stocks Fall After Bird Flu Strain Detection link

By ELLEN SIMON AP Business Writer

NEW YORK Feb 7, 2006 (AP)— Stocks turned lower Tuesday after Hong Kong authorities said they suspected two birds that died in the area were infected with a deadly strain of the bird flu virus.

Nervous investors have been fearing news of a bird flu pandemic, which has potential to send affected economies grinding to a halt and stymie international trade. The news comes at a time when Wall Street is especially nervous about what it calls "the geopolitical situation," which includes Iran's nuclear program and unrest in oil-rich Nigeria.

viieastmeline aktsepteerimine ja kommentaarid

eelpool oli sellest ka juttu, aga tõlkisin ära ja kommenteerisin (endast lähtuvalt) :p

1) eitus
selline asi ei ole võimalik, siin ja lähitulevikus,
võibolla kuskil hiinas kanad surevad ja paar hiinlast, a mis see meisse puutub?
peale selle on AIDS ja tuberkuloos märksa ohtlikumad haigused eestis ja nendega tuleb tegeleda!

2) viha
MIKS KEEGI MIDAGI EI TEE??
pagana ametnikud
kus on tamifluhunnikud ja ettevalmistusplaanid, ahh?
istuvad seal sadade viisi ja mitte midagi ei tee!

3) hamsterdamine
siis tuleb hamsterdamiseperiood .. ostadostadostad
ja teed nimekirju mida veel vaja osta
ja siis ostad veel edasi
ja siis ahastad et kuhu ma selle kõik ometi topin ..

4) depressioon
miks seda üldse mõtet teha on???
kui niikuinii enamus sureb ja kestab nii kaua ja on ülinakkav?
ma ei saa mitte midagi ju teha
ja üleüldse on see nii õudne

5) aktsepteerimine
nojah, kui peab nii minema siis läheb :)
eks ma teen omalt poolt kõik mida ma suudan,
ja edasise suhtes loodan saatusele/jumalale/kaitseinglitele

ma vist olen juba viiendal astmel .. mitmendal sina oled? :D

6. veebruar 2006

viieastmeline aktsepteerimistee

oli cureventsis arutelu teemal, et kuidas inimesed psühholoogiliselt suudavad aktsepteerida võimalust, et pandeemia on reaalne oht
üks kommentaar:

I think once I realized that a flu pandemic is a real possibility, I experienced the loss of a certain type of innocence. With that loss began a process of grieving, not unlike when someone dies.
I think we're all in various stages of grief.
As I understand it, the five typical stages are
1) Denial (most people we know are still here)
2) Anger (I'm guessing some soldiers in Iraq may be here soon)
3) Bargaining (PREPPING, busy, busy, busy... pretend control!!!!)
4) Depression
5) Acceptance

pandemic reference guides

infokogu - kogutud ja lahterdatud lingid
Pandemic Reference Guides link

The most important way to prevent the spread of communicable disease is to wash your hands.
The single most important thing you can do to survive a disaster is to be mentally prepared.
Being prepared for an emergency will ultimately save lives.

Flu Information
Prevention
Infection Control
Disinfection
Personal Protective Equipment (PPE)
Nursing
Quarantine
Emergency Preparation for Individuals
Emergency Preparation for Businesses
Food
Water
Emotional and Psychological Support
Related Issues
Related Issues – Agriculture
Commercial Websites

5. veebruar 2006

US: Tamiflu prioriteedid

Antiviral Drug Priority Group Recommendations
Info extracted from U. S. HHS Pandemic Influenza Plan
Page D-21 thru D-29

For each priority group, the plan provides a definition, a rationale for why this group is considered a priority and a medication strategy or how much antiviral a member of a group will be given. Info is also included re:estimated number for each group, as well as any "unresolved issues" pertaining to that group.

Listed strategies for Tamiflu use: Treatment (T) requires a total of 10 capsules and is defined as 1 course. Post-exposure prophylaxis (PEP) also requires a single course. Prophylaxis (P) is assumed to require 40 capsules (4 courses) though more may be needed if community outbreaks last for a longer period.

Selected Comments:
"Based on this guidance, state, local, and tribal implementation plans should be developed to 1) include more specific definitions of the priority groups (e.g., which functions are indeed critical to maintaining continuity) and their size; 2) define how persons in these groups will be identified; and 3) establish strategies for effectively and equitably delivering vaccines and antiviral drugs to these populations. The committees acknowledged that further work is needed, in particular, to identify the functions that must be preserved to maintain effective services and critical infrastructures and to identify the groups that should be protected to achieve this goal. The committees also acknowledge that the specific composition of some priority groups may differ between states or localities based on their needs and that priority groups should be reconsidered when a pandemic occurs and information is obtained on its epidemiology and impacts."

“The committee considered the primary goal of a pandemic response to decrease health impacts including severe morbidity and death. Minimizing societal and economic impacts were considered secondary and tertiary goals.”

Antiviral Drug Priority Group Recommendations
1. Persons admitted to hospital with influenza infection
2. Healthcare workers and emergency medical service providers who have direct patient contact
providers.
3. Outpatients at highest risk for severe morbidity or mortality from influenza infection
4. Pandemic health responders, public safety workers, and key government decision-makers
5. Outpatients at increased risk of severe morbidity or mortality from influenza
6. Outbreak control
7. Healthcare workers in ER, ICU, EMS, and dialysis settings
8. Pandemic societal responders and healthcare workers who have no direct patient contact
9. Other outpatients

In addition to recommendations for priority groups, NVAC unanimously adopted the following recommendations:
Sufficient drugs should be stockpiled to address top priorities. NVAC recommends that the minimum stockpile size be about 40 million courses, allowing coverage of the top 7 priority groups.

Antiviral Drug Priority Group Recommendations
1. Persons admitted to hospital with influenza infection

a) Definition
Persons admitted to acute care facilities (traditional or non-traditional with a clinical diagnosis of influenza; laboratory confirmation not required). Excludes persons admitted for a condition consistent with a bacterial superinfection (e.g., lobar pneumonia developing late after illness onset) or after viral replication and shedding has ceased (e.g., as documented by a negative sensitive antigen detection test)

b) Strategy
Treatment within 48 hours of symptom onset. (10 capsules)

c) Rationale
This group is at greatest risk for severe morbidity and mortality. Although there are no data to document the impacts of antiviral drug treatment among persons who already suffer more severe influenza illness, benefit is biologically plausible in persons with evidence of ongoing virally mediated pathology (e.g., diffuse pneumonia, ARDS). Providing treatment to those who are most ill is also consistent with standard medical practices, would be feasible to implement, and would be acceptable to the public.

d) Population size
The number of persons admitted to hospital in an influenza pandemic would vary substantially depending on the severity of the pandemic and on the ability to expand inpatient capacity, if needed.

e) Unresolved issues
More specific guidance should be provided to healthcare workers on implementing antiviral treatment, including when and when not to treat. In some persons with severe illness, the ability to take oral medication or its absorption may be important issues. For infants <1 year old admitted to hospital, decisions about whether to treat with antiviral drugs may depend on the child’s age and potential risk versus benefit as the neuraminidase inhibitors are not licensed for use in infants. If possible, data on time from symptom onset to hospital admission, current use of antiviral drug treatment among inpatients, and its impacts should be collected during interpandemic influenza seasons.

2. Healthcare workers and emergency medical service providers who have direct patient contact

a) Definition
Persons providing direct medical services in inpatient and outpatient care settings. Includes doctors, nurses, technicians, therapists, EMS providers, laboratory workers, other care providers who come within 3 feet of patients with influenza, and persons performing technical support functions essential to quality medical care.

b) Strategy
Treatment within 48 hours of symptom onset. (10 capsules)

c) Rationale
Maintaining high quality patient care is critical to reduce health impacts of pandemic disease and to prevent adverse outcomes from other health conditions that will present for care during the pandemic period. Treatment of healthcare providers will decrease absenteeism due to influenza illness and may decrease absenteeism from fear of becoming ill, given the knowledge that treatment can prevent serious complications of influenza. Good data exist documenting the impacts of early treatment on duration of illness and time off work, and on the occurrence of complications such as lower respiratory infections. Treating healthcare providers is feasible to implement, especially for inpatient care providers who can be provided drugs through the occupational health clinic. It also would be acceptable to the public, who would recognize the importance of maintaining quality healthcare and would understand that persons with direct patient contact are putting themselves at increased risk.

d) Population size
There are about 12.6 million persons designated as healthcare workers by the Bureau of Labor Statistics and about 820,000 EMS providers. Among HCWs, two-thirds are estimated to provide direct patient care services.

e) Unresolved issues
Further work is needed to hone definitions and estimate population sizes. Implementation issues include the approach to identifying healthcare providers who would be eligible for treatment and where the treatment would be provided, particularly for outpatient care providers.

3.Outpatients at highest risk for severe morbidity or mortality from influenza infection

a) Definition
The Advisory Committee on Immunization Practices defines groups at high risk (or increased risk) of complications from influenza infection during annual outbreaks based on age (6-23 months and >65 years) and underlying illnesses. Among this population of about 88 million persons, some can be identified who are at highest risk of severe disease and death. These include persons with hematopoetic stem cell transplants (HSCT) and solid organ transplants; those with severe immunosuppression due to cancer therapy or hematological malignancy; persons receiving immunosuppressive therapy for other illnesses (e.g., rheumatoid arthritis); persons with HIV infection and a CD4 count <200; persons on dialysis; and women who are in the second or third trimester of pregnancy.

b) Strategy
Treatment within 48 hours of symptom onset. (10 capsules)

c) Rationale
Of the large group of persons who are at increased risk of severe disease or death from influenza, these groups represent the population at highest risk and who are least likely to be protected by vaccination. Studies show that neuraminidase inhibitor therapy decreases complications and hospitalizations from influenza in high-risk persons and one unpublished study shows a significant decrease in mortality among patients who have undergone a hematopoteic stem cell transplant.

d) Population size
About 150,000 persons have had an HSCT or solid organ transplant. Assuming that the period of severe immunosuppression after a cancer diagnosis lasts for 1 year, the population targeted with non-skin, non-prostate cancers would equal the incidence of about 1.35 million persons. Based on a birth cohort of 4.1 million, a 28-week risk period during the second and third trimesters, and an 8-week pandemic outbreak in a community, there would be about 400,000 pregnant women included in this risk group. Further work is needed to estimate the size of other immunosuppressed groups.

e) Unresolved issues
Specific definition of included groups and population sizes.
4. Pandemic health responders, public safety workers, and key government decision-makers

a) Definition

Public health responders include those who manufacture vaccine and antiviral drugs; persons working at health departments who are not included as healthcare workers; and those who would be involved in implementing pandemic vaccination or other response components. Public safety workers include police, fire, and corrections personnel. Key government decision-makers include chief executives at federal, state, and local levels.

b) Strategy
Treatment within 48 hours of symptom onset. (10 capsules)

c) Rationale
Preventing adverse health outcomes and social and economic impacts in a pandemic depend on the ability to implement an effective pandemic response. Early treatment of pandemic responders will minimize absenteeism and ensure that vaccination and other critical response activities can be maintained. Implementing early treatment for public health workers and vaccine manufacturers is feasible at workplace settings. Public safety workers prevent intentional and unintentional injuries and death, are critical to maintaining social functioning, and will contribute to a pandemic response, for example by ensuring order at vaccination clinics. A small number of decision-makers at federal, state, and local levels are needed to for an effective pandemic response.

d) Population size
An estimated 40,000 workers who produce pandemic vaccine and antiviral drugs in the U.S.; ~300,000 public health workers who would not be included in the HCW category; 3 million public safety workers; and a small number of government decision-makers.

e) Unresolved issues
Need to define the exact composition and size of this group.

5. Outpatients at increased risk of severe morbidity or mortality from influenza

a) Definition
For planning purposes, this group would include those currently designated as high-risk groups, except for those who have been categorized as being at highest-risk and included in a separate category. This increased-risk group includes persons 6-23 months and >>65 years old, or who have underlying illnesses defined by the ACIP as associated with increased risk. Definition of this group may change based on the epidemiology of the pandemic.

b) Strategy
Treatment within 48 hours of symptom onset. (10 capsules)

c) Rationale
Early treatment has been shown to significantly decrease lower respiratory infections and to reduce the rate of hospitalization in elderly and high-risk populations. By extrapolation and based on the results of one small uncontrolled study, significant reductions of mortality can be expected as well. As these risk groups are familiar to the public given recommendations for annual vaccination, communication would be easy and acceptability high.

d) Population size
About 85.5 million persons are included in this group. Although all are at increased risk of annual influenza compared with the healthy under-65 year old population, there are different levels of increased risk for severe complications and death within this category. Further stratification may be possible based on several parameters including number of underlying conditions; recent hospitalization for a high-risk condition, pneumonia, or influenza; and age.

e) Unresolved issues
Stratifying this group into those at greater and lesser risk may be important if antiviral supplies are limited. Implementing treatment will be challenging given that it should be provided at the initial point of care to accrue the greatest benefit from early therapy.

6. Outbreak control

a) Definition
Use of antiviral drugs to support public health interventions in closed settings where an outbreak of pandemic influenza is occurring.

b) Strategy
Treatment of cases and post-exposure prophylaxis of contacts (once daily antiviral medication for 10 days).

c) Rationale
Influenza outbreaks in nursing homes are associated with substantial mortality and morbidity. Nursing home residents also are less likely to respond to vaccination. Post-exposure prophylaxis has been shown to be effective in stopping influenza outbreaks in closed settings.

d) Population size
The number of outbreaks that may occur during a pandemic is unclear. Measures should be implemented to prevent outbreaks including limiting visitors, vaccination of staff, furloughing non-critical staff, and screening and exclusion for illnesses consistent with influenza.

e) Unresolved issues
Should this policy also be implemented in prisons or other settings where explosive spread of illness may occur but the risk for severe complications is not high?

7. Healthcare workers in ER, ICU, EMS, and dialysis settings

a) Definition
Includes all staff in these settings who are required for effective functioning of these health care units.

b) Strategy
Prophylaxis (40 capsules)

c) Rationale
Optimally effective functioning of these units is particularly critical to reducing the health impacts of a pandemic. Prophylaxis will minimize absenteeism in these critical settings.

d) Population size
Need to obtain population estimates.

e) Unresolved issues
Population sizes

8. Pandemic societal responders and healthcare workers who have no direct patient contact

a) Definition
This group includes persons who provide services that must be sustained at a sufficient level during a pandemic to maintain public well-being, health, and safety. Included are workers at healthcare facilities who have no direct patient contact but are important for the operation of those facilities; utility (electricity, gas, water), waste management, mortuary, and some transport workers.

b) Strategy
Treatment within 48 hours of symptom onset.(10 capsules)

c) Rationale
Maintaining certain key functions is important to preserve life and decrease societal disruption. Heat, clean water, waste disposal, and corpse management all contribute to public health. Ensuring functional transportation systems also protects health by making it possible for people to access medical care and by transporting food and other essential goods to where they are needed.

d) Population size
Within these broad categories, there are about 2 million workers at healthcare facilities who have no direct patient contact; 730,000 utility workers; 320,000 waste management workers; 62,000 in mortuary services; and 2.3 million in transportation. Not all occupations within these categories would be classified as pandemic societal responders. Estimates are that 35% of this population will develop illness and present within 48 hours of onset regardless of pandemic severity.

e) Unresolved issues
Need to stratify within these groups to identify who fills specific pandemic societal response functions and to assess whether those functions could still operate if a substantial proportion of the workforce became ill during a 6-8 week pandemic outbreak within a community. Implementation issues need to be addressed, especially with respect to how persons would be identified as falling within this priority group when presenting for treatment and where that treatment would be provided.

9. Other outpatients

a) Definition
Includes persons not in one of the earlier priority groups.

b) Strategy
Treatment within 48 hours of illness onset. (10 capsules)

c) Rationale
Treatment reduces the risk of complications and mortality, reduces duration of illness and shortens time off work, and decreases viral shedding and transmission. If sufficient antiviral supplies are available, providing treatment to all who are ill achieves equity and will be most acceptable to the public.

d) Population size
There are an estimated 180 million persons who are not included in previously targeted groups.

e) Unresolved issues
Consider whether there are any strata that can be defined within this population.
Note: a chart of the priority groups on pg. D-21 contains the following 2 groups that were not accounted for in the the wider explanations listed above:

Highest Risk Outpatients:
Definition: Unknown
Strategy: Prophylaxis (40 capsules)
Rationale: Prevents illness in the highest risk groups
for hospitalization and death
Population: Estimated 2.5 million
Unresolved issues: Unknown

Other Health Care Workers with direct patient contact
Definition: Unknown
Strategy: Prophylaxis (40 capsules)
Rationale: Prevention would best reduce absenteeism
and preserve optimal function.
Population: Estimated 8 million
Unresolved issues: unknown


C. Additional NVAC recommendations on antiviral drugs for pandemic influenza :

In addition to recommendations for priority groups, NVAC unanimously adopted the following recommendations:
Sufficient drugs should be stockpiled to address top priorities. NVAC recommends that the minimum stockpile size be about 40 million courses, allowing coverage of the top 7 priority groups.
Oseltamivir should be the primary drug stockpiled, but some zanamivir also should be obtained as it is effective against some oseltamivir-resistant strains, may be preferred for treatment of pregnant women, and supporting two manufacturers enhances security against supply disruptions. Approximately 10% of the stockpile should be zanamivir if feasible and cost effective. No additional adamantanes should be stockpiled.
Antiviral drugs can also be used as part of an international effort to contain an initial outbreak and prevent a pandemic. Use to slow disease spread early in a pandemic may be useful but requires large amounts of drug.
Critical research should be conducted to support development and implementation of recommendations for pandemic influenza antiviral drug use, including:
Impact of treatment at hospital admission on outcome
Optimal treatment dose for H5N1 and other potential pandemic strains
Sensitivity and use of rapid diagnostic tests for H5N1 and other influenza strains with pandemic potential
Safety and pharmacokinetics of oseltamivir among infants <1 year old
Investigation of the impact of other drugs (new antiviral agents and other classes such as statins) on influenza
Additional work with public and private sector groups should be done to further hone definitions of target groups and their estimated population sizes, and to provide further guidance on antiviral drug distribution and dispensing.

kahte sorti ettevalmistujad

cureventsi foorumist üks hea kommentaar, mida ma ei raatsi jätta siia kopeerimata :D
kirjutab Frankilee link

It's becoming increasingly obvious that there are two very distinct camps here at CE. There are many similarities between the two, but one HUGE divide as well.

Group 1 has prepared and plans on riding it out with as much limited exposure as possible. Private transportation, social distancing etc. Proper hygiene. Group 1 believes that after 3 months or so, (see poll) life will pretty much return to normal. "Wow, that pandemic was bad! Nasty stuff that flu! Almost lost an uncle. Who do you think will win the world series?"

Group 2 is prepared and has also put into place measures for telecommuting. Group 2 will not under any circumstances, or very limited ones, risk exposure to the populace. Group 2 understands that this may well lead to a significant breakdown of services and even the collapse of society. Group 1 snickers like children in church when these assertions are made. Group 2 has prepared as best as one can for total chaos, if preparing for such is truly possible.


Both camps have their spokespeople. Group 1 posts threads like "Vaccine 100% effective!" "Tamiflu appears to work against...." "Bird flu fears overblown!"

Group 2 posts Osterholm and others but silently bookmarks sites such as:

"This is a nation-busting event!" warned Tara O'Toole, CEO of the University of Pittsburgh Medical Center's Center for Biosecurity. Speculating that 40 million Americans could die -- that's about one in eight -- she warned: "We must act now."

"We and the entire world remain unprepared for what could arguably be the most horrific disaster in modern history," inveighed Gregory A. Poland of the Mayo Clinic and the Infectious Diseases Society of America. Somebody in the audience sneezed, and Poland added: "The clock is ticking. We've been warned."

http://www.washingtonpost.com/wp-dy...5101202250.html

Or:

Bird flu 'could be 21st-century Black Death'

· Economists predict rioting and flight from cities
· Markets not prepared for risks occurring together

The assessment, undertaken by risk experts at the insurance companies Swiss Re and Marsh and McLennan (MMC), and Merrill Lynch and given at last weeks World Economic Forum in Davos:

"These impacts might include the disruption of supply chains and trade flows; an exacerbation of financial imbalances and the transformation of intellectual property regimes for pharmaceutical products; rioting to gain access to scarce supplies of antivirals and vaccines; a collapse of public order; partial de-urbanisation as people flee population centres; the extinction of trust in governments; decimation of specific human skill sets; and forced, large-scale migration, associated with the further collapse of already weak states."

It added: "In such a scenario, the impact on society might be as profound as that which followed the Black Death in Europe in 1348. That plague caused a fundamental transformation of socio-economic relations in Europe."

http://business.guardian.co.uk/story/0,,1695910,00.html

Or:

Russian Expert Says Flu Epidemic May Kill Over One Billion This Year

The world is on the brink of a major flu epidemic — one that could claim more than a billion lives, the head of the Russian Virology Institute, Academician Dmitry Lvov said at a press conference organized by the RIA-Novosti news agency on Thursday.

"Up to one billion people could die around the whole world in six months," Lvov said. The expert did not give a timeframe for the epidemic, but said that it is highly probable that it will start this year. "We are half a step away from a worldwide pandemic catastrophe," the academic said.

The Russian expert said that U.S. researchers possessed data suggesting that if a pandemic hits, up to 700,000 people will fall ill in the United States. He said that the population of the United States can be roughly compared to that of Russia and thus the number of cases will be approximately the same.

http://www.mosnews.com/news/2004/10/28/pandemic.shtml

Or:

David Nabarro, the U.N.'s top influenza coordinator at last week's world economic forum:

One of the most important conclusions (from a pandemic simulation) was that maintaining infrastructure -- water, power and the provision of food -- could take a higher priority than providing care to the sick, Nabarro told Reuters.

"It is maybe even more important to concentrate on the essentials of life for those who are living than it is to focus on the treatment of those who are sick," he said.

"Governments are starting to realize that they are nowhere near prepared for the damage that it could cause," he said at a panel discussion.

I guess you can tell which camp I'm in.


4. veebruar 2006

toiduvarud USA-s

Food: U.S. Achilles’ heel? link
Publishing date: 02.02.2006 22:20

The U.S. has been giving away a lot of food in recent years. So much food, in fact, has American given away that its own emergency food reserves are shockingly low.

There was a time, not too long ago, that by law the U.S. government was forced to maintain emergency food provisions for every man, woman and child in the country for three years.
That was considered good stewardship through much of the 1960s. It was a program put together by men who read the Bible and recalled the idea Joseph gave the Pharoah to avoid famine in the seven lean years.

But then the political winds of change began to blow through America. There were calls in Congress to bail out starving nations throughout the world. There were even actions to bail out America’s enemies – like the Soviet Union.

Within 20 years, the grain elevators were virtually empty – yet the amount of food given away as direct aid to foreign nations continued to increase.

By 1996, the U.S. Department of Agriculture claimed – and it was something of a hollow boast — that there was enough emergency food in storage to provide for every American in the cities for three days. The total was five days, the USDA said, for those in rural areas in the event of a national emergency.

Then came Sept. 11, 2001. There was talk of nuclear terrorism, biological and chemical weapons threats. America had seen that it was not invulnerable to massive, unforeseen attacks. Rogue nations such as North Korea and Iran were developing nuclear weapons and the missiles to fire them.

The Department of Homeland Security was formed and hundreds of billions were spent to make Americans feel safe.

But the food supply continued to dwindle.

By 2003, the USDA stopped counting in terms of “days” for emergency food supplies, because there was less than one day for every American. The new calculations were made not in terms of time, but in terms of pounds. They were made not in terms of how much food was actually stored and awaiting delivery, but rather how much was in the economy – including what was currently being harvested, what was on store shelves, what was en route in the transportation system.
The federal government claimed, under this new formulation, that there were 77 pounds of food per person in the U.S. at any given moment. Yet the number has continued to plummet more rapidly than ever before.

By September 2005, there were only 15.7 pounds of food for every American. That represented an 80 percent decrease in just two years.

According to USDA figures analyzed by Alan Guebert of the Farm & Food Report, the decrease gets worse every day. Of the 15.7 pounds of emergency food per person, 11 pounds consists of unprocessed wheat – of questionable value in times of emergency. The rest consists of non-fat dry milk, cheese, corn, peanuts and lentils.
Even after the Katrina disaster, almost no one is talking about food supplies in America.

epidemioloogia

ARMED FORCES EPIDEMIOLOGY BOARD 6-7 December 2005
link
lk 107-130
otsene jutt levikust, lindudest, ravimitest - aga puudutab ehk rohkem planeerijaid kui lihtinimesi :D
seega, ei viitsi kopeerida, kel vaja või huvi loeb ise :)

lisatud: foorumis keegi noppis olulisemad faktid välja
* says it was in 15 countries in the first of Dec.
* Virologist in Hong Kong states, "Avian flu virus can be found in most poultry markets in China".
* DOD purchased 24 million capsules of Tamiflu 15 million of which were to be delivered Dec. 15. 5mill to be delivered 28, Fed.
* They (DOD or Department of Defense) have also bought 10% of all known Relenza supplies.
* Ms. Embry (unknown person who evidently works for the Bush admin.) says their first priority is protecting our forces and the second is keeping business between countries alive. She also states that they are walking a tightrope re: what their position should be in protecting the public and their international partners happy. And balancing the other priorities. Fairly straightforward speech in my estimation. The American public wasn't as high on the list as I would like to have seen.
* 20% of pediatric patients develop a resistance to Tamiflu

3. veebruar 2006

just-in-time ruulib

Stockpiles should include more than vaccines and anti-virals, says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
"Today we have a just-in-time delivery system for masks, syringes, for IV bags," he says. "Most people don't realize that 80% of the drugs we use in this country come from offshore. Right now, the two manufacturers of N95 masks in this country are operating on 100% capacity. They have no surge capacity. We will run out quickly of all these things. And at that time, we'll be dealing with the equivalent of a 1918 health care system." link

meditsiinivarustus laevadele

CRUISING MEDICAL KIT link
This medical kit is designed to be of use to cruising sailors and to anyone else that may need to function independantly of traditional medical resources.

maskid ja nende korduvkasutus hädaolukorras

kirjutatud küll SARS-i jaoks, aga pidavat sobima ka gripi korral

Interim Domestic Guidance on the Use of Respirators to Prevent Transmission of SARS link

väljavõtted

A NIOSH-certified, disposable N95 respirator is sufficient for routine airborne isolation precautions.
If a sufficient supply of respirators is not available, healthcare facilities may consider reuse as long as the device has not been obviously soiled or damaged (e.g., creased or torn). Data on reuse of respirators for SARS are not available. Reuse may increase the potential for contamination; however, this risk must be balanced against the need to fully provide respiratory protection for healthcare personnel.

If N95 respirators are reused for contact with SARS patients, implement a procedure for safer reuse to prevent contamination through contact with infectious droplets on the outside of the respirator.

* Consider wearing a loose-fitting barrier that does not interfere with fit or seal (e.g., surgical mask, face shield) over the respirator.
* Remove the barrier upon leaving the patient’s room and perform hand hygiene. Surgical masks should be discarded; face shields should be cleaned and disinfected.
* Remove the respirator and either hang it in a designated area or place it in a bag. (Consider labeling respirators with a user’s name before use to prevent reuse by another individual.)
* Use care when placing a used respirator on the face to ensure proper fit for respiratory protection and to avoid contact with infectious material that may be present on the outside of the mask.
* Perform hand hygiene after replacing the respirator on the face.


Respiratory protective devices with a filter efficiency of 95% or greater (e.g., N95, N99, N100) may not be available in some settings due to supply shortages or other factors. In this situation, a surgical (procedure) mask should be worn. Surgical masks will provide barrier protection against large droplets that are considered to be the primary route of SARS transmission. However, surgical masks may not adequately protect against aerosol or airborne particles, primarily because they allow for leakage around the mask and cannot be fit tested. The mask should resist fluid penetration and fit tightly around the mouth and nose when properly applied to the face.

WHO: linnugripi sümptomid ja tamiflu

Avian influenza (" bird flu") - Fact sheet link

Clinical features (uuendatud jaanuaris, vt märkust)
mõned lõigud

In many patients, the disease caused by the H5N1 virus follows an unusually aggressive clinical course, with rapid deterioration and high fatality.

The incubation period for H5N1 avian influenza may be longer than that for normal seasonal influenza, which is around 2 to 3 days. Current data for H5N1 infection indicate an incubation period ranging from 2 to 8 days and possibly as long as 17 days. However, the possibility of multiple exposure to the virus makes it difficult to define the incubation period precisely. WHO currently recommends that an incubation period of 7 days be used for field investigations and the monitoring of patient contacts.

Initial symptoms include a high fever, usually with a temperature higher than 38oC, and influenza-like symptoms. Diarrhoea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums have also been reported as early symptoms in some patients.

One feature seen in many patients is the development of manifestations in the lower respiratory tract early in the illness. Many patients have symptoms in the lower respiratory tract when they first seek treatment. On present evidence, difficulty in breathing develops around 5 days following the first symptoms. Respiratory distress, a hoarse voice, and a crackling sound when inhaling are commonly seen. Sputum production is variable and sometimes bloody. Most recently, blood-tinted respiratory secretions have been observed in Turkey. Almost all patients develop pneumonia. During the Hong Kong outbreak, all severely ill patients had primary viral pneumonia, which did not respond to antibiotics. Limited data on patients in the current outbreak indicate the presence of a primary viral pneumonia in H5N1, usually without microbiological evidence of bacterial supra-infection at presentation. Turkish clinicians have also reported pneumonia as a consistent feature in severe cases; as elsewhere, these patients did not respond to treatment with antibiotics.

In patients infected with the H5N1 virus, clinical deterioration is rapid. In Thailand, the time between onset of illness to the development of acute respiratory distress was around 6 days, with a range of 4 to 13 days. In severe cases in Turkey, clinicians have observed respiratory failure 3 to 5 days after symptom onset. Another common feature is multiorgan dysfunction, notably involving the kidney and heart. Common laboratory abnormalities include lymphopenia, leukopenia, elevated aminotransferases, and mild-to-moderate thrombocytopenia with some instances of disseminated intravascular coagulation.

Limited evidence suggests that some antiviral drugs, notably oseltamivir (commercially known as Tamiflu), can reduce the duration of viral replication and improve prospects of survival, provided they are administered within 48 hours following symptom onset.


However, prior to the outbreak in Turkey, most patients have been detected and treated late in the course of illness. For this reason, clinical data on the effectiveness of oseltamivir are limited. Moreover, oseltamivir and other antiviral drugs were developed for the treatment and prophylaxis of seasonal influenza, which is a less severe disease associated with less prolonged viral replication. Recommendations on the optimum dose and duration of treatment for H5N1 avian influenza, also in children, need to undergo urgent review, and this is being undertaken by WHO.

In suspected cases, oseltamivir should be prescribed as soon as possible (ideally, within 48 hours following symptom onset) to maximize its therapeutic benefits. However, given the significant mortality currently associated with H5N1 infection and evidence of prolonged viral replication in this disease, administration of the drug should also be considered in patients presenting later in the course of illness.

Currently recommended doses of oseltamivir for the treatment of influenza are contained in the product information at the manufacturer’s web site. The recommended dose of oseltamivir for the treatment of influenza, in adults and adolescents 13 years of age and older, is 150 mg per day, given as 75 mg twice a day for 5 days. Oseltamivir is not indicated for the treatment of children younger than 1 year of age.

As the duration of viral replication may be prolonged in cases of H5N1 infection, clinicians should consider increasing the duration of treatment to 7 to 10 days in patients who are not showing a clinical response. In cases of severe infection with the H5N1 virus, clinicians may need to consider increasing the recommended daily dose or the duration of treatment, keeping in mind that doses above 300 mg per day are associated with increased side effects. For all treated patients, consideration should be given to taking serial clinical samples for later assay to monitor changes in viral load, to assess drug susceptibility, and to assess drug levels. These samples should be taken only in the presence of appropriate measures for infection control.

In severely ill H5N1 patients or in H5N1 patients with severe gastrointestinal symptoms, drug absorption may be impaired. This possibility should be considered when managing these patients.

* This section has been reviewed by a virtual network of clinicians experienced in the treatment of H5N1 infections and other severe respiratory diseases. The network was convened for the first time on 16 January 2006. Physicians from Yüzüncü Yil University, Faculty of Medicine, Van, Turkey participated in the exchange of information and experiences. Other institutions represented include the University of Hong Kong (China); the Hospital for Tropical Diseases, Ho Chi Minh City (Viet Nam); and the University of Virginia, Charlottesville, Virginia (USA).

2. veebruar 2006

veidi otseütlemist pandeemia teemal :D

Some Hard Truths About Bird Flu link
Miller Op-Ed in the Taipei Times
by Henry I. Miller
January 14, 2006

Intensive animal husbandry procedures that place billions of poultry and swine in close proximity to humans, combined with unsanitary conditions, poverty and grossly inadequate public health infrastructure of all kinds, make it unlikely that a pandemic can be prevented or contained at the source. It is noteworthy that China's chaotic effort to vaccinate 14 billion chickens has been compromised by counterfeit vaccines and the absence of protective gear for vaccination teams, which might actually spread disease by carrying fecal material on their shoes from one farm to another.

In theory, it is possible to contain a flu pandemic in its early stages by performing "ring prophylaxis"—using anti-flu drugs and quarantine aggressively to isolate relatively small outbreaks of a human-to-human transmissible strain of H5N1.According to Johns Hopkins University virologist Donald Burke, "it may be possible to identify a human outbreak at the earliest stage, while there are fewer than 100 cases, and deploy international resources—such as a WHO stockpile of antiviral drugs—to rapidly quench it. This tipping point strategy is highly cost-effective."

However, a strategy can be "cost-effective" only if it is feasible. Although ring prophylaxis might work in Minneapolis, Toronto, or Zurich, in the parts of the world where flu pandemics begin, the probability of success approaches zero. In places like Vietnam, Indonesia and China—where the pandemic strain will likely originate—expertise, coordination, discipline, and infrastructure are lacking.

The response in Turkey—where as many as 50 possible cases have appeared in the eastern part of the country—is instructive. Officials in that region warned the government on Dec. 16 of a surge in bird deaths, but it took 12 days for an investigation to begin. When a 14-year-old boy became Turkey's first avian flu mortality last week (soon followed by two siblings), a government spokesman criticized doctors for mentioning the disease because they were "damaging Turkey's reputation." This is ominously reminiscent of China's initial response to SARS in 2003.

For now, it seems that all of the human H5N1 infections have been contracted from contact with infected poultry. But the situation in Turkey is what the outbreak of a human to human pandemic could look like at its earliest stages: the rapid spread of confirmed cases (and deaths) from an initial site to nearby villages and cities. We would expect to see a large number of illnesses among both employees and patients in hospitals where the victims are treated, and soon someone [perhaps even a carrier who is not ill] would spread it to Ankara, Istanbul, Tbilisi, Damascus, Baghdad and beyond.

The anti-flu drugs Tamiflu and Relenza are extremely expensive and in short supply. History suggests that if we were to make these drugs available to poor countries for ring prophylaxis, they would often be administered improperly—such as in sub-optimal doses—in a way that would promote viral resistance and only intensify a pandemic. Or perhaps they would be sold on the black market to enrich corrupt government officials.

If the pandemic were to begin relatively soon—say, within a year or two—there would be little that could be done to attenuate significantly the first wave of infections. But, if we're ready to rush the pandemic strain into an emergency program to manufacture vaccine, we could possibly blunt the second wave.

A flu pandemic will require triage on many levels, including not only decisions about which patients are likely to benefit from scarce commodities such as drugs, vaccines and ventilators, but also broader public policy choices about how best—among, literally, a world of possibilities—to expend resources.

inimesed ei kipu alluma riiklikele plaanidele

tehti USAs uuring ja küsitleti inimesi, kuidas nad käituksid kui terroristid levitaks rõugenakkust või dirty bomb rünnaku korral,
siit võiks ehk natuke tõmmata paralleele inimeste võimaliku käitumisega gripipandeemia korral ..

ja ei maksa eeldada, et eestlased paremini käituksid, pigem veel enam tõrksalt :D

Redefining Readiness link

THE PUBLIC’S REACTIONS TO THE SMALLPOX AND DIRTY BOMB SITUATIONS
Far fewer people than needed would follow protective instructions in these two terrorist attack situations.
Only two-fifths of the American people would go to the vaccination site in the smallpox outbreak.
Only three-fifths of the American people would shelter in place for as long as told in the dirty bomb explosion.

One reason for this lack of cooperation is that many people would be seriously worried about something other than what planners are trying to protect them from.
Two-fifths of the American people would be seriously worried about what government officials would say or do. This concern is even more prevalent among members of the public who are Hispanic, African-American, foreign-born, have a low income, lack health insurance coverage, live in New York City, or have not attended college. People’s trust in official instructions and actions is important because people who don’t have a lot of trust are only half as likely to cooperate in the smallpox and dirty bomb situations as are those who do.
Three-fifths of the American people would have serious worries about the smallpox vaccine — that’s twice as many people as would be seriously worried about catching smallpox in the outbreak situation.
Worries about vaccine side effects would make one-fifth of the American population afraid to follow instructions to go to the vaccination site.
The public’s worries appear to be well founded since it is estimated that over 50 million people in this country have conditions that put them at risk of developing serious complications from the vaccine, either from being vaccinated themselves or from accidentally coming in contact with someone who has recently been vaccinated.

Half of the American people — and two-thirds of African Americans — would be seriously worried if they were told that the smallpox vaccine is investigational. More people would be seriously worried about this issue than about any other aspect of the smallpox situation. Concern about the investigational status of the vaccine would make one-third of the population decide not to get it, even if they were at the vaccination site already.Many people would face conflicting worries and trade-offs in these situations, which would make it very difficult for them to decide what the most protective course of action would be.

Three-quarters of the people who would be seriously worried about catching smallpox in the outbreak situation also would be seriously worried about the vaccine. People who are only worried about catching smallpox are three times more likely to cooperate as those who are not. But that increase in cooperation is completely eliminated when people are also seriously worried about the vaccine.
Two-thirds of the American people would try to avoid being in the same place with other people they don’t know in the smallpox situation. But going to a public vaccination site violates people’s inclination toward protective isolation.
Two-fifths of the population would be afraid of catching smallpox from other people at the site.
One-fifth would be afraid of coming in contact with people at the site who shouldn’t be exposed to anyone who recently got the vaccine.
In the dirty bomb situation, many people face conflicting obligations, and assuring the safety of people who are dependent on them is often more important than assuring their own safety. One-third of the people who would not cooperate fully in this situation would leave the shelter of their building in order to take care of their children; one-quarter would leave to take care of other family members.
A substantial number of people would be able to cooperate with protective instructions if certain conditions were met, but those conditions are not met now.

Three-quarters of the people who said they would not fully cooperate with instructions to stay inside the building in the dirty bomb situation would do so if they could communicate with people they care about or if they knew that they and their loved ones were in places that had prepared in advance to take good care of them in this kind of situation. But three-fifths of the American population know only a little or nothing at all about how people would actually be cared for in those places.

Overall, the American people are half as likely to cooperate in the dirty bomb situation if they don’t know a lot about their building’s shelter-inplace plans than if they do. And they are half as likely to cooperate if they lack confidence in their community’s preparedness plans than if they don’t.

Not surprisingly, considering the serious worries and trade-offs people face, many people would want more information or advice to decide what to do in these situations. Members of the public are looking for decision-making support, not just facts, and they want to be able to talk with someone beforehand, not just during an
attack.
For free telephone support from a trained person in the smallpox situation, considerably more people would find it very helpful to talk with someone who they know wants what is best for them (like their health practitioner) than to talk with someone they don’t know who works for their local government.

WHO: me teame linnugripist liiga vähe

WHO chief says bird flu still little understood link
osa jutust:

ANKARA, Feb 2 (Reuters) - The World Health Organisation (WHO) said on Thursday the death of an Iraqi girl believed to have had bird flu showed how little was known about the disease.
Tests carried out by a British laboratory on the Iraqi teenager have confirmed she died of bird flu, the New Scientist magazine said on its Web site on Thursday.
WHO officials have declined to confirm the report but say they are working on the assumption that the H5N1 strain of bird flu was indeed the cause of her death.

"(The death) has highlighted how little is still known about the spread of the avian flu virus among poultry. Before her death, the presence of H5N1 in poultry in Iraq was not known," WHO director-general Lee Jong-Wook told a news conference during a visit to the Turkish capital Ankara. "Similarly here there was almost no prior warning of infection in poultry in the eastern part of Turkey," he added.

1918: tsitaadikogumik

lugemist AINULT tugevate närvidega isenditele,
kogumik cureventsi foorumist - noppeid mälestustest, artiklitest jne, kirjeldused et kuidas 1918a pandeemia oli ..

ära loe enne uinumist, saad õudusunenäod!

The flu began in March 1918 when a mess cook, Pvt. Albert Gitchell, complained of a sore throat and achiness as he reported to sick call at Camp Funston, a large cantonment constructed just months before and housing 60,000 soldiers.
"The next day there were 40 more of them," said Gaylynn S. Childs, director of the Geary County Historical Society Museum at Junction City. A week later, 522, cases had been reported at Fort Riley in what would be the mildest of the flu's three waves. Forty-six died at Fort Riley that spring.
Around the time the flu itself was dying out, the 89th Division--and the influenza--were deployed to France during World War 1, Childs said. And the American troops helped spread the disease to the English, Germans, French and Spanish. The flu gained its name because Spain was one of the hardest hit countries, with its king almost dying from it, she said.
From there, the flu went on through the Middle East and on around the world, eventually returning to the United States as the troops also came home for its second wave through Kansas.

Shortly before breakfast on Monday, March 11, the first domino would fall signaling the commencement of the first wave of the 1918 influenza. Company cook Albert Gitchell reported to the camp infirmary with complaints of a "bad cold." Right behind him came Corporal Lee W. Drake voicing similar complaints. By noon, camp surgeon Edward R. Schreiner had over 100 sick men on his hands, all apparently suffering from the same malady.

In October 1918, word of the flu’s growing presence in Minnesota began appearing on the front page of the Minneapolis Morning Tribune, below the news from the battlefields of Europe:
"Influenza Spread Held Slight Here" — Oct. 2
"Epidemic in City Shows Slight Gain" — Oct. 3
"Influenza Halts ‘U’ Opening …" — Oct. 5
"8 Deaths From Influenza Here" — Oct. 8
"Influenza Gains Slowly in City" — Oct. 10
"Doctors Propose Drastic Lid Be Clamped on City" — Oct. 11
By Oct. 12, hundreds of new cases and a dozen or so deaths were being reported in Minneapolis each day. The city’s health commissioner ordered all churches, schools, dance halls and theaters closed, beginning Sunday, Oct. 13. In the end, the flu killed more than 10,000 in Minnesota.
The influenza lid went on in Minneapolis at midnight last night. Not a single service will be held in any Minneapolis church today. The schools will not open tomorrow morning. Theaters, dance halls, pool halls and other meeting places closed at midnight to remain closed until the health department revokes its order, made as an emergency measure to stop the spread of Spanish influenza.

Nurse Jane MacDonald describes a trip through downtown Toronto during the peak of the pandemic:
"I went downtown today, in the afternoon, and I didn’t see a single soul. No cars, no bikes, no buses. Not a single store open. Y’ know, it was really... creepy."

Original account from the recollections of Alfred Hollows of Wellington, New Zealand:
"Our death rate was really quite appalling - something like a dozen a day – and the women volunteers just disappeared, and weren’t seen again ... I stood in the middle of Wellington City at 2 P.M. on a weekday afternoon, and there was not a soul to be seen – no trams running, no shops open, and the only traffic was a van with a white sheet tied to the side, with a big red cross painted on it, serving as an ambulance or hearse. It was really a City of the Dead."

A reporter in India describes the scene there:
"Hospitals are so choked, it is impossible to remove the dead to make room for the dying. Burning ghats and burial grounds are literally piled with corpses."
"Perhaps the greatest horror was occurring in India. All over India, immense mountains of bodies were rising beside fiery ghats. Oozing through the slums of Calcutta, the Hooghly River was 'choked with bodies.'
"Streets and lanes of India’s cities are littered with the dead. Hospitals are so choked, it is impossible to remove the dead to make room for the dying. Burning ghats and burial grounds are literally piled with corpses."

Nurse Jane MacDonald explains how a flu victim dies:
"In some patients, when their lungs are collapsing, they get bubbles of air trapped just below the surface of their skin, starting at their neck and sometimes spreading throughout the rest of their body. And when those patients move they crackle and pop like cereal in milk."
Those pockets of air leaking through ruptured lungs made patients crackle when they were rolled onto their sides. One navy nurse later compared the sound to a bowl of rice crispies, and the memory of that sound was so vivid to her that for the rest of her life she could not tolerate being around anyone who was eating rice crispies."
"If you haven’t been in there, you, you couldn’t imagine it. Pools of blood scattered throughout the rooms from several nasal hemorrhages. People, staff can’t avoid stepping in the mess ‘cause the people are packed in so closely together. Floors are slippery and wet and... Cries and groans from the terrified just add to the confusion. This is hell."

"The ship was packed ... (C)onditions were such that the influenza could breed and multiply with extraordinary swiftness ... The number of sick increased rapidly, Washington was apprised of the situation, but the call for men from the Allied armies was so great that we must go on at any cost ... Doctors and nurses were stricken. Every available doctor and nurse was utilized to the limit of endurance. The conditions during the night cannot be visualized by anyone who had not actually seen them ... (G)roans and cries of the terrified added to the confusion of the applicants clamoring for treatment and altogether a true inferno reigned supreme.
"It was the same on other ships. Pools of blood from hemorrhaging patients lay on the floor and the healthy tracked the blood through the ship, making decks wet and slippery.
Finally, with no room in sick bay, no room in the areas taken over for makeshift sick bays, corpsmen and nurses began laying men out on deck for days at a time. Robert Wallace aboard the Briton remembered lying on deck when a storm came, remembered the ship rolling, the ocean itself sweeping up the scuppers and over him and the others, drenching them, their clothes, their blankets, leaving them coughing and sputtering. And each morning orderlies carried bodies away."

We have lost an outrageous number of Nurses and Drs., and the little town of Ayer is a sight. It takes Special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce, we used to go down to the morgue (which is just back of my ward) and look at the boys laid out in long rows. It beats any sight they ever had in France after a battle. An extra long barracks has been vacated for the use of the Morgue, and it would make any man sit up and take notice to walk down the long lines of dead soldiers all dressed and laid out in double rows.

The general store at Paradise Hill sat empty except for the dead bodies of the store-keeper and his wife. Inside a nearby tent there were three more victims. The eerie silence was only broken by the sounds of a young boy digging graves for his dead mother, father, brother and sister. Sadly, scenes like these were not uncommon in Saskatchewan at the end of the Great War. Between 1918 and 1920 more than 5,000 lives were lost in the province, not on any battlefield, but in their own homes, victims of a silent but deadly enemy.

It was the saddest lookin‘ time then that ever you saw in your life. My brother lived over there in the camps then and I was working over there and I was dropping cars onto the team pole. And that, that epidemic broke out and people went to dyin’ and there just four and five dyin‘ every night dyin’ right there in the camps, every night. And I began goin‘ over there, my brother and all his family took down with it, what’d they call it, the flu? Yeah, 1918 flu. And, uh, when I’d get over there I’d ride my horse and, and go over there in the evening and I’d stay with my brother about three hours and do what I could to help ’em. And every one of them was in the bed and sometimes Doctor Preston would come while I was there, he was the doctor. And he said "I’m a tryin‘ to save their lives but I’m afraid I’m not going to."And they were so bad off. And, and every, nearly every porch, every porch that I’d look at had—would have a casket box a sittin’ on it. And men a diggin‘ graves just as hard as they could and the mines had to shut down there wasn’t a nary a man, there wasn’t a, there wasn’t a mine arunnin’ a lump of coal or runnin' no work. Stayed that away for about six weeks.

The undertaker just ran, I don’t know how many, into their wagon and took them to the cemetery and that was it and had to dig your own grave. I mean, the families had to dig their own graves. Grave diggers were sick and that was the terrible thing.

They didn’t even bury the people. They found them stuck in garages and everything.

.....my mother went and shaved the men and laid them out, thinking that they were going to be buried, you know. They wouldn’t bury 'em. They had so many died that they keep putting them in garages. That garage on Richmond Street. Oh, my gosh, he had a couple of garages full of caskets.

Bodies! On Thompson and Allegheny, Schedpa. He used to get the people and take them out and pile them in the garage. And people smelled something and they notified him. There he’d take the people out of the coffin and put them in the garage and give the coffin to somebody else and got paid for it. He lost his license and all. The smell would knock you, it would run down through the alley, so they caught up with him. People used to die. Oh, they used to die. It was an awful disease.

We were the only family saved from the influenza. The rest of the neighbors all were sick. Now I remember so well, very well, directly across the street from us, a boy about 7, 8 years old died and they used to just pick you up and wrap you up in a sheet and put you in a patrol wagon. So the mother and father screaming. "Let me get a macaroni box." Before, macaroni, any kind of pasta used to come in these wooden boxes about this long and that high, that 20 lbs. of macaroni fitted in the box. "Please, please, let me put him in the macaroni box. Let me put him in the box. Don’t take him away like that." And that was it. My mother had given birth to my youngest sister at the time and then, thank God, you know, we survived. But they were taking people out left and right. And the undertaker would pile them up and put them in the patrol wagons and take them away.

I just had to lie there and look at the ceiling. You couldn't stand up and walk because your legs would go," says Robert. "I was lucky. I had it, but not as bad as some. It was a funny one - not funny but strange - it was the big strong people who were the worst off. They went the quickest. "One chap I worked with, there was seven in his family died of it," Robert says. "There was nothing you could do. You'd be talking to someone today and the next minute someone says, 'He died last night'. It wasn't very pleasant."

"You know the Waikumete cemetery? That's north of Auckland - about 14 miles. Well when you'd go to Auckland on the train, you'd see the hearses bumper to bumper, one behind the other.

"Then it got that bad they couldn't run the trains. Perhaps say engine drivers, they'd gone down with it, or perhaps (someone in) the signal box."

"I was told that at the end of the epidemic, every family in our street had someone go down with the flu. But for some reason - it may have been immunological reasons or something in our genes - not one member of the Hayton family went down with the flu.

"People fell dead in the streets; in many houses no one was left alive. All ordinary business came to a standstill; one just concentrated on keeping alive. Every person left untouched by the pestilence turned his hand to whatever task needed doing,"

At Fort Riley, Kansas, an Army private reports to the camp hospital just before breakfast on March 11 complaining of fever, sore throat, and headache. He was quickly followed by another soldier with similar complaints. By noon, the camp's hospital had dealt with over 100 ill soldiers. By week's end that number jumped to 500.

Dr. Victor Vaughn, acting Surgeon General of the Army, receives urgent orders to proceed to Camp Devens near Boston. Once there, what Vaughn sees changes his life forever: "I saw hundreds of young stalwart men in uniform coming into the wards of the hospital. Every bed was full, yet others crowded in. The faces wore a bluish cast; a cough brought up the blood-stained sputum. In the morning, the dead bodies are stacked about the morgue like cordwood." On the day that Vaughn arrived at Camp Devens, 63 men died from influenza.

Boston registers 202 deaths from influenza on October 2. Shortly thereafter, the city canceled its Liberty Bond parades and sporting events. Churches were closed and the stock market was put on half-days.

On October 6, Philadelphia posts what would be just the first of several gruesome records for the month: 289 influenza-related deaths in a single day.

851 New Yorkers die of influenza in a single day. In Philadelphia, the city's death rate for one single week is 700 times higher than normal.

October 1918 turns out to be the deadliest month in the nation's history as 195,000 Americans fall victim to influenza.

Sirens wail on November 21, signaling to San Franciscans that it is safe--and legal--to remove their protective face masks. At that point, 2,122 were dead due to influenza.
December, 5,000 new cases of influenza are reported in San Francisco.

The onset of illness for those battling the flu of 1918 was quite sudden. In a matter of mere hours, a person could go from strapping good health to being so enfeebled they could not walk. Victims complained of general weakness and severe aches in their muscles, backs, joints, and heads. Often enduring fevers that could reach 105 degrees, the sick fell prey to wild bouts of delirium. Innocent objects--pieces of furniture, wallpaper, lamps--would adopt wicked manifestations in the minds of those consumed by fever. When the fevers finally broke, many victims fortunate enough to have survived now endured crushing post-influenzal depression.

Citizens of rural outbacks especially found themselves relying on folk remedies to fend off or cure the flu. Tales abounded of mothers insisting that their children stuff salt up their noses and wear goose grease poultices or bags of garlic-scented gum around their necks. For some, onions were looked upon as a potential savior. A Pennsylvania woman boasted of serving up onion omelets, onion salads, and onion soup with every meal. Not one of her eight children contracted the flu. Meanwhile, a four-year-old girl from Portland, Oregon was said to have recovered fully from the flu after her mother dosed her with onion syrup and buried her from head-to-toe for three days in glistening raw onions. Those with an aversion to onions swore by a shoveful of hot coals sprinkled with sulfur or brown sugar, which enveloped every room in a noxious blue-green smoke. While evidence that any of these measures had any positive effect was anecdotal, they were in keeping with the belief that doing anything to fend off influenza was better than sitting idly by, waiting to become a statistic.

"During the 1918 pandemic Maori death rates were seven times higher than European," says Kathrine Clarke, Chief Executive of Hapai te Hauora Tapui said today.
"This is what we know, but it’s also likely that the rates were even higher because many Maori deaths were not recorded."

One anectode shared of 1918 was of four women playing bridge together late into the night. Overnight, three of the women died from influenza (Hoagg). Others told stories of people on their way to work suddenly developing the flu and dying within hours (Henig). One physician writes that patients with seemingly ordinary influenza would rapidly "develop the most viscous type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate," (Grist, 1979). Another physician recalls that the influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth," (Starr, 1976).

Kenneth Crotty was 11 years old when the "great flu" hit his neighborhood in Framingham, outside Boston.
"It was scary, because every morning when you got up, you asked, 'Who died during the night?' You know death was there all the time." Five neighbors on his street of about 20 houses died during the season of death, he recalled.

Violent hacking contorted bodies as victims struggled to breathe. With lungs filled to uselessness, oxygen disappeared and victims quickly turned blue, the "purple death." First the mahogany patches rose near the cheekbones and ears; then it spread across the face. People turned so dark near death, reported one army physician in the day’s vernacular, "it became hard to distinguish the coloured men from the white."

The news walloped Kansas City like a Jack Dempsey uppercut:

"A DRASTIC BAN IS ON," shouted the bold, black headline of The Kansas City Star, on Oct. 17, 1918.
Spanish influenza had been ravaging the city since late September. Hundreds in town were sick and dying of "the purple death." Over the next 27 weeks, the flu would kill an estimated 2,300 in the city, putting Kansas City in the ranks of the 10 most devastated cities in the nation.
"Effective at once, to remain in effect indefinitely" the newspaper related. Then came the list of closings:
All theaters and motion picture shows.
All schools.
All churches.
Public gatherings of 20 or more persons, including dances, parties, weddings, funerals.
But business interests and political ward bosses, worried about the loss of money, objected, as they would throughout the epidemic.
On Oct. 14, the day that an early ban was lifted, a disapproving Army medical officer from Camp Funston warned, "the responsibility for 400,000 lives" in Kansas City lies in the balance.
Assured that a ban could always be reinstated, Capt. A.A. Hobbs, responded, "A dead man cannot accept apologies."
With the ban lifted, flu cases erupted. Deaths increased.
Three days later, the "drastic" ban was on and held for a month.

"You’ve got the Red Cross reporting that people are starving to death, not because there is not enough food, but because people are too terrified to bring them food. It became every person for himself and herself, and society began to disintegrate."

By October’s end — with newspapers reporting deaths approaching 1,000 — stories declared the epidemic at a standstill.
Bans were eased. On Armistice Day, Nov. 11, 1918, more than 100,000 Kansas Citians — many likely sick — flooded the streets
In the euphoria over peace, stories about the flu all but disappeared until it erupted again.
On Dec. 4, the health department estimated an average of 107 cases and 17 deaths each day. Deaths: 1,089; Cases: nearly 7,000.
Federal health officials were called in to help. Soon, the front pages of The Star and The Times were running tables of daily cases and deaths.
Between Dec. 1 and Dec. 9, 2,854 new cases of flu would be reported. Of those, 231 people would die, 41 of them in a single day.

"Ben’s long thin body lay three-quarters covered by the bedding; its gaunt outline was bitterly twisted below the covers, in an attitude of struggle and torture. It seemed not to belong to him, it was somehow distorted and detached as if it belonged to a beheaded criminal. And the sallow yellow of his face had turned gray, out of this granite tint of death, lit by two red flags of fever, the still-black three-day beard was growing. ... Ben’s thin lips were lifted, in a constant grimace of torture and strangulation, above his white somehow dead-looking teeth, as inch by inch he gasped, a thread of air into his lungs.
The next day,
"By four o’clock it was apparent that death was near. ... Ben had brief periods of consciousness, unconsciousness, and delirium -- but most of the time he was delirious. His breathing was easier, he hummed snatches of popular songs, some old and forgotten, called up now from the lost and secret attic of his childhood.
Gradually Ben sank into unconsciousness.
"His eyes were almost closed; their gray flicker was dulled, coated with the sheen of insensibility and death. He lay quietly upon his back, very straight, without any sign of pain, and with a curiously upturned thrust of his sharp thin face. His mouth was firmly shut."
Through the night Wolfe kept vigil over his dying brother. He prayed, "Whoever You Are, be good to Ben to-night." Wolfe fell asleep for a while and then awoke suddenly and called his family into his brother’s room.
"[Ben’s] body appeared to grow rigid before them. Ben drew upon the air in a long and powerful respiration; his gray eyes opened. Filled with a terrible vision of all life in the one moment, he seemed to rise forward bodily from his pillows without support—a flame, a light, a glory...[Ben] passed instantly, scornful and unafraid, as he had lived, into the shades of death."

"When the Spanish Influenza epidemic invaded Rochester in the fall of 1918, the community was paralyzed. Military demands of World War I have steadily drained the area of trained nurses...the epidemic prostrated nearly 13,000 Rochesterians, at its peak killing thirty to forty victims a day...as many as 800 a day collapsed with chills and fever...they were parents and teachers on whom Rochester’s children depended and the workforce on whom Rochester’s businesses and factories relied....In mid October, when 400 to 600 new cases appeared each day, the city closed down; schools, stores, factories, theaters, taverns and even churches were ordered to suspend all activities. In one home the father and mother were both powerless to do anything because of the force with which influenza had seized them. Their two little children, 5 and 7 years old, could not be cared for. Although there was plenty of coal in the house there was no one to build a fire.

"The 1918 Flu Pandemic was the deadliest disease outbreak in New Zealand history, killing over 8000 people in just four months - almost half as many New Zealanders as had died in the four terrible years of the First World War," said Neill Atkinson, historian at the Ministry for Culture and Heritage.

He took me in his arms and carried me to see my dead sister before she was carried to the grave. He took me for a last visit to my mother for he thought that both of us would die. But we didn't. We gasped for breath, our chests and throats rattled with the passage of the hard-won air. We sweated and we shivered, we fainted and revived. Death waited for us but we survived.

Everyone was sick, no one to help, they were dying one after the other. My father was very, very sick then. He was the first to die. I couldn't do anything for him. I remember we put him in a coffin, like a box. There were many others, you could see them on the roads, on the sledges, the ones that are able to drag them away, dragged them away to the cemetery.

At all times it seems, day and night, ambulances were on the move everywhere. They must have been manned in relays. In those days there was no free ambulance, the hospitals carried their own. These vehicles had tinkling bells instead of sirens.

At night time was, I think, the most saddest of all because the trucks were rumbling past my place all night long. We found out after that they didn't have time to make coffins they were just buried in boxes and the sad part was when we went over to cemetery later, when it was all over, no one knew where they were putting the flowers, they just put them on a mound of ground and trusted the luck of it being one of their own.

Most of them got over it but if you bled at the nose - if they bled at the nose - they got over it. If they didn't they went black and that was a finish.

And the thing was they came in with terrific temperatures and if we couldn't get those temperatures down, they dropped suddenly - below subnormal - and they started delirium. And once they got very delirious, we just couldn't save them and there was no way of bringing the temperatures down then except by cold sponging. And that had to be done by somebody with experience you see, otherwise they'd get an awful shock if it's badly done and chills as well. So I'm trying to keep the patients moderately clean and then when they got really delirious keeping them in bed. And the noise of the delirium at night was terrific.

And he went raving mad one night before they took him away. He was running around the room with a knife… he just couldn't control himself. So they came and took him away to the hospital. Next morning they came over and told me poor old Jack had died, so that was one of my mates who went.

One particular night there was a chap - I won't mention any names - but he jumped out of bed and I grabbed him and I said 'where are you going?' He was a big fella and of course I'm not very big, but I got me arms around just big around him and said 'come on, come on back to bed'. 'Let me go, let me go' he said, 'let me go' he said, 'I must get down and meet Massey and Ward'. Massey and Ward at that time were coming back from an Imperial conference at home [Britain] you see, and anyway I said 'come on get back into bed'. Yes, I got him back - I just got him on to bed and he said 'oh God' he said, and he was dead as a doornail, just went dead.

Ah no, the children were very good; we had to keep them, they were not allowed out the gate. They had to play in their own back yards. So no the children seemed to realize too how dreadful the time was and the unfortunate part was when anyone having a baby, the mothers were lost, the babies seemed to survive. But there was a dreadful lot of babies were left without their mothers. And I think that was one of the saddest parts.

At the school, when we're in the class, and that some of my friends whose parents had passed away would all of a sudden start their crying and the teacher would have to console them later.

I remember that the schools were closed and we rather enjoyed the holiday, the extended holiday for the tragedies that were happening everyday. It didn't touch me, I was far too young to realize.

Mother would come home and she would boil up and make the most beautiful vegetable and meat soups and then I would take them in thermos flasks to people who were too ill to perhaps warm their own food. And I wasn't allowed to enter the house, I just placed it on the door step and then went back to my pony and where people were a little better I could carry it in a billy in a jelly form and people were able to get food in that manner. But most of these people were almost unable to more than come to the door and just pick up the container that was left for them.

It wasn't safe for men to go out on the farms alone in case they were struck down and no one knew where they were. So one of the children or someone, they generally went in twos. When we wanted to do our shopping we had to go into Waverly by a horse and gig and when we got into the grocer's shop we rattled a kerosene tin which was hanging from a beam of the verandah. They came out to their door, took our order and then put the things on the pavement and we collected them and put our money into a mug with disinfectant in it and they collected it out of the mug.

It just got so that if you wanted help - if you didn't feel so well - you opened your window and you put a white rag out the window and you unlocked you front door and left a white rag on the handle of the door you see so that anybody could come in and when these people who were going around on motorbikes in cars saw them you see they got out to investigate because it was beyond, you couldn't deal with it. You just couldn't deal with it at all. It was beyond anything.

I lived in Wellington at the time and was working in a chemist shop. People started to pour in with prescriptions of all descriptions and people were collapsing on the road and being picked up and taken to hospital until the hospitals were full and then it began that we could hardly deal with them for the simple reason they came in so thick and fast. I gave prescriptions. I was working in the shop and the chemist was working flat out and the doctors finally put the prescription in the paper and so they copied it out and copied this and gave it in bulk form.

A mail boat delivered mail and supplies to small ports in Labrador. People soon got sick and many died. In many cases, survivors were unable to cut firewood or hunt, and died from the cold or starvation. Some hunters disappeared in the bush and were never heard of again. In the village of Okak, only fifty-seven of 266 survived. The mother and father of one eight-year-old girl died and the hungry dogs ate their bodies, but she survived in minus 30-degree temperatures for five weeks. In November 1918 a plea for help went out to the Hudson's Bay Company went out, but they curtly replied that there was a shortage of fuel for their ship, and that they could not come. In the spring of 1919 they finally came with a doctor and a load of lumber to make coffins. By then, one third of the Labrador population had died.

Edna Cary, 100, remembers vividly when the Spanish flu pandemic swept through her town. "People were dying like flies, whole families were wiped out," said Cary, who now lives in Denver. "It was really terrible." Cary, who entered high school that fall of 1918, recalls that "everything was shut. All the churches, all the movie houses, the theaters. Some stores were open, but everybody was so sick, I don't see how you could get to a store anyhow."
That long ago summer in Poughkeepsie, N.Y., the flu swept through her house as well. "Oh, it took everything out of you," Cary said. "It was two weeks before you could hardly stand on your legs. "My mother, my aunt and myself all had the flu. "My sister didn't get it because she was at Vassar and they quarantined the campus.
"But if you got it, you just ached in every part of your body. You could hardly get up to crawl to the bathroom and get back to bed." When she finally thought she was getting her strength back, Cary tried to walk from one end of her front porch to the other, but had to stop from exhaustion. "As far as taking care of the dead, I don't know how they did that," said Cary. "People were dying so fast. The few funeral homes in town couldn't possibly take all of them."

When Blanche Kennedy, of Denver, died of the flu on Sept. 27, 1918, the city's manager of health vainly hoped he could keep it an isolated case by quarantining her friends and family, according to Metropolitan State College of Denver history professor Stephen Leonard, co-author of Denver: Mining Camp to Metropolis. But when 10 more Denver residents died eight days later, the order was sent out: Close all the schools, churches and theaters.
"But they didn't close the department stores - that shows where their priorities were," Leonard said last week. Store owners pressured the health department and kept their doors open.
"And they let people go on streetcars, which were a wonderfully contagious place," Leonard said.
Denver banned indoor meetings, but not outdoor meetings, such as war bond drives. "That meant that they were just colder and got the flu a little faster," Leonard said.

Katherine Anne Porter was a reporter at the Rocky Mountain News in 1918. In her book, Pale Horse, Pale Rider, she described Denver's reaction to the flu: "It's as bad as anything can be . . . all the theaters and nearly all the shops and restaurants are closed, and the streets have been full of funerals all day and ambulances all night."
All told, Colorado lost about 8,000 people in the 1918-19 outbreak.
The flu rampaged west and hit the small town of Blaine, Wash., shortly before Christmas, recalls Flossie Shamness, now a 100-year-old resident of the Meridian community in Lakewood.
"My dad got the flu and he went to the hospital," said Shamness, a retired math teacher. "My mother would leave us four children with the neighbors and go to the hospital to see him. We felt neglected.
"He was only there a week and then he died. I was very close to him. He was only 36.

By fall 1918, Kansas and Fort Riley were heading into their deadliest confrontation with the flu. "The soldiers were going so fast," Foveaux recalled. "They were piling them up in a warehouse until they could get coffins for them." The dying continued at such a pace that morticians couldn't keep up. There were piles of wooden coffins, and the bodies were eventually wrapped and put outside, where they froze and were stacked "like cord wood," Childs said.
"Fall crops were ready to be harvested, but there were no field hands to get the crops in," Childs said. "It was an agricultural disaster." The medical community struggled to keep up with those infected. "The doctors and nurses in most communities were very thinly stretched," Childs said. She said two or three of the area's doctors were serving overseas, so those left in the area were forced to handle the workload. She tells of an Alta Vista country doctor who traveled for six weeks caring for the sick, without returning home during that time.

The life of Armond Cohen, Park Synagogue’s distinguished service rabbi, was dramatically influenced by the 1918 flu epidemic. His 34-year-old mother and 35-year old father died within two days of each other at the family’s home in Canton. "I was nine years old at the time, the youngest of four children," recalls Cohen. "My mother was eight months pregnant at the time. Cohen’s older brother Ernest, then 15, woke all the children. He put his arms around them as he told them the sad news that they were orphans.
"I began to cry," recalls Cohen. "I asked my brother, ‘Who is going to take care of us?’ My brother looked directly upwards and pointed to the heavens. ‘He will,’ he said. And He did."

About a year before she died, my mother said that she wanted me to have a glass water pitcher decoratively covered in silver.
It also came with a story more precious that the pitcher itself.
My mother had an older sister, Fanny, who miraculously survived the (1911) Triangle Shirtwaist Co. fire (but that’s another story), and a few years later Fanny met a fine young man to whom she became engaged.
My grandmother decided to make Fanny a beautiful engagement party to which all the neighbors were invited.
At that time, a young man in the neighborhood wanted to date my mom (she wasn’t interested), and he asked if he could come to the party.
Not wanting to be rude, my mother said yes, of course. Everyone was invited. The young man arrived at the party with a glass-and-silver pitcher, engraved with Fanny’s initials, as a gift for the delighted bride-to-be.
Fanny got married, became pregnant, and contracted the flu. Unfortunately, the year was 1918, and, as my mother put it, in 1918, if you were pregnant and caught the flu, you didn’t stand a chance.
Poor Fanny succumbed to the flu, and her bridegroom became hysterical. He brought all of Fanny’s things to my grandmother and asked that she take care of them because he could not manage.
My grandmother did the best she could. When she came across the pitcher, she turned to my mom and said, "This pitcher really should go to you. Fanny received it only because that young man wanted to impress you. Keep it in Fanny’s memory."
That’s how my mother obtained the pitcher. Through countless years she cherished it as a reminder of a beloved sister tragically cut down during the happiest time of her life by the 1918 flu epidemic.
Sixty years later, when my mother handed it to me, I could still feel Fanny’s loss reflected in the pitcher’s silver trim.

1. veebruar 2006

hispaania gripp soomes

Kun espanjantauti riehui Suomessa: linkl
influenssaepidemia vv. 1918-1920
Eila Linnanmäki

huvitav lugemine, kes soome keelt valdab :)
paar lõiku:

Tauti levisi räjähdyksenomaisesti maan lähes joka kolkkaan ja oli paljon tappavampi kuin kesällä. Lokakuu oli monella paikkakunnalla "musta" kuukausi. Kokonaiset kyläkunnat sairastuivat viimeistä henkeä myöten. Kouluja ja myymälöitä suljettiin, sairaalat täyttyivät. Piirilääkärit huomasivat, että tauti iski erityisen ankarasti nuoriin ja vahvoihin aikuisiin. Espanjantauti asetti nuoren tasavallan voimat kovalle koetukselle. Viranomaiset olivat espanjantaudin edessä ymmällään, eikä ensimmäisten aaltojen aikana osattu tehdä paljon mitään taudin vastustamiseksi. Lääkintöhallitus julkaisi sanomalehdissä julistuksen, jossa yleisölle annettiin ohjeita tartunnan ehkäisemiseksi. Julistus antoi ymmärtää, että sairastuminen oli kiinni ihmisen omista toimista. Ihmisten tuli varoa joutumasta tarpeettomasti tartunnalle alttiiksi. Ihmisiä kehoitettiin välttämään yleisötilaisuuksia, koska taudin ymmärrettiin leviävän helposti väentungoksessa. Henkilökohtaista puhtautta, erityisesti käsien pesua, pidettiin tärkeänä. Taudin raivo lientyi vuoden vaihteeseen mennessä, mutta jo keväällä 1919 puhkesi uusi epidemia-aalto. Joillakin paikkakunnilla, kuten esimerkiksi Helsingissä, tämä kevään aalto osoittautui kaikkein ankarimmaksi. Hautoja ei ehditty kaivaa sitä tahtia kuin olisi ollut tarvetta.
Viimeinen tautiaalto tammi-helmikuussa 1920 oli erityisesti Lapissa kohtalokas. Pohjois-Lappi oli osittain säästynyt aiemmista influenssa-aalloista, mutta nyt tauti iski yhdellä kertaa sitäkin voimakkaammin. Lapissa kerrottiin taisteltavan elämästä ja kuolemasta. Inarin pitäjässä taudin raivo oli ilmeisesti pahin. Tautiin kuoli kahdessa kuukaudessa noin 200 henkeä, eli lähes 10 % väestöstä. Monista taloista olivat kaikki menehtyneet. Kuolleita löytyi sekä taloista että navetoista, joihin heikot olivat raahautuneet turvautuakseen eläinten lämpöön, kun eivät enää jaksaneet lämmittää huoneita. Monet menehtyivät talviteiden varsille, kun olivat lähteneet apua hakemaan.

Keskaeg. Must Surm. Pandeemiad inimkonna ajaloos

meditsiiniajaloo konspektist link
eesti keeles ja puha :D
päris huvitav lugemine :)
vt eeskätt kahte aspekti - et mis võis soodustada pandeemia teket ja millised tagajärjed olid ühiskonna arengule

eestlaste meenutused 1918a pandeemiast

üllataval kombel praktiliselt puuduvad ..
oma ema käest küsisin, tema on nüüd üle 60a vana - ütleb, et mitte midagi ei tea, elas maal ja seal küll mingeid jutte ei olnud..
arvas, et ju siis eesti maapiirkonnad vähemalt eriti kannatada ei saanud, inimesed elasid eraldatult ja ei suhelnud tihedalt, et kui midagi oli, siis linnades ..

ühe vastuse sain tutvusringkonda küsitledes

Vanaema mul siin sündind 1926 a, ja tema räägib, et kui mingid puhangud tulid, kuulutati kogu külas karantiin. Noja mõni ikka suri ära kah. Aga et põhiline oli range eemalhoidmine, isegi osad teed suleti. 1957 suri nende külas üks pere grippi.

vanarahvaravist:
Põhiline asi iga asja vastu oli viin – üleni viina visse, või viina ja äädika segu, millega üleni kokku määriti.
Peamised ravimtaimed oli pärnaõis ja raudrohi ja piparmünt (seda anti isegi sunniest saadik paar tilgakest). Kogu aeg joodi raviteesid. Mdx küüslaugust ei teatud siis veel midagi. Noja siis vanainimesed panid suhkrutükile peale eetrit ja sõid seda. Köha jaoks mesi, kummelitee. Angiini puhul pandi vee sisse tilk soola ja joodi, sellega kuristati kurku. Noja siis oli mingi kibe kollakasroheline löga, millega arstid kurku vatiga puhastasid, samas mõikas jubehästi ja valu oli kohe läind.

Aili Paju raamat pidada olema suht samasugune nagu vanasti käituti – st seal on need põhilised ravimtaimed välja toodud ja nende raviomadused. Vanaema on nüüd takkajärgi lugenud ja ütleb, et näe nagu meie ajal oli….
Ja siis vanaema räägib, et riietus oli hoopis teine- villast hästi palju ja see nagu hoidis tugevamana.

desinfitseerimine

kuidas end desinfitseerida, kui oled sunnitud vahepeal kodust lahkuma pandeemia ajal
Fluwikie foorumist, hea jutt, vääris arhiveerimist :D

It is the “middle” of the pandemic. You’re having a Jack day and you have to bug out. Hmmm. H-H going on big-time and you just have to get to the store/drug store/home depot/relatives etc. I don’t think the question is what you bring with you, but what do I do in order to keep my home virus free when I get back? First, don’t go. Ok, you have to go. Don’t go. You went anyway. Have a key in your pocket for your car and your house – no key chains etc. Before you leave setup a plastic tray with a bleach solution and put it on the ground somewhere near your car. Setup a second one on a surface that is nonporous with sponges etc. Put permanent marks a lot pen on the table. Setup an outside shower with a hose of mixed/hot cold water hanging from above and put a shower curtain around it. Setup lots of soap there. Stand on a skid or other way for the water to drain away from you. Setup a second outdoor black hanging bag shower with a bleach solution in it. Setup a 55 gal drum with holes drilled in the bottom away from the house. Have a bag with stick matches available and some things to get a fire started. Dress in a full body rain gear with rubber boots, rubber gloves, surgical under gloves, swimming goggles, n95 face mask, hood up, and breath very shallow. Make sure the mask fits. Go do your thing you should not ever have had to. Touch only with your hands while you are out. Think about it. Go slow. Be deliberate. Consider the car you drove in to be contaminated. Consider everything you wear to be contaminated. Consider everything you bring back to be contaminated. Exit your car. Step in the bleach tray and use your gloves to clean your boots. Take one bag at a time and empty the contents on your table (or whatever you got). Remove the label and place it in the bag. Clean your gloves first and then clean the can with a bleach solution. Mark it with whatever information you want. Let it dry. Take all paper and bring it to your 55 gal drum and burn it. Remove your mask and burn it. Move to your first shower of bleach. Take a bleach shower and clean all the plastic as best as you can. Hang it up near your shower. Remove all your stuff and take a shower in the water shower. Put on some clean clothes/shoes etc. Get in the place where you can be isolated for 3 to 9 days stocked with food and heat etc. Have someone from the inside of your house get into a second pair of rubber boots and get a spray bottle of concentrated bleach solution. Spray the entire floor area and everything that was touched by you before. Now they can gather up what you went out for and be sure to step into the beach solution as you enter. I am sure I missed something…and it is fatal. Last thing…Don’t go. After your period of isolation you can rejoin your family. Don’t go.

marketite ettevalmistused

jahah, optimistlik kutt see intervjueeritav :)
pandeemia erinevus nt maavärinast on just see, et ei kuskilt abi kutsuda .. kõik riigid ja piirkonnad on korraga hädas ja omade probleemidega maadlemas

Key concern for grocers will be fresh shipments link

Grocers should expect a spike in demand during a pandemic, said Tim Hammonds, president and CEO of the Food Marketing Institute, which represents food retailers and wholesalers.

The institute hasn't devised a plan for a pandemic, Hammonds said, but he expects a health care emergency plan to be incorporated into the industry's overall disaster preparation. Supermarkets including H-E-B, Albertsons, Randall's and Whole Foods declined to comment on their emergency plans.

Stores would have time to stockpile key supplies, including water, face masks, canned goods, frozen foods, batteries, vitamins, cold remedies and other items, Hammonds said. But fresh food supplies might be tight, he said.

In general, stores get several deliveries a week, but if many truckers were out sick, he said, regions not being hit by the pandemic could help those under siege.

"There is a lot of excess capacity and flexibility built in there," he said. Pharmacy chains can reroute supplies immediately when demand increases, said Karen Reagan, vice president of the Texas Retailers Association, which represents groceries and pharmacies. After Hurricane Katrina brought evacuees to Texas, CVS, Wal-Mart, Walgreens and H-E-B cooperated to set up pharmacies in evacuation centers, she said.

Vaccinating truck drivers would be crucial for maintaining supplies of many essential goods, said Bill Webb, president and chief executive officer of the Texas Motor Transportation Association. Food, water and fuel shipments would be top priorities, he said. Given the fragmented nature of the trucking industry, with 40,000 companies and 300,000 commercial drivers, "it would be difficult" to come up with a comprehensive and binding emergency plan, he said.

The association has worked with state emergency preparedness officials on tabletop exercises focusing on bioterrorism, and that planning could be applied to a pandemic, Webb said.

10 soovitust ettevalmistusteks

veel üks jutt, mida peaks arvestama ja milliseid ettevalmistusi tegema, asjalik :)

10 Life Saving Tips For Surviving An Impending Avian Flu link

Bird Flu:
"An influenza pandemic of even moderate impact will result in the biggest single human disaster ever - far greater than AIDS, 9/11, all wars in the 20th century and the recent tsunami combined. It has the potential to redirect world history as the Black Death redirected European history in the 14th century." -- Michael T. Osterholm, Director, Center for Infectious Disease Research and Policy at the University of Minnesota

A new killer flu virus is on its way. Ducks and geese carrying this virus are now winging their way across the globe, spreading the disease wherever they go. Started in Asia, it has now spread to Europe. Soon it will be in North and South America.

So far it has only killed a few dozen humans. It is, after all, a virus that's passed from bird to bird. Or from bird to animals. So far it can't be transmitted from human to human. But flu viruses are crafty. They have the ability to change. This is what happened in 1918 when the Spanish Flu Pandemic swept over a war weary planet killing 50 - 100 million people - far more than were killed in the war.

This time it will be much worse. After all, we now have 4 times the number of people living on the planet. And most of them live in cities. Large, crowded cities. The five largest cities in the world have over 100 million people living in them. A killer virus that can be passed from human to human, let loose in our major cities where people are living elbow to elbow, would have a catastrophic effect.

And consider this...back in 1918 it was a much bigger world. It took weeks to get from one side of the world to the other. It took days to get from one side of the continent to the next. Today it takes hours. Last year more than 46 million international visitors came to the United States. If only one infected visitor passes on the virus to 2 others, who pass it on to 2 others, and so on, by the end of a month everyone in the US could be infected.

I don't even want to consider the implications if this idea ever occurs to muslim terrorists who are only too happy to blow themselves to bits in order to take out a few infidels.

So what can we do?

Fortunately it's not all doom and gloom. There are some very specific steps you can take to minimize the dangers and protect yourself and your loved ones.

1. Draw up a Plan. Outline the steps you and your family need to take, both pre-pandemic and during. Identify responsibilities for each family member. Make lists of supplies required. Find appropriate sources. Develop a realistic timeline. By establishing a plan now, you will avoid becoming a victim of the panic that will grip the general population, resulting in civil chaos and pandemonium.

2. Keep Informed. If and when the virus mutates so that it is being spread from human to human, it is likely to start in
Southeast Asia. Pay attention to the news. When you hear that this has taken place, it's time to act. We might only have weeks before the pandemic reaches North America, but with international travel so fast and easy it could be much sooner.

3. Prepare Your Child for Home Schooling. Most flu outbreaks get their start at schools. You can be certain that the schools will be closed. And if they're not, you should give very serious thought to keeping your children at home.

4. Minimize Contact with Others. The H5N1 avian flu virus can be transmitted for two days before a person is showing any symptoms and for a week after symptoms have disappeared. You never know who isn't and who might be infected. If possible you should stay home. Every time you go into an area where there are people you
are at risk.

5. Wash Your Hands Often. Sneeze particles can travel across a room at 600 miles per hour. If the person sneezing has the flu, everything in that room is covered with flu virus. And when you touch anything, the virus is transmitted to your hand. Eventually it will be transmitted to your mouth. Your only protection is to wash your hands, well and often. Each washing should involve vigorous scrubbing with soap for at least 20 seconds.

6. Stock up on Food & Water. Supermarkets only have enough food for about a week or less. It's critical that you stock up on enough food to last you for the duration which could be 3-4 months.

7. Buy Enough Anti-Viral Medication for Every Member of your Family.

8. Stock up on Face Masks.

9. Exercise. According to the American Council on Exercise, research has shown that moderate exercise (such as brisk walking) brings about measurable changes in the immune system, sending white blood cells zipping around the body to find intruders and kill them. But after a few hours, the immune system returns to normal so it's best to exercise regularly.

10. Spread the Word. Regardless of how much coverage the avian threat is receiving in the media, most people are reluctant to act. Perhaps if they don't acknowledge the danger they think it will somehow go away. Or maybe they think the government will look after the situation.

Desperate, panic stricken people are arguably even more dangerous than the virus. The more people surrounding you who are prepared for the pandemic, the safer you will be. You'll be secure in the knowledge that your neighbors won't be eyeing your resources. So please spread the word. And don't give up, even though you may feel like the voice in the wilderness. Eventually, if they hear it often enough, some people will take notice. And then they will also spread the word. And in this way we'll all be a little safer.

"Up to one billion people could die around the whole world in six months.... We are half a step away from a worldwide pandemic catastrophe." Dmitry K. Lvov, Director, D.I. Ivanovsky Institute of Virology, Russian Academy of Medical Sciences.

Whether or not it will happen this year, and whether or not it will be as catastrophic as many virologists are predicting, one thing is clear: There WILL be a pandemic of unimaginable proportions some time soon.

We can either bury our heads in the sand and hope it won't happen, or we can begin taking immediate steps to ensure that in a worst case scenario, we've given ourselves and our loved ones the best possible chance for survival.