Treat this Swine Flu as a Serious Pandemic ! [Archive]

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The Cub

04-25-2009, 07:21 PM

MOD MESSAGE: While most of the following links are not front page material, the last link from the BBC (http://news.bbc.co.uk/2/hi/talking_point/8018428.stm) is very much COC news. ~Buttercup

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Everyone should treat this Swine Flu event as a serious pandemic (or a pandemic to be). You have nothing to loose by doing so.

The last link below is from the BBC. It is a montage of communique from people within Mexico City. Each post speaks of the seriousness of the pandemic (to be?) of Swine Flu. The main stream media within the USA has put a lid on it.

This is very serious. Before you read all of the posts to the BBC link at the end, please consider the following.....and read each of the writings at the links provided below:

STAY OUT OF CROWDS!! Do not visit hospitals unless you must especially emergency rooms, Avoid: sporting events, concerts, dances, parties, crowded restaurants, eating from public utensils (i.e. in a cafeteria or restaurant), drinking from public water fountains, confined public spaces, shaking hands or kissing others, drinking or eating after others, touching public door knobs or handles, buses, trains, subways, tunnels, public libraries, air ports, airplanes, etc.

Wash your hands frequently. Pray and bless everything that you ingest in the Name of Jesus before ingesting it.

Be very careful.

The Plagues Will Now Begin

http://groups.yahoo.com/group/era-of-peace/message/333 (http://groups.yahoo.com/group/era-of-peace/message/333)

Drug Co. Caught Injecting Live Bird Flu Virus Into Flu Vaccines

http://groups.yahoo.com/group/era-of-peace/message/400 (http://groups.yahoo.com/group/era-of-peace/message/400)

Pray and Bless in Jesus' Name Everything That is Used or Ingested

http://groups.yahoo.com/group/era-of-peace/message/351 (http://groups.yahoo.com/group/era-of-peace/message/351)

Never Drink Water From Public Fountains

http://groups.yahoo.com/group/era-of-peace/message/362 (http://groups.yahoo.com/group/era-of-peace/message/362)

Avoid Crowds & Strangers - Answer No Questions

http://groups.yahoo.com/group/era-of-peace/message/287 (http://groups.yahoo.com/group/era-of-peace/message/287)

Beware of Medication & Evil Men

http://groups.yahoo.com/group/era-of-peace/message/283 (http://groups.yahoo.com/group/era-of-peace/message/283)

Supplement Your Daily Nutrition

http://groups.yahoo.com/group/era-of-peace/message/255 (http://groups.yahoo.com/group/era-of-peace/message/255)

Wash, Cook, Bless & Sterilize

http://groups.yahoo.com/group/era-of-peace/message/228 (http://groups.yahoo.com/group/era-of-peace/message/228)

Tribulation Protection: The Blood of the Lamb

http://www.call2holiness.org/TribulationProtection/TribulationProtection.htm

Mexico flu: Your experiences

Readers in Mexico have been emailing the BBC describing the sense of fear gripping the country as a result of a flu virus outbreak, which has so far claimed up to 60 lives.

The World Health Organization says the virus has the potential to become a pandemic.

http://news.bbc.co.uk/2/hi/talking_point/8018428.stm (http://news.bbc.co.uk/2/hi/talking_point/8018428.stm)

.

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Ben Sunday

04-25-2009, 10:48 PM

The basic information about personal sanitation and risk reduction is fine.

Having said that, the Tomkiel and Leary material is completely over the top. Most of the links I looked at were several years old. The Tomkiel comments about larvae compressed in prescription medications is fear mongering tinfoil, not to mention irrelevant.

Sunflower

04-25-2009, 11:01 PM

251bravo

04-25-2009, 11:04 PM

One of the links suggested praying to Michael the archangel.....I don't pray to angels...I pray to my savior Jesus and God.

+1 my dear sister:-D

LibertyNotDeath

04-25-2009, 11:09 PM

2dollarbill

04-25-2009, 11:19 PM

ethan hunt

04-25-2009, 11:24 PM

check

Sunflower

04-25-2009, 11:34 PM

Ok....not to downplay all the flu worries, but please remember.....This is the USA....not Mexico....we have better living conditions and healthcare than them. I know it is not "the best healthcare" by far, but it really is better than Mexico.

I would not panic unless I started seeing deaths in the USA. I work in the ER and we are still seeing LOTS of Influenza A and B, still! Most have fever, chills, headache, body aches, poor appetite. Most are uncomfortable, but tolerating the symptoms with rest and fluids and fever management.

Please do not get yourself in a panic....be cautious, but remember....NO deaths in the USA.....until then, just be calm and cautious....

If you do visit the ER with flu symptoms, do not expect a cure. All we provide is fever management (you can take tylenol at home), maybe tamiflu (only within 24 hrs of symptoms), and occasionally IV fluids if we think you are dehydrated (most are not). So don't run to the ER and expect a cure.....we don't offer much, except perhaps a secondary infection from all the other sick people visiting the ER. :shock:

Best advice....try to rest, take fever medicine, light diet, and lots of fluids.....If you have shortness of breath/difficulty breathing, then come to the ER for help, otherwise you may be disappointed with the care you get in the ER. We have little to offer for the FLU......best to all....:grin:

LibertyNotDeath

04-25-2009, 11:38 PM

kelee877

04-26-2009, 07:08 AM

I'm sorry. I just don't get it. In my town every winter the flu claims more victims than have been reported here world wide. I think hysteria is setting in. Yes the flu of any nature is bad, and when folks loose the fight over it is even worse, but it does happen, and it happens every year. May all those who have passed, rest in peace.

2DB

The flu that your are talking about is the yearly flu that effects those with low immune systems and the elderly...This H1N1 is a mutated virus that no one has had before and it making normal healthy people sick(ages 20-40) and they are dying..the CFR is now at .081(which means 8% of those catching it are dying) and so far only in Mexico...if the perfect storm virus finds a yearly flu bug that it can adhere too, then this could turn really deadly in a matter of days...it could alreadt be mutated enough to cause a world wide pandemic....

janetn

04-26-2009, 07:15 AM

Notayup

04-26-2009, 07:51 AM

.
Everyone should treat this Swine Flu event as a serious pandemic (or a pandemic to be). You have nothing to loose by doing so.

The last link below is from the BBC. It is a montage of communique from people within Mexico City. Each post speaks of the seriousness of the pandemic (to be?) of Swine Flu. The main stream media within the USA has put a lid on it.
This is very serious. Before you read all of the posts to the BBC link at the end, please consider the following.....and read each of the writings at the links provided below:
STAY OUT OF CROWDS!! Do not visit hospitals unless you must especially emergency rooms, Avoid: sporting events, concerts, dances, parties, crowded restaurants, eating from public utensils (i.e. in a cafeteria or restaurant), drinking from public water fountains, confined public spaces, shaking hands or kissing others, drinking or eating after others, touching public door knobs or handles, buses, trains, subways, tunnels, public libraries, air ports, airplanes, etc.

Wash your hands frequently. Pray and bless everything that you ingest in the Name of Jesus before ingesting it.

Be very areful.

The Plagues Will Now Begin
http://groups.yahoo.com/group/era-of-peace/message/333 (http://groups.yahoo.com/group/era-of-peace/message/333)
Drug Co. Caught Injecting Live Bird Flu Virus Into Flu Vaccines
http://groups.yahoo.com/group/era-of-peace/message/400 (http://groups.yahoo.com/group/era-of-peace/message/400)
Pray and Bless in Jesus' Name Everything That is Used or Ingested
http://groups.yahoo.com/group/era-of-peace/message/351 (http://groups.yahoo.com/group/era-of-peace/message/351)
Never Drink Water From Public Fountains
http://groups.yahoo.com/group/era-of-peace/message/362 (http://groups.yahoo.com/group/era-of-peace/message/362)
Avoid Crowds & Strangers - Answer No Questions
http://groups.yahoo.com/group/era-of-peace/message/287 (http://groups.yahoo.com/group/era-of-peace/message/287)
Beware of Medication & Evil Men
http://groups.yahoo.com/group/era-of-peace/message/283 (http://groups.yahoo.com/group/era-of-peace/message/283)
Supplement Your Daily Nutrition
http://groups.yahoo.com/group/era-of-peace/message/255 (http://groups.yahoo.com/group/era-of-peace/message/255)
Wash, Cook, Bless & Sterilize
http://groups.yahoo.com/group/era-of-peace/message/228 (http://groups.yahoo.com/group/era-of-peace/message/228)
Tribulation Protection: The Blood of the Lamb
http://www.call2holiness.org/TribulationProtection/TribulationProtection.htm
Mexico flu: Your experiences
Readers in Mexico have been emailing the BBC describing the sense of fear gripping the country as a result of a flu virus outbreak, which has so far claimed up to 60 lives.
The World Health Organization says the virus has the potential to become a pandemic.
http://news.bbc.co.uk/2/hi/talking_point/8018428.stm (http://news.bbc.co.uk/2/hi/talking_point/8018428.stm)
Check all of your email inboxes from anywhere on the web. Try the new Email Toolbar now (http://toolbar.aol.com/mail/download.html?ncid=txtlnkusdown00000027)!

The last link with info from Mexico is very informative. Thanks!

Sunflower

04-26-2009, 07:53 AM

I work in healthcare -a nursing home to be exact. I will tell you me and my coworkers are taking this very seriously. We are going to be right in the thick of this mess. We will be in close contact with patients. Please pray for all the healthcare workers out there, many will loose thier lives caring for others.

And please everyone - stay home, nothing is worth loosing your life or the life of a loved one over. Most of us here are prepped - its time to put those preps to good use.

May God be with all of us

Ok....not to downplay all the flu worries, but please remember.....This is the USA....not Mexico....we have better living conditions and healthcare than them. I know it is not "the best healthcare" by far, but it really is better than Mexico.

I would not panic unless I started seeing deaths in the USA. I work in the ER and we are still seeing LOTS of Influenza A and B, still! Most have fever, chills, headache, body aches, poor appetite. Most are uncomfortable, but tolerating the symptoms with rest and fluids and fever management.

Please do not get yourself in a panic....be cautious, but remember....NO deaths in the USA.....until then, just be calm and cautious....

If you do visit the ER with flu symptoms, do not expect a cure. All we provide is fever management (you can take tylenol at home), maybe tamiflu (only within 24 hrs of symptoms), and occasionally IV fluids if we think you are dehydrated (most are not). So don't run to the ER and expect a cure.....we don't offer much, except perhaps a secondary infection from all the other sick people visiting the ER. :shock:

Best advice....try to rest, take fever medicine, light diet, and lots of fluids.....If you have shortness of breath/difficulty breathing, then come to the ER for help, otherwise you may be disappointed with the care you get in the ER. We have little to offer for the FLU......best to all....:grin:
__________________

Buttercup

04-26-2009, 08:12 AM

Mexico flu: Your experiences (http://news.bbc.co.uk/2/hi/talking_point/8018428.stm)

Readers in Mexico have been emailing the BBC describing the sense of fear gripping the country as a result of a flu virus outbreak, which has so far claimed more than 80 lives.
The World Health Organization says the virus has the potential to become a pandemic.
Read a selection of BBC readers' comments below.

I'm a specialist doctor in respiratory diseases and intensive care at the Mexican National Institute of Health. There is a severe emergency over the swine flu here. More and more patients are being admitted to the intensive care unit. Despite the heroic efforts of all staff (doctors, nurses, specialists, etc) patients continue to inevitably die. The truth is that anti-viral treatments and vaccines are not expected to have any effect, even at high doses. It is a great fear among the staff. The infection risk is very high among the doctors and health staff.

There is a sense of chaos in the other hospitals and we do not know what to do. Staff are starting to leave and many are opting to retire or apply for holidays. The truth is that mortality is even higher than what is being reported by the authorities, at least in the hospital where I work it. It is killing three to four patients daily, and it has been going on for more than three weeks. It is a shame and there is great fear here. Increasingly younger patients aged 20 to 30 years are dying before our helpless eyes and there is great sadness among health professionals here.

Antonio Chavez, Mexico City

http://newsimg.bbc.co.uk/shared/img/o.gifhttp://newsimg.bbc.co.uk/nol/shared/img/v3/start_quote_rb.gif Friends working in hospitals say that the situation is really bad, they are talking about 19 people dead in Oaxaca, including a doctor and a nurse http://newsimg.bbc.co.uk/nol/shared/img/v3/end_quote_rb.gif

Alvaro Ricardez, Oaxaca City

I think there is a real lack of information and sadly, preventative action. In the capital of my state, Oaxaca, there is a hospital closed because of a death related to the porcine influenza. In the papers they recognise only two people dead for that cause. Many friends working in hospitals or related fields say that the situation is really bad, they are talking about 19 people dead in Oaxaca, including a doctor and a nurse. They say they got shots but they were told not to talk about the real situation. Our authorities say nothing. Life goes on as usual here.

Young people are going to schools and universities. Buses and planes go and come from Mexico City as frequently as before. Even with two people dead locally, last night the local baseball stadium was full, mainly with young people. What's really happening? I know vaccines are good for nothing, and if you take care, maybe you won't die, so, why not
acknowledge the real situation? I know that the economic situation is not the best, and it will worsen with panic. But panic comes from a lack of information. Many people travel for pleasure or without any real need. Stopping those unjustified trips can help a lot to ease the situation. We must do something!

Alvaro Ricardez, Oaxaca City, Oaxaca, Mexico

The truth is that it is very strange, what we are living through here. The streets are empty, we are all staying in our houses. People are only going out to the hospitals, drugstores and to buy food. The great majority have their mouths covered. Concerts, festivals, masses have all been cancelled, the football matches have all been played behind closed doors. On the television and radio, every commercial break contains information on the symptoms, saying that if you have them to go to the doctor at once. Although we have been told to go to work as normal on Monday, I am worried because I am employed at a company where there are many people and believe that it could be highly contagious. They say on the news that the cases that are most critical involve people aged 20 to 50.

Nallely T, State of Mexico

http://newsimg.bbc.co.uk/shared/img/o.gifhttp://newsimg.bbc.co.uk/nol/shared/img/v3/start_quote_rb.gif Everyone is very frightened, there are few people on the streets and we are all trying to be as safe as possible http://newsimg.bbc.co.uk/nol/shared/img/v3/end_quote_rb.gif

Mariana, Mexico City

Right now the situation is quite scary. We've never been living under such circumstances and it's caught us completely off guard. We are a developing country so our health system isn't very effective, plus the fact that our city is overpopulated doesn't help much; the government is doing what they can but I don't think it's enough. So the future isn't looking too bright. Everyone is very frightened, there are few people on the streets and we are all trying to be as safe as possible. But not knowing exactly how the virus works and how it can be killed off creates a horrible uncertainty. I'm being pessimistic but that's how most people I've talked to feel.

Mariana, Mexico City

I have a sister-in-law from San Luis Potosi state in Mexico and we were told that in San Luis Potosi there have been at least 78 deaths, just in that city alone, not 68 in all of Mexico, as is being reported. Schools have been closed until 6 May in this state and in other areas in Mexico. Also, many public venues are being closed, so this makes it more deadly and dangerous than has been stated.

Migdalia Cruz, Phoenix, Arizona, USA

It's certainly been very quiet where I'm living in the Historic Centre of Mexico City, whereas normally the centre is almost uncomfortably packed at the weekend. Most people also seem to be wearing the face masks being handed out by the army around the city. There always seems to be a healthy mistrust of the government here, but I wouldn't say I'm sensing a great deal of paranoia or panic. It does seem as though the unprecedented actions being taken by the government to contain the virus don't match with the statistics being provided, however, so there is some doubt as to whether they're just being overly cautious or whether things are a lot worse than what they're telling the public.

Randal Sheppard, Mexico City

Right now, things are far from under control here. All the museums, zoos, and concert venues have been closed. Masses, football games, sporting activities, cultural activities, have all been cancelled. All schools will be closed until 6 May, from kindergarten to university. We don't know what to think, the truth is that the government isn't telling us the truth. This case is worst than we think, some people take this just like a joke but not me, this is serious! Als it seems clear that this illness doesn't appear to be affecting the whole country, just Mexico City, the State of Mexico and San Luis Potosi.

Carla, Mexico City

I work as a resident doctor in one of the biggest hospitals in Mexico City and sadly, the situation is far from "under control". As a doctor, I realise that the media does not report the truth. Authorities distributed vaccines among all the medical personnel with no results, because two of my partners who worked in this hospital (interns) were killed by this new virus in less than six days even though they were vaccinated as all of us were. The official number of deaths is 20, nevertheless, the true number of victims are more than 200. I understand that we must avoid to panic, but telling the truth it might be better now to prevent and avoid more deaths.

Yeny Gregorio Dávila, Mexico City

The situation in Mexico City is really not normal. There is a sense of uncertainty that borders on paranoid behaviour in some cases. At this very moment, Mexican TV is showing how military forces are giving masks to the people in the streets. Moreover the news is sending alarming messages for the audience. Really, the atmosphere in the city is unsettling, a good example: pubs and concerts are being closed or cancelled and people don't haven thorough information. In this city (and country) there is an urgent need for assertive information, no paranoid messages from the government or the Mexican media.

Patricio Barrientos and Aranzazu Nuñez, Mexico City

Massive events have been cancelled at the National Auditorium - Mexico City's largest indoor venue with capacity of 10,000 - which has been closed. Two soccer games have been cancelled at the Olympic Stadium. A sold out game with 70,000 expected attendance will be played behind closed doors. Another game at the famous Azteca Stadium that would draw an attendance of 50,000 will also be played behind closed doors.

Juan Carlos Leon Calderon, Mexico City

It's eerily quiet here in the capital. Lots of people with masks, Facebook communities exchanging gallows humour, everybody waiting to see if schools and universities will stay closed for ten days (as goes the rumour). All masks have been used up, and we are waiting for new supplies.

Dr Duncan Wood, Mexico City

http://newsimg.bbc.co.uk/shared/img/o.gifhttp://newsimg.bbc.co.uk/nol/shared/img/v3/start_quote_rb.gif We will be sick soon and, well, do the math - 400 can infect at least another two per day http://newsimg.bbc.co.uk/nol/shared/img/v3/end_quote_rb.gif

Adriana, Mexico City

Yesterday in my office it was a bit surreal walking in to see all in blue masks with deep cleansing of computer equipment and surfaces going on. Let's hope it is contained and does not escalate. The local news is reporting 200 fatalities and reports of flu spreading from areas outside of Mexico City. Given the volume of daily commuter traffic on cramped busses and trains, this may not have to be too virulent to be disastrous in human terms. I wonder what controls there will be on flights in and out.

Will Shea, Mexico City

I work for the government as a head of a computer infrastructure operations department. At work we are doing several actions to try not to expose workers. We sent several home. I support the Pumas football team and the very important match with the Guadalajara team will be played behind closed doors. My family and I are going to stay home all weekend. We feel a little scared and confused with the feeling that we are not given being told the truth. Many people think the numbers of dead people is higher than we are being told.

Marcos, Mexico City

The whole city is affected, I have a very bad feeling about this. Two of my friends at work are sick, they were sick for a couple of days, they went to the hospital and they sent them back to work. The doctor told them it was just a flu until Friday when the alarm was spread, then they were allowed to go home. I work in a call centre and I'm worried because there are no windows in the building so it cannot be ventilated and around 400 people work there.

We all have talked to our supervisor but no one has done anything not even sterilise or disinfect the area. We will be sick soon and, well, do the math - 400 can infect at least another two per day. The authorities say there's nothing they can do since it's a private company and I can assure you, the company I work for is not the only one like this in the whole city. Us workers don't have much protection from our government and if we want to keep our jobs we have to go anyway.

Adriana, Mexico City

My sister got influenza like symptoms two weeks ago. She is fine now, thank god, but similar cases have been showing up since two weeks ago. I work for a bank and we were told to take our laptops because there is a high possibility to work from home. I have gone out to buy some face masks.

Ruben Farfan, Mexico City

I'm a college student in Mexico City, and I can only say that the information that the media has provided doesn't seem to be enough, we do not now how serious it is because they have failed to mention it. There have been two ways of responding to this event, the ones that have entered themselves into quarantine claiming that the government is hiding something much more serious, and those who take this as a joke saying that everyone is overreacting. To put a cherry on top all kind of crazy rumours are flying around - that they are going to quarantine Mexico City, that a school and some specific branches of offices and jobs are going to be suspended for days to come, and so on. I wish more info was available, for example how to prevent it? Have there been many deaths? Is there a threat of an epidemic?

Mari A, Mexico City

I didn't hear about the flu epidemic until last night at 2330. Yesterday the streets were almost empty compared to a normal Friday afternoon. The media is bombarding the same information over and over again, but the authorities haven't said anything new yet, only that they have enough vaccines for those with the flu and that we should avoid public spaces.

Paulina, Mexico City

This is another blow to the tourism industry in Mexico, even though non of the events that is taken place is anywhere near the tourist areas of Cancun, Playa del Carmen or Puerto Vallarta, the news comes across as all of Mexico is affected! After wrong reports of drug related violence, military presence etc. in Cancun, which hurt the industry tremendously, now people think that all of Mexico is affected by a virus that is mostly present in the capital. I guess the problem is that this is a country where the capital carries the same name as the country, thus when people hear news about Mexico, albeit it refers to Mexico City, they assume it is affecting the whole country.
Rainer, Cancun

Sunflower

04-26-2009, 08:16 AM

taztoo

04-26-2009, 08:43 AM

NYS dept of health just sent me and "alert" about this. I am on their notification list as I am am emergency dept PA. last night it was just and advisory but the status was upgraded to "alert" this am. If someone can tell me how to cut and paste (its on my acrobat viewer, right click doesnt seem to work) ill post it. essentially it talks about what to look for when examining pt's, what testing to perform, and how to protect yourself(gloves gown and n95 mask-although they say the mask alone may be enough). they also talk about using bleach or lysol to sanitize equipment/bedding.
i am heading out to visit my folks in a bit but if someone can help me post this ill do it when i get back this evening as well as post any future info i get on this.
taz/mike

taztoo

04-26-2009, 08:53 AM

Richard F. Daines, M.D. Wendy E. Saunders
Commissioner Executive Deputy Commissioner
April 25, 2009
To: Healthcare Providers, Hospitals, Laboratories, Local Health Departments
From: NYSDOH Bureau of Communicable Disease Control and Wadsworth Laboratory
HEALTH ADVISORY: UPDATE #1--SWINE INFLUENZA A (H1N1) INFECTION
Please distribute immediately to staff in the Departments of Laboratory Medicine, Critical Care, Emergency Medicine, Family Practice, Internal Medicine, Infectious Disease, Infection Control, Pediatrics, Pulmonary Medicine, and all inpatient and outpatient units.
SUMMARY
This is an update to the Health Advisory released on 4/24/09. The New York State Department of Health (NYSDOH) is sending this advisory to provide updated information regarding the ongoing investigation of swine influenza A (H1N1) virus infections being conducted by the Centers for Disease Control and Prevention (CDC). The guidance in this advisory only applies to providers seeing patients outside of New York City. For guidance related to providers seeing patients in New York City, see the New York City Department of Health and Mental Hygiene Advisory at: ].
This interim information is based on currently available information and is subject to change as additional information becomes available.
•
Swine influenza A (H1N1) has been diagnosed in patients in California, Texas, Kansas, and Mexico.
•
Cases were first identified when specimens were determined to be positive for influenza A but could not be subtyped with standard methods. Subsequent subtyping at CDC determined that patients were infected with swine influenza A (H1N1).
•
New York City Department of Health and Mental Hygiene (NYCDOHMH) has reported a cluster of respiratory illness in a private school in New York City. Nine affected students are now considered probable cases of swine influenza A (H1N1) following preliminary viral testing on nose and throat swabs. The specimens have been sent to CDC for confirmatory testing. Results of those tests are expected by the morning of 4/26/09.
•
NYSDOH is requesting local health departments (LHDs) to review their Emergency Department syndromic surveillance (ED Serv) reports daily as a method to monitor influenza activity.
page 1 of 9
•
For all patients presenting with acute respiratory illness, NYSDOH requests that providers obtain recent travel histories to affected areas and test patients meeting the case definition for suspect swine influenza A (H1N1).
•
Hospitals and providers should have a low threshold for contacting their LHD regarding patients who are highly suspicious for swine influenza A (H1N1), especially if the patient(s) is (are) severely ill.
•
NYSDOH requests that providers report any outbreaks of influenza-like illness to their LHD immediately.
•
Additional information on the outbreaks in the US and Mexico, as well as further clinical guidance, will be provided as it becomes available.
BACKGROUND
CDC is investigating 11 human cases of swine influenza A (H1N1) virus infection that have been identified in San Diego County and Imperial County, California, San Antonio, Texas, and Dickinson County, Kansas. In addition, swine influenza A (H1N1) viruses have also been confirmed by CDC from patients in Mexico. Investigations are ongoing to determine the source and extent of the infection. CDC is working with Mexican health officials, the World Health Organization (WHO), state and local officials in California, Texas, and Kansas, and other health and animal officials on investigations into these cases.
Currently, NYCDOHMH is investigating a cluster of respiratory illness in a private school in New York City. More than 100 of the school’s students were absent several days this week due to fever, sore throats, and other flu-like symptoms. NYCDOHMH has interviewed more than 100 students or their families; all students have had mild symptoms and none have been hospitalized. Some family members have developed similar symptoms, suggesting spread within the family.
The NYCDOHMH Public Health Laboratory has completed preliminary viral testing on nose and throat swabs from nine affected students. Eight of the nine tests are positive Type-A Influenza. Because they do not match H1 and H3 human subtypes of Type-A influenza by available testing methods, they are considered probable cases of swine flu. The specimens have been sent to the CDC for confirmatory testing. Results of those tests are expected by the morning of 4/26/09.
CDC has provided the following interim guidance for providers, as detailed on the CDC web site for this investigation: [url]This guidance is current as of 9:00 PM on 4/25/09.
CASE DEFINITIONS FOR INFECTION WITH SWINE INFLUENZA A (H1N1) VIRUS
The CDC has developed the following case definitions for the purpose of investigation of suspected, probable, and confirmed cases of swine influenza A (H1N1) virus infection:
1.
A Confirmed case of swine influenza A (H1N1) virus infection is defined as a person with an acute respiratory illness with laboratory confirmed swine influenza A (H1N1) virus infection at CDC by one or more of the following tests:
1.
real-time RT-PCR
2.
viral culture
3.
four-fold rise in swine influenza A (H1N1) virus specific neutralizing antibodies
page 2 of 9
2.
A Probable case of swine influenza A (H1N1) virus infection is defined as a person with an acute respiratory illness with an influenza test that is positive for influenza A, but H1 and H3 negative.
3.
A Suspected case of swine influenza A (H1N1) virus infection is defined as:
1.
A person with an acute respiratory illness who was a close contact to a confirmed case of swine influenza A (H1N1) virus infection while the case was ill OR
2.
A person with an acute respiratory illness with a recent history of contact with an animal with confirmed or suspected swine influenza A (H1N1) virus infection OR
3.
A person with an acute respiratory illness who has traveled to an area where there are confirmed or probable cases of swine influenza A (H1N1) **INCLUDING TRAVEL TO NEW YORK CITY
Definitions of Respiratory Illness:
1.
Acute respiratory illness Recent onset of at least two of the following:
1.
rhinorrhea or nasal congestion
2.
sore throat
3.
cough
4.
fever or feverishness
2.
Influenza-like illness: fever >37.8°C (100°F) plus cough or sore throat
Patients who meet the suspect case definition should be tested for influenza. Clinicians should obtain a nasopharyngeal swab from the patient (following appropriate infection control precautions), place the swab in viral transport medium, refrigerate the specimen (do not freeze), and submit to their clinical laboratory. Only high-priority specimens should be submitted to NYSDOH Wadsworth Center after consultation with local and state health. Please see the detailed guidelines, “Diagnostic Laboratory Testing for Suspected Swine Influenza,” at the end of this advisory.
Any unusual clusters of febrile respiratory illness should be reported to the LHD immediately.
INTERIM GUIDANCE FOR INFECTION CONTROL
For interview and assessment of healthy individuals with epidemiologic links to suspect or confirmed cases of swine influenza, follow Standard Precautions.
For interview, assessment, and care of a suspect, probable, or confirmed swine influenza patient (meeting current case definition outlined in this advisory):
•
Use an airborne infection isolation room (AIIR) with negative pressure air handling, if available; otherwise use a single patient room with the door kept closed.
•
Use Standard, Droplet and Contact precautions for all patient care activities. For hospitalized patients, continue precautions for 7 days after illness onset or until symptoms have resolved. page 3 of 9
•
Personnel should wear N95 respirators (or if unavailable, surgical masks) when entering the patient room, and should don disposable gown, gloves, and goggles if coming within 6 feet of the patient for any reason.
•
For suctioning, bronchoscopy, or intubation, use a procedure room with negative pressure air handling. Personnel should wear N95 respirators, gowns, gloves, and goggles for the procedure.
•
When care is completed, place all personal protective equipment (PPE) in a biohazard bag for appropriate disposal.
•
Maintain strict adherence to hand hygiene by washing with soap and water or using hand sanitizer immediately after removing gloves and other equipment and after any contact with respiratory secretions.
The ill person should wear a surgical mask when outside of the patient room, and should be encouraged to wash hands frequently and follow respiratory hygiene practices. Cups and other utensils used by the ill person should be washed with soap and water before use by other persons.
Routine cleaning and disinfection strategies used during influenza seasons can be applied to the environmental management of swine influenza. More information can be found at].
Emergency departments should place signage at the entrances in English and Spanish directing patients with respiratory symptoms to self-identify so that a surgical mask can be immediately placed. Supplies of masks should be available for this purpose.
INTERIM GUIDANCE FOR HEALTHCARE WORKERS (HCW) EXPOSED TO SUSPECT SWINE INFLUENZA CASES
An ‘exposed healthcare worker’ is a HCW who came within 6 feet (2 meters) of a suspect, probable, or confirmed case of swine influenza A (H1N1) to interview, examine, or collect a nasopharyngeal specimen.
Exposed healthcare workers who donned a surgical mask or N95 respirator during contact with the suspect case patient need NOT be offered post exposure prophylaxis.
Exposed healthcare workers who did not don any type of mask during contacts with the suspect case patient should be offered post exposure prophylaxis as soon as possible and within 7 days of exposure, according to the CDC guidance below.
While it is recommended that HCW don full PPE, including gown, gloves, and eye protection, donning of any or all of these items in the absence of a mask is sufficient exposure to warrant post exposure prophylaxis. Similarly, HCW who did not don any PPE other than a surgical mask or N95 respirator is considered sufficiently protected to not need post exposure prophylaxis.
All exposed HCW, independent of PPE worn, should self-monitor for signs and symptoms of respiratory illness and influenza for seven days following exposure. Any HCW displaying symptoms of illness should refrain from work and seek medical evaluation by their personal
page 4 of 9
medical provider. HCWs should call ahead to their provider to notify them of the possibility of swine influenza-related illness.
INTERIM GUIDANCE FOR ANTIVIRAL TREATMENT-4/25/09
Antiviral treatment for confirmed or suspected ill cases of swine influenza virus infection may include either oseltamivir or zanamavir, with no preference given at this time. Initiate treatment as soon as possible after the onset of symptoms. Recommendations for use of antivirals may change as data on antiviral susceptibilities become available. As such, please refer to the CDC website for the most up-to-date guidance on antiviral treatment at: [url]
As of 4/25/09, the current CDC national recommendations for antiviral treatment are as follows:
Duration of antiviral chemoprophylaxis is 7 days after the last known exposure to an ill confirmed case of swine influenza A (H1N1) virus infection. Antiviral dosing and schedules recommended for chemoprophylaxis of swine influenza A (H1N1) virus infection are the same as those recommended for seasonal influenza:
Antiviral chemoprophylaxis (pre-exposure or post-exposure) is recommended for the following individuals:
1.
Household close contacts who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) of a confirmed or suspected case.
2.
School children who are at high-risk for complications of influenza (persons with certain chronic medical conditions) who had close contact (face-to-face) with a confirmed or suspected case.
3.
Travelers to Mexico who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly).
4.
Border workers (Mexico) who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly).
5.
Health care workers or public health workers who had unprotected close contact with an ill confirmed or probable case of swine influenza A (H1N1) virus infection during the case’s infectious period.
Antiviral chemoprophylaxis can be considered for the following:
1.
Any health care worker who is at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) who is working in an area with confirmed swine influenza A (H1N1) cases, and who is caring for patients with any acute febrile respiratory illness.
2.
Non-high risk persons who are travelers to Mexico, first responders, or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection.
PUBLIC HEALTH NOTIFICATION
Clinicians should contact their LHD to report any suspect case meeting the case definitions. The LHD will involve the NYSDOH Regional Epidemiology Program. Once the LHD and NYSDOH have decided that the suspect case meets the CDC enhanced surveillance criteria, the LHD will give approval to the clinician for the patient specimen to be submitted to the NYSDOH
page 5 of 9
Wadsworth Center for testing. The clinician should complete the NYSDOH Virus Detection History Form (DOH-1795) noting testing is for a suspect case of swine influenza. Also note relevant patient travel history on this form and results of any influenza laboratory testing that has already been performed. Specimens should be shipped refrigerated (not frozen) overnight to Griffin Laboratory. Specific instructions and contact information for providers are available at: [url]
CONTINUING GUIDANCE
The NYSDOH will provide updated guidance as additional information and CDC recommendations become available. Updated information will be posted on the CDC website at:
SWINE INFLUENZA A (H1N1) VIRUS BIOSAFETY GUIDELINES FOR LABORATORY WORKERS
This guidance is for laboratory workers who may be processing or performing diagnostic testing, including virus isolation, on specimens from patients with suspected swine influenza A (H1N1) virus infection.
At this time the recommended front-line assay is a real-time RT-PCR assay that detects influenza A. If sub-typing assays for H1 and H3 are available, they should also be performed. If the sample is influenza A positive but H1 and H3 negative and therefore not sub-typeable, the sample should be considered as a “probable” case of swine influenza (H1N1). An assay specific for swine influenza A (H1N1) will be available shortly from the CDC and we will provide details as soon as it is available.
Diagnostic laboratory work on clinical samples from patients who are suspected cases of swine influenza A (H1N1) virus infection should be conducted in a BSL2 laboratory. All sample manipulations should be done inside a biosafety cabinet (BSC).
Viral isolation on clinical specimens from patients who are suspected cases of swine influenza A (H1N1) virus infection should be performed in a BSL2 laboratory with BSL3 practices (enhanced BSL2 conditions) as described below.
Additional precautions include:
* Recommended Personal Protective Equipment (based on site specific risk assessment )
* Respiratory protection – fit-tested N95 respirator or higher level of protection.
* Shoe covers
* Closed-front gown
* Double gloves
* Eye protection (goggles or face shields)
Waste
* All waste disposal procedures should be followed as outlined in your facility standard laboratory operating procedures.
Appropriate disinfectants
* 70% Ethanol
* 5% Lysol
page 6 of 9
* 10% Bleach
All personnel should self monitor for fever and any symptoms of swine influenza infection, which include cough, sore throat, vomiting, diarrhea, headache, runny nose, and muscle aches. Any illness should be reported to your supervisor immediately.
For personnel who had unprotected exposure or a known breach in personal protective equipment to clinical material or live virus from a confirmed case of swine influenza A (H1N1), antiviral chemoprophylaxis with zanamivir or oseltamivir for 7 days after exposure can be considered.
page 7 of 9
Diagnostic Laboratory Testing for Suspected Swine Influenza
•
Collect one nasopharyngeal swab or nasopharyngeal aspirate or nasopharyngeal wash, for submission to the Wadsworth Center for molecular testing. Note: preferred specimen is nasopharyngeal swab in viral transport medium. Use Dacron or rayon swabs with a fine-tip flexible metal shaft swab, or NP-flocked swab with flexible plastic shaft, for nasopharyngeal swab. Do not use calcium alginate or wooden-shafted swabs. Place swab in sterile vial containing 2ml of viral transport medium. Keep sample cold (4ºC) after collection.
Collection Guidelines:
o
Nasopharyngeal swab: Use a swab with a fine, flexible metal shaft and Dacron or rayon tip, or a flocked swab with long, flexible, plastic shaft, specific for nasopharyngeal swab sample collection. Insert swab into posterior nasopharynx. Rub swab against mucosal surface and leave in place for 5 seconds to absorb secretions. Collection of specimens from both nostrils increases amount of material available for analysis. Place swab in a vial of viral transport medium. Use scissors to cut metal shaft, or snap plastic shaft of flocked swab, so that top of vial can be screwed on tightly.
o
Nasopharyngeal aspirate: Requires source of suction (syringe, vacuum pump, or wall suction), specimen trap with two outlets, and catheter (no. 6 to 14 depending on size of patient). Without applying suction, insert catheter through nose into posterior nasopharynx (approximately the distance from tip of the nose to the external opening of the ear when measured in a straight line). Apply gentle suction, leaving catheter in place for a few seconds, then withdraw slowly. Suction contents of a vial of viral transport medium or non-bacteriostatic saline through catheter tubing to assist in moving material from tubing into trap and to add viral transport media to specimen. Transfer specimen to a screw cap tube for transport to laboratory.
o
Nasopharyngeal wash: Use rubber bulb (1-2oz for infants) or syringe to instill 3-5 ml of non-bacteriostatic saline into one nostril while occluding the other. If patient is able to co-operate, instruct them to close glottis by making a humming sound with mouth open. If a rubber bulb is used, release pressure on bulb to allow saline and mucus to enter bulb. Remove from nose and squeeze into vial of transport media. If syringe is used, apply suction to syringe to recover saline and nasal secretions. Alternately, hold sterile container such as urine cup under patient’s nose and ask patient to expel material into it. In either case, add recovered saline-nasal secretions to a vial of viral transport media.
•
Results of testing of initial cases suggest that rapid EIA influenza tests may be insensitive for the detection of swine influenza A (H1N1) and these assays should not be relied on as screening tests for this agent. However, a rapid influenza antigen detection test may be performed on the nasopharyngeal/oropharyngeal sample using standard BSL2 work practices in a Class II biological safety cabinet. Regardless of the result, specimens should still be referred to the Wadsworth Center for further testing. page 8 of 9
page 9 of 9
•
Submit a completed Virus Reference and Surveillance Laboratory patient history form (Appendix 2-D) with the specimens. The form is also available on the HPN and HIN at:
[
•
Viral culture may be performed on respiratory specimens from patients suspected of having swine influenza A (H1N1) infection, who meet the surveillance criteria as described in the advisory update. All specimen manipulutions and viral culture procedures should be performed under BSL2 containment with enhancements as described in the laboratory safety guidelines.
•
It is essential that specimens be sent to the Viral Reference and Surveillance Laboratory at the Wadsworth Center as soon as possible after collection. If shipped within two days of collection, store at 4ºC post-collection and ship with cold packs to maintain temperature at 4ºC. Do not use wet ice. If shipment is delayed >2days, then the specimens should be stored frozen at -70ºC and shipped on dry ice.
•
It is the shipper’s responsibility to ensure that appropriate shipping materials are used. Please contact your carrier for shipping and packaging information. Patient specimens must be shipped as “Diagnostic Specimens.” All specimens must be shipped "Priority Overnight" and received within 24 hours via chosen carrier. Specimens should ONLY be shipped Sunday - Thursday so that appropriate laboratory personnel can be present to accept and accession specimens Monday - Friday.
Address for courier shipping:
Wadsworth Center, NYSDOH
Griffin Laboratory
Virus Reference and Surveillance Laboratory
5668 State Farm Road (Rt. 155)
Slingerlands, NY 12159

LibertyNotDeath

04-26-2009, 10:22 AM

I have personal experience with FLU this week. My youngest child has been sick with it. He had 4 days with high fevers and headaches. He is not a toddler, but middle school age. His fevers were 103-104F with headaches, chills, poor appetite, cough with phlegm in the back of his throat. I treated his symptoms with rest, fluids and motrin. The one thing that broke the fever was apple cider vinegar. After one dose (1tsp) the fever broke and so far has not returned (aprox. 24 hours now). He is still fatigued and his cough is lingering, but he is improving. His appetite has returned. :grin:

I don't think the MSM is telling the truth, but I do think they like us to panic. We are easy to control if we panic and look to TPTB for help. jmho :grin:
__________________

I am glad the Lord has blessed your family with such a healthy child!

However, please do realize the primary target of this disease appears to be adults in the age range of 20 to 40, for some reason young children can fight it off and older folks seem to be relatively immune.

But the largest population of the world is in the 20 to 40 age range, and they are our next generation.

AngelDance

04-26-2009, 10:26 AM

I'm sorry. I just don't get it. In my town every winter the flu claims more victims than have been reported here world wide. I think hysteria is setting in. Yes the flu of any nature is bad, and when folks loose the fight over it is even worse, but it does happen, and it happens every year. May all those who have passed, rest in peace.

2DB

"Normal" flu season IS during the winter, as you pointed out. It is not winter anymore, it is Spring, hardly the season for normal garden variety influenza. The deaths attributable to the winter flu season are comprised of those with immature or worn out immune systems (the very young and the very old)

This flu is killing people in the healthiest, most flu death resistant population: the young. It is also beginning in the Spring as opposed to the traditional flu season. It is spreading rapidly and, by all rights, should actually have sparked a level 5-6 on the WHO scale for epidemics/pandemics.

This flu reminds me very much of the Spanish flu pandemic beginning of 1918. I do not think we are on the cusp of another worldwide pandemic which will occur in waves over the next 12 months or so.

Angel

The Cub

04-26-2009, 11:04 AM

.
Michael Savage on the Swine Flu and Immigration, et al

http://www.youtube.com/watch?v=YwHCO_trqhM

.

AngelDance

04-26-2009, 01:26 PM

I do not think we are on the cusp of another worldwide pandemic which will occur in waves over the next 12 months or so.

Angel

As I waited too long to edit my post, this sentence SHOULD read, I DO think we are on the cusp of another worldwide pandemic which will occur in waves over the next 12 months or so.

Sorry for any confusion.

Angel

2dollarbill

04-27-2009, 10:29 PM

DustMusher

04-27-2009, 10:33 PM

Actually, the death toll is up to 81, that's just the death toll, not infected (in Mexico).

There are a number of "suspected" cases in NY and it has been confirmed that this new virus is extremely contagious and has mutated to transfer from person to person.

It's like AIDs, making a leap and a bound, except this time it's airborne.

For all the government we have, they sure do a crappy job at keeping extremely deadly diseases properly contained.

I'll pray for those who are infected...and the rest of us as well.

The 81 death toll is only those who have had a positive test for H1N1. If you have all the symptoms, and a family member of someone with confirmed H1N1, but not test, you do not OFICIALLY have H1N1 and therefore you do not count in the satistics.

I think the death toll is MUCH higher.

DM