DISCUSSION: How would the Draft Guidance affect me and my family?

COMMENT THREAD

• Progress with community education and outreach
  

  Submitted by Kerry Kernen on 12/6/07 07:28 AM

  I am going to disagree with some of your issues as far as public perceptions and knowledge, based on what has been done in our county. Over the last 12 months we have given over 400 presentations (reaching approximately 15,000 people who take this information back to family and friends to share) to county businesses, schools, faith-based organizations, health care providers and civic organizations on pandemic flu. We have mailed pandemic flu information to every household in our county and have surveyed through the radio and through our yearly community flu clinics how this information has impacted citizens and their level of preparedness.
  We certainly have much more work to do as far as education but in our county we have made great strides to educate and inform our communities and the citizens involved regarding the realities and challenges of pandemic flu.
  
  The greater challenges as I see them, from a public health perspective, is trying to keep this information at the fore front of our messages and focusing our education efforts on the special needs population: age (pediatric and elderly populations), geophraphically displaced (those in jails, universities, homeless), those that are mentally or physicaly handicapped, those that are economically disadvanted and those with language competence (that do not speak, read or write english or blind). Right now we are seeing information fatigue and we are continually challenged to keep pandemic flu information at the forefront of our public health messages.
  In our pandemic flu outreach we are very upfront about the realities of the effects of pandemic flu once the virus reaches the nation, our state and our locality and we continue to bring partners from all over our county to the table as we continue conversations and planning efforts in preparing for this outbreak.
  

  • Your dept gets an "A" - you are an island.
    

    Submitted by Roy Kamen on 12/6/07 07:30 AM

    Kerry - please come do that in my town.....

    • You are the exception, not the rule....
      

      Submitted by Cathy Pinette on 12/6/07 09:33 AM

      These are great steps your community is taking but they are the exception, not the rule from my experiences.
      
      In the past two years there has been one community meeting regarding pandemics. It was attended by 1 member of the public and three CERT (Community Emergency Response Team) members.
      
      The member of the public asked many questions and answers consisted of: We will get back to you (which they never did), no we haven’t done that yet, no we did not think of that, etc.
      
      Minutes of the Regional Pandemic Committee (consisting of 16 towns) are not available to the public; all parts of the Pandemic plan are not available for the public, just a generic version. There is no public education going on except by our local CAP (Community Awareness and Preparedness Organization) for all hazards which pandemics are discussed.
      
      There have been no business meetings, no faith based meetings.
      
      Our Board of Selectman signed a Memorandum of Understanding with the State of NH stating that all shareholders would be on the Regional Pandemic Committee. These stakeholders included emergency personal, businesses, and the general public to name a few. There are no businesses and there are no people from the general public.
      
      Education is key, secrecy such as is what is happening right now is not the way to get the American People to buy in.
      

      • Why the secrecy?
        

        Submitted by Katharine Fisher on 12/6/07 01:20 PM

        Cathy, my local experience is the same as yours. Perhaps it is only New England? ;-)
        
        Why the secrecy surrounding so many local and regional pandemic plans?
        
        Our citizens cannot be prepared for what they know nothing about.
        
        And, as we've discussed at length here on this dialogue, the one solution that our local town and public health leaders hold so tightly to - that of a vax and its distribution - is not going to provide the easy answer they are hoping for.
        
        There should be no pandemic plans that are hidden from the public - that's step one. And the public needs to be engaged with this planning - that's step two. Local officials need to stop acting like their citizens are children (quote Jack Nicholson now from the movie A Few Good Men).

        • Counties seem to differ a lot in education efforts
          

          Submitted by Sharon Hutchins on 12/6/07 04:24 PM

          My county is more like Kerry's than what Roy and Katharine were describing. Our Pan Flu plan is on out website for public viewing and comment. We have given many dozens of trainings to schools, colleges, medical practices and providers, faith groups, community organizations, etc. We have a very active Pan Flu Coordinating Committee made up of community members from business & banking, healthcare, emergency services, etc.
          
          It's too bad that counties (and maybe states?) differ so much in preparedness level. Perhaps more guidance along with money and accountability pressure can help?

          • Sharon, thanks for the comment
            

            Submitted by Katharine Fisher on 12/6/07 05:04 PM

            I'm glad to hear that there are places that are engaged in robust pandemic planning. Apparently both Roy and I have to move. ;-)
            
            Funding is not necessarily an issue. CT is not lacking in funding. Some of the towns most recalcitrant about pandemic planning are among the wealthiest in our nation (some with average home sale prices above $1 million). It's not for lack of an educated populace, then, nor for lack of resources. It comes down to lack of will.
            
            I wish our federal authorities would step in with an impactful pandemic awareness campaign. If they did, there might be enough pressure cultivated in individuals to change things here. Lacking that, I don't believe they will change. We are worlds away from the organized and intelligent planning and collaboration that you describe.
            

  • Serious education is not happening in my state
    

    Submitted by Katharine Fisher on 12/6/07 08:39 AM

    Kerry, the people of Ohio are fortunate to have you. I wish you would come here to CT where we are stuck in first gear, with nothing of note being done to educate our public since Leavitt's flu summit in 2006.
    
    We are a state full of independent folks, and our 190 towns operate very independently from one another. We have counties on our maps, but there are no actual county governmental mechanisms apart from our courts. Public health is disbursed into local alliances between towns. Each of these districts follows their own agenda. Only a few towns or districts I know of are making any kind of efforts to educate their public about pandemic flu. It's just not on the radar here.
    
    When those rare public health presentations on pandemic flu happen, only a handful of people attend (I know of no presentation with an attendance of more than 20 or so, in towns with populations of 30,000, for example, and most of those attendees are EMS or Red Cross, so the presenters end up preaching to the choir).
    
    We have a long way to go here to get pandemic flu into the awareness of our public here in CT. They believe that pandemic flu is not a problem because "there will be a vaccine for that." When asked, this is invariably what both my fellow citizens and public health officials have stated without exception in my experience. When someone will disabuse them of this notion, is beyond me.
    

    • Peer Pressure
      

      Submitted by Catherine Jackie Mitchell on 12/6/07 08:43 AM

      Hi Katharine, I am your neighbor over your northern border. As I make successful efforts in my town maybe your town or county will catch on. It just takes a little ripple to make a great big wave.
      
      There are many ripples all moving in the direction toward full disclosure and honesty for the American public. Just don't give up.

      • It so hard without Gov and media support and a mixed message.
        

        Submitted by Roy Kamen on 12/6/07 09:22 AM

        We who try to alert the public to the fact that we are in a pandemic alert year are knocked down by lack of Media coverage and the mixed rosy messages by the Gov and PH workers.
        
        stop talking 2.5% death rate and start talking 50%+
        stop talking 2 weeks of prep and start talking 6-8 or more weeks to coincide with the pandemic wave, school closures and other social distancing measures.

  • You Are The Exception, Not The Rule.
    

    Submitted by Cathy Pinette on 12/6/07 09:32 AM

    These are great steps your county is taking but they are the exception, not the rule from my experiences.
    
    In the past two years there has been one community meeting regarding pandemics. It was attended by 1 member of the public and three CERT (Community Emergency Response Team) members.
    
    The member of the public asked many questions and answers consisted of: We will get back to you (which they never did), no we haven’t done that yet, no we did not think of that, etc.
    
    Minutes of the Regional Pandemic Committee (consisting of 16 towns) are not available to the public; all parts of the Pandemic plan are not available for the public, just a generic version. There is no public education going on except by our local CAP (Community Awareness and Preparedness Organization) for all hazards which pandemics are discussed.
    
    There have been no business meetings, no faith based meetings.
    
    Our Board of Selectman signed a Memorandum of Understanding with the State of NH stating that all shareholders would be on the Regional Pandemic Committee. These stakeholders included emergency personal, businesses, and the general public to name a few. There are no businesses and there are no people from the general public.
    
    Our Board of Health website has a link to pandemicflu.gov. No local information.
    
    Education is key, secrecy such as is what is happening right now is not the way to get the American People to buy in.
    

• Government Pandemic Planning
  

  Submitted by Howard Beaver on 12/6/07 07:31 AM

  Roy
  
  I can't speak for the 'government', the country or the general public, but my recent experience at my local level does not support your 'general public' statements. Recently our local public health department sponsored a symposium on business continuity during a pandemic, and the attendance and response by local businesses was overwhelming. These local business leaders came well prepared and knowledgable, and asked serious pointed questions about what to expect and had detailed thoughts as to how they would respond and help support pandemic response. They were aware of many if not all of the items you stated the general public was unaware of.
  
  As a result of this symposium, several working groups, focused on different aspects of maintaining our local infrastructure have been formed, and planning and work is proceeding.
  

  • is the information reaching homes
    

    Submitted by Catherine Jackie Mitchell on 12/6/07 07:45 AM

    What I am seeing is that people who attend symposiums and meetings are not the people that "we" need to reach. We need to reach the single mom who is too tired to take off her shoes at night. The teen parents struggling to put food on the table. The dads who are working two or three jobs just to keep their homes afloat.
    
    Person-to-person, door-to-door.....we do it to take a census. Why not to give lifesaving information?
    
    Perhaps some of you folks are doing this and I applaud you for your efforts but there are just too few doing this. This is important.
    
    As far as the draft guidance affecting me and my family...
    
    Most of us are in tier 5. I am. I am alright with this. I understand that the needs of our nation must be paramount. If I am in a position to help out then I am sure that there will be some protection that I can utilize, if not, then life is about the journey...is it not?
    
    My children, my wonderful children, work in the fire department, security, Air National Guard, medicine, and banking. No matter what, I know that they will rise to the occasion, wherever that may lead. My husband works in retail. I know he has every intention of leaving his store open for people to prepare as long as there are goods in his store, personal protection or not.
    
    This is just the way we have chosen to go forward. I bear no animosity towards people who make different choices.
    
    As for me, I will keep on keeping on.

    • No Information is not reaching homes
      

      Submitted by Roy Kamen on 12/6/07 08:10 AM

      And whatever they do know is the rosy picture being painted of a potentially catastrophic event.

      • Balance and Measure
        

        Submitted by Catherine Jackie Mitchell on 12/6/07 08:19 AM

        If there is one thing that I have had to learn with this awful intensity that I have is that we must be moderate. Allow the public to discover the deeper truths. Just give them the full picture.

    • evolution again
      

      Submitted by larry wright on 12/6/07 11:49 AM

      Here we will see natural selection operating by selecting for memes, not genes, but the selection process operates nonetheless.
      
      Those who favor individual self reliance and family preparedness are more likely to survive than those who do not, since it is not possible for government to support everyone, especially during a pandemic.
      
      Those who listen to those who espouse self-reliance are probably slightly more likely to survive a pandemic than those who don't.
      
      After a pandemic, I predict that there will be a lot more consideration for self-reliance than before.
      
      There is a reason why my parents (both conceived and born during the last great pandemic) were fanatical about personal hygiene and about cough and sneeze etiquette even before it regained popularity. There is a reason why both of my parents were abnormally (by today's standards, anyhow) concerned with keeping food in the house, and with being self-sufficient.
      
      They got these memes from their parents, all of whom lived through the great pandemic of 1918, and all of whose parents lived through the pandemic of 1890. Evolution weeds out ideas as well as genes.... and the 'meme pool' is going to get cleaned out during the next pandemic.
      

  • Local business here has no idea
    

    Submitted by Katharine Fisher on 12/6/07 08:59 AM

    Howard, with your comment and Kerry's above, I am realizing how disparate the preparation efforts have been. You both have convinced me that I live in the wrong place. Either I need to move, or you need to come here to work.
    
    Local businesses here have not had any outreach or panflu education. I am attempting to get our local Rotary Clubs to pick up this ball since no one else will.
    
    However, not all businesses here are unprepared. CT is home to many Fortune 500 companies. For example, General Electric's corporate headquarters is here. I am sure that they have attended many pandemic conferences, and have hired their own experts as consultants. They lilkely have a vault full of Tamiflu for their workers (corporations have been allowed to make such purchases). No question that they've made plans for many of their workers to telecommute and when a vax is ready, they'll probably hire their own health care workers to adminster it to their staff.
    
    But GE resides in a different sphere with regard to pandemic preparation than the rest of our businesses here in CT. They don't know much about the subject. They are unaware of the extensive government and big corporate preparation for a pandemic. They don't know they can buy antivirals, and would not know the first thing about how to do so. They don't know they need to order PPE or sanitizing gel for their workforce and they wouldn't know how much to order if someone told them they'd need it.
    
    Frankly, public health officials, who've purchased no antivirals and no PPE for their districts, and who really don't personally *believe* a pandemic is likely, are poor models of leadership in this regard. One cannot expect public health folks who have not purchased PPE to advise small businesses to do so.
    
    As a member of a BOE, I can say that apart from the private efforts of a leading pandmeic flu educator who happens to live in our state, there have been no presentations to or meetings for superintendents or board of education members here in an effort to educate them about pandemic flu, even though they'll have to make some very critical decisions on the subject (decisions absolutely crucial to NPI as laid down in the Community Mitigation Guidelines).
    
    Nobody is thinking about this subject here, and nobody is educating on this subject here. There are plenty of vax clinics taking place, though, since CDC has mandated and funded them. Newspaper stories report on these, and state that the town is now prepared for pandmeic flu and that everyone will be efficiently vaxed within hours. They leave out the part where that "within hours" piece will only take place months after pandemic has begun. We see story after story like this. The public, as a result, doen't see the need for any education, business doesn't see the need for any outlay on PPE, and nobody understands what the fuss is all about. "There will be a vax for that, we just practiced and it went really well." (That's a direct quote).
    

    • It all comes down to funding in the end
      

      Submitted by Nick Kelley on 12/6/07 10:04 AM

      Business respond to the pressures on them. The Federal message has been primarily received by the business community as its going to happen and we are going to be on our own. The States have been more supportive but it depends on where you live/work. Business group have been really active in talking about pandemic preparedness but there is a lot of work to be done. The bottom line is that there are no strong financial pressures to get business more motivated. This needs to be addressed from multiple levels. Pandemic preparedness is expensive, so the business case for pandemic preparedness needs to be clearly articulated on multiple levels.
      

      • Where are our agencies involved in commerce in this discussion?
        

        Submitted by Katharine Fisher on 12/6/07 01:27 PM

        Nick, you make a good point and bring to mind the fact that I haven't seen many of our agencies that usually promote business or commerce involved much in the pandemic issue.
        
        They're really MIA here, along with our Department of Education, which has been similarly silent.
        
        For small businesses, somebody should be helping them out by pointing out that if they're not ready, they may not survive the pandemic as an ongoing entity. That makes things seem a lot more cost effective and quickly. But where's that voice?
        
        And, most small business owners and employees are going to find themselves on the lowest rung of the vaccine priority chart. Who is going to tell them that, and when? Knowing that just might make a difference.
        

      • Where are our agencies involved in commerce in this discussion?
        

        Submitted by Katharine Fisher on 12/6/07 01:27 PM

        Nick, you make a good point and bring to mind the fact that I haven't seen many of our agencies that usually promote business or commerce involved much in the pandemic issue.
        
        They're really MIA here, along with our Department of Education, which has been similarly silent.
        
        For small businesses, somebody should be helping them out by pointing out that if they're not ready, they may not survive the pandemic as an ongoing entity. That makes things seem a lot more cost effective and quickly. But where's that voice?
        
        And, most small business owners and employees are going to find themselves on the lowest rung of the vaccine priority chart. Who is going to tell them that, and when? Knowing that just might make a difference.
        

• I can't plan for what I can't imagine
  

  Submitted by MoMos Mom on 12/6/07 08:15 AM

  I have heard the comment of 'I can't plan for what I can't imagine' several times in 2 different states from local public health officials regarding a pandemic of over a 2% CFR.
  
  My husband and I are in Tier 5 of the vaccination plan where our daughter is in Tier 1. We have prepared as best we can with the limited resources that we have. No one is ready for a pandemic that starts tomorrow, but we have our plan, and we have done our best.
  
  A chain is only as strong as its weakest link. We have tried to get our neighbors to prepare, but, without a strong message from the government, that has been very hard. Communities need to prepare and start preparing now. Once the pandemic has begun, the time to prepare has ended. Every American needs to be educated and informed and needs to start preparing now. If a pandemic is truly inevitable, then every American needs to be on board and prepared. We will need all of us to weather this storm and to emerge strong and triumphant on the other side.

• I can't plan for what I can't imagine
  

  Submitted by MoMos Mom on 12/6/07 08:15 AM

  I have heard the comment of 'I can't plan for what I can't imagine' several times in 2 different states from local public health officials regarding a pandemic of over a 2% CFR.
  
  My husband and I are in Tier 5 of the vaccination plan where our daughter is in Tier 1. We have prepared as best we can with the limited resources that we have. No one is ready for a pandemic that starts tomorrow, but we have our plan, and we have done our best.
  
  A chain is only as strong as its weakest link. We have tried to get our neighbors to prepare, but, without a strong message from the government, that has been very hard. Communities need to prepare and start preparing now. Once the pandemic has begun, the time to prepare has ended. Every American needs to be educated and informed and needs to start preparing now. If a pandemic is truly inevitable, then every American needs to be on board and prepared. We will need all of us to weather this storm and to emerge strong and triumphant on the other side.

• I cannot plan for what I cannot imagine
  

  Submitted by MoMos Mom on 12/6/07 08:16 AM

  I have heard the comment of 'I can't plan for what I can't imagine' several times in 2 different states from local public health officials regarding a pandemic of over a 2% CFR.
  
  My husband and I are in Tier 5 of the vaccination plan where our daughter is in Tier 1. We have prepared as best we can with the limited resources that we have. No one is ready for a pandemic that starts tomorrow, but we have our plan, and we have done our best.
  
  A chain is only as strong as its weakest link. We have tried to get our neighbors to prepare, but, without a strong message from the government, that has been very hard. Communities need to prepare and start preparing now. Once the pandemic has begun, the time to prepare has ended. Every American needs to be educated and informed and needs to start preparing now. If a pandemic is truly inevitable, then every American needs to be on board and prepared. We will need all of us to weather this storm and to emerge strong and triumphant on the other side.

• I cannot plan for what I cannot imagine
  

  Submitted by MoMos Mom on 12/6/07 08:17 AM

  I have heard the comment of 'I can't plan for what I can't imagine' several times in 2 different states from local public health officials regarding a pandemic of over a 2% CFR.
  
  My husband and I are in Tier 5 of the vaccination plan where our daughter is in Tier 1. We have prepared as best we can with the limited resources that we have. No one is ready for a pandemic that starts tomorrow, but we have our plan, and we have done our best.
  
  A chain is only as strong as its weakest link. We have tried to get our neighbors to prepare, but, without a strong message from the government, that has been very hard. Communities need to prepare and start preparing now. Once the pandemic has begun, the time to prepare has ended. Every American needs to be educated and informed and needs to start preparing now. If a pandemic is truly inevitable, then every American needs to be on board and prepared. We will need all of us to weather this storm and to emerge strong and triumphant on the other side.

  • Sorry about the double post
    

    Submitted by MoMos Mom on 12/6/07 08:28 AM

    I seemed to be having a computer glitch where it was giving me a fatal redirect error but was posting the information anyway. Oops! :)

  • Leaving my family behind?
    

    Submitted by Karen Rose on 12/6/07 01:05 PM

    I am a Public Health Nurse in one of the largest cities in the country, Phoenix, and am in Tier 1. If the pandemic hits within the year, 1 of my children will be in Tier 2 because of his asthma and his age of 17 years. After that year, he will be in Tier 4, where my other 2 sons and all 3 step daughters would be. My husband would be in Tier 5. I cannot recommend bumping my entire family to Tier 1 just because I might be running a POD and dispensing anti virals and then vaccine, and thereby denying someone more in harms' way the medication or vaccine they deserve. It would be very difficult to decide whether to stay with my own family vs. help the public, without at least anti virals for my family members. Assuming they are shown to be of some benefit. If there is nothing offered to my family for protection, I will have to choose to leave them behind to serve the public... and maybe not come home for a very long time. Honestly, I don't know what I will do. I am a dedicated health professional, but a more dedicated wife and mother...and I don't think I am alone in this.

    • Dialog about this on allnurses.com
      

      Submitted by Roy Kamen on 12/6/07 01:13 PM

      The allnurses.com message board had a dialog about this. the consensus was that no PPE, No work. It was eye opening.

      • Nurses input is very interesting
        

        Submitted by Katharine Fisher on 12/6/07 01:34 PM

        Roy, that is a very interesting conversation. They all seem to be of one mind on that issue.
        
        How much PPE do we have? How much have hospitals put aside for a pandemic? Hospitals are run with the same thin financial and JIT margins that any other enterprise is run with these days.
        
        Can these nurses count on the PPE being there when they need it, in the quantities they will need it in? (Quantities that are probably mind-boggling).
        

      • Thanks for the resource...and the wake up call
        

        Submitted by Karen Rose on 12/6/07 01:58 PM

        Roy,
        Thanks for sharing this website. I just registered for allnurses.com.
        I am learning a lot from the exchange of information here, and feel better informed and more able to prepare for my own family as a result.
        Although I am employed in Public Health, and am confident that when an effective vaccine is available, we can quickly administer it to our citizens, I feel incredibly uninformed about how to survive the pre-vaccine time period. I have no Tamiflu. I have not even been fitted for a N95 mask, despite requests for this, yet have worked in 2 POD exercises and am expected to be on the front lines. I work in Public Health largely because of my interest in Pan Flu, yet I have little knowledge of our county's preparedness. Besides POD's. I have given in to some of the "oh well" mentality around me, and stopped asking some of my questions. That is going to change.

        • Other resources to become informed how to prepare
          

          Submitted by Roy Kamen on 12/6/07 02:10 PM

          http://www.fluwikie.com - a well rounded and calm board
          http://www.pfiforum.com - great if you cab stomach roller coaster rides
          http://www.flutrackers.com - excellent for reference
          http://www.planforpandemic.com - good well rounded board
          
          and one of the best site -
          http://web.mac.com/monotreme1/iW...
          
          and for college students -
          http://www.studentsprepamerica.o...
          

          • Favorited
            

            Submitted by Karen Rose on 12/6/07 02:54 PM

            Thanks for the resources! All have been added to my Favorites menu and I will pass them on as well.