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On the lookout for bird flu
[April 14, 2006]

On the lookout for bird flu

(Hartford Courant, The (CT) (KRT) Via Thomson Dialog NewsEdge) Apr. 14--Every morning before most people have poured the first cup of coffee, two doctors huddle in front of a computer screen at the state Department of Public Health scanning overnight hospital reports from Connecticut and New York City for a spike in cases of diarrhea and respiratory ailments.

A spate of those symptoms could herald the arrival of avian flu on U.S. soil -- and in Connecticut, Dr. Albert Geetter, a retired surgeon, and Dr. John Bigos, a lung specialist who recently closed his New London practice, are on the front lines.

One of the biggest challenges they face is that nobody knows for sure how long it might take for the bird flu to spread to humans in the United States.

"We know we're going to meet an enemy, but we don't know the face," said Dr. J. Robert Galvin, the state health commissioner.

Scientists planning for an outbreak here can only follow evidence from China and Vietnam, where people seem to have become infected after very close contact with sick poultry.

Few New Englanders routinely slaughter or pluck chickens for dinner. And most do not drink duck blood -- a tradition during the Vietnamese New Year's celebration of Tet, when there was a spike in bird flu cases in Vietnam, Geetter said.

While the U.S. Department of Health and Human Services has warned that this year's spring migration could bring the dreaded H5N1 bird flu virus into the United States, Bigos and Geetter say they don't expect an immediate human outbreak.

They are comforted by new evidence that the known strain of bird flu binds to cells in the alveoli, the deepest part of the lungs. This could make it less likely that the virus would be transmitted by coughing and sneezing, which is the way garden-variety influenza spreads.

But they also know that viruses have a nasty habit of mutating. "We don't know yet what that mutation is going to be and whether it [will learn] to get into the upper respiratory system," Geetter said.

Bigos said he thinks it will be at least 18 months before the United States sees its first case of H5N1 in humans. Geetter expects it may be another two to three years.

"The public should not be overly panicked about H5N1 anywhere in the near future," Bigos said this week. "We think it's highly unlikely there will be human H5N1 in the foreseeable future."

Nonetheless, they worry. And at 7 a.m. each weekday morning the men, who are used to keeping early morning surgical schedules, scan the computer for clues. They also keep tabs on Connecticut hospitals, wanting to know exactly what weapons are available once the computer indicates a direct viral hit.

They know Connecticut's hospitals have 750 mechanical ventilators, machines that pump oxygen into the lungs when a virus or bacterium attacks the respiratory system. That's enough to meet everyday needs, but probably inadequate if a pandemic hits.

They also are tracking hospital stockpiles of antibiotics, anti-viral medications such as Tamiflu, gowns, masks, gloves, linens, saline solution and other common supplies needed to safeguard workers and treat critically ill patients.

But nobody is sure that even one person will get sick, or what the illness will be like if it does arrive. That makes it difficult to justify investing in stocks of ventilators, which cost about $30,000 each, and in expensive medications that might reach their expiration dates before they are ever used.

Dr. Michael J. McNamee, director of intensive care and pulmonary medicine at New Britain General Hospital, said planning is important, but no amount of hoarding can provide the extra staff that hospitals would need if a pandemic hits.

Hospitals operate on such a tight shoestring, he said, that they don't have extra staff members to care for unexpected patients.

"I don't care if you have 300 [ventilators]," McNamee said. "Who would staff them?"

Even during a busy flu season when New Britain General is filled to capacity, 20 extra patients can send the hospital into a tailspin, he said. "You can warehouse supplies in advance," he said. "The bigger problem is who is going to take care of these people."

Another daunting reality is that health care professionals are not immune to illness. So a shortage of nurses, doctors and respiratory therapists, for example, could be compounded if hospital employees do not come to work because they or their family members are sick, said Christopher Cannon, system director of the office of emergency preparedness for the Yale-New Haven Health System, which includes five hospitals.

All of the state's hospitals are trying to prepare for a doomsday scenario without knowing exactly what type of illness they will be expected to handle. There is some evidence that the avian flu can start with fever and diarrhea -- not the classic cough and body aches most people recognize as influenza.

That is why individuals also should plan ahead, Galvin said. He wants Connecticut residents to stockpile three days' worth of drinking water and a supply of canned foods and to establish a plan for contacting family members if the flu strikes quickly and someone is not able to return home. Everyone should get into the habit of frequent hand-washing to prevent the spread of disease.

"We're not telling people they're left to fend for themselves," Galvin said. "But the time to plan is not when the event occurs."

Galvin said he is confident that the state will be prepared for avian flu if it materializes. Sometimes, he feels confident that it won't be so bad. Then, he looked out his third-floor window at the health department's headquarters on Capitol Avenue in Hartford and saw a chicken walking in a homeowner's backyard. His pulse quickened.

"Are we looking at a doomsday scenario? Probably not," Galvin said. "Are we looking at an ordinary flu year? Definitely not. What is the model? The three of us and two epidemiologists are trying to design a model that's appropriate."

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