Who Should MDs Let Die in a Pandemic? Report Offers Answers

JTT wrote:

I'm no doctor/scientist but I think that a new bug that is able to create a pandemic is going to worry much about a list. By its nature, it'll get those, strong or weak, that don't have the necessary stuff inside to fight it.

It's gonna get a lot of us, no doubt, in more ways than our health. Just imagine for a moment how it's going to affect the economy.

My grandpa nursed a lot of his family thru the 1918 outbreak. He was the only one who didn't get sick. and now that I think about it caused the death of any of my family back then. That seems odd, given how bad it was. More research needed.

The original question assumes that there is something doctors can do to either cure or increase the chance of survival for a given patient.

If nothing can be done for anyone, then of course each individuals natural immune system will determine his or her fate.

The Canadian experience with SARS provides some insight into management during a biological disaster. Ontario Ministry of Health Guidelines to manage and mitigate the outbreak commented specifically on adequate hospital staffing [ 7 ]. The Ontario Health Coalition report submitted to the SARS commission specifically noted inadequate hospital capacity and understaffed facilities [ 8 ]. The SARS epidemic resulted in significant psychological stress for hospital staff, as noted by a survey of the hospital staff of a tertiary care facility [ 9 ]. Two thirds of respondents expressed concern regarding their own or their family's health and well-being. While 29% of staff overall met criteria for probable emotional distress, the rate amongst nurses was 45%. The four factors which most correlated with degree of concern for family and personal well-being were perception of a greater risk of death from SARS, living in a household with children, personal or family lifestyle affected by SARS outbreak, and most interestingly, being treated differently by individuals simply because of working in a hospital.

dlowan wrote:

JTT wrote:

dlowan wrote:

I would imagine many of us will cark it at home.

I've never heard that one, dlowan. Interesting. Is it solely Australian?

Not at all.


Or do you mean "cark it"? Don't know where that comes from.

Yup, I meant 'cark it', dlowan. It seems that you've used it as a synonym of 'die'. Can it be used in a passive sense like 'kill' is, as in,

They were carked by the tornado/bird flu.

JTT wrote:

I'm no doctor/scientist but I think that a new bug that is able to create a pandemic is going to worry much about a list. By its nature, it'll get those, strong or weak, that don't have the necessary stuff inside to fight it.

It's gonna get a lot of us, no doubt, in more ways than our health. Just imagine for a moment how it's going to affect the economy.

My grandpa nursed a lot of his family thru the 1918 outbreak. He was the only one who didn't get sick. and now that I think about it caused the death of any of my family back then. That seems odd, given how bad it was. More research needed.

The original question assumes that there is something doctors can do to either cure or increase the chance of survival for a given patient.

If nothing can be done for anyone, then of course each individuals natural immune system will determine his or her fate.

I assume that life-support measures like breathing support, intravenous fluids, temperature control etc. will have some benefit to those fighting the disease, as will anti-viral drugs for some people.

The big surprise came when we tested masks being used by those most at risk ?- health care workers. A procedure mask ?- similar to a surgical mask has been deemed acceptable for protection against SARS by Health Canada and the Ontario Ministry of Health.

The procedure mask scored 34 per cent. The surgical mask filtered out 62 per cent of the particles ?- much better than the dust mask or bandana.

But even health care workers are wearing surgical masks to protect from the risk of SARS. Ever since the scare first hit, Ugis Bickis has been saying they don't work. He's angry that this is the frontline protection for many health care workers.

"Particularly health care workers or family members of people who are sick and who are trying to protect themselves, really deserve better protection that a surgical mask," Bickis told Marketplace.

One piece of good news: the masks that all health officials recommend as the best protection against SARS did well in our test. They are called N95s ?- and they more than live up to their name. The three kinds we tested filtered out between 97 and 99.7 per cent of all the virus-like particles.

One thing we didn't test for was how these masks fit. Bickis says that's a big concern.

"What happens when I put this mask on, and again if I were to tie it up…there would be some kind of gap between the mask and my face, and when I inhale, some of the air would come in through that gap. That means that there is no filtration offered."

These masks don't usually work for children or men with beards.

Bickis is dismayed by the lack of information.

"I think people are very seriously misinformed. Those who are advising on what kind of protection to wear simply don't have the necessary knowledge to do so properly."

Our tests suggest the N95 might offer the best protection against SARS. But there's another worry: if people who don't really need them keep buying them, there might not be enough left over for those in real danger of being exposed to the virus.

SARS lawsuits against Ontario get the go-ahead
Last Updated: Tuesday, August 23, 2005 | 7:18 PM ET
CBC News
An Ontario judge ruled Tuesday that two lawsuits launched over Ontario's handling of the SARS crisis two years ago can proceed.

Both lawsuits charge that the government put the province's economic interests ahead of the safety of its nurses.

One suit is a $600 million class action by Andrea Williams, a nurse who became infected with SARS on the verge of a second outbreak in May 2003. Williams was exposed to SARS while undergoing a surgical procedure at North York General Hospital in Toronto.

The other is a $12 million suit brought by the family of nurse Nelia Laroza, who died in June. Laroza was an orthopedic nurse at the same hospital.

Both nurses became infected during a second wave of the disease.

Ontario Superior Court Justice Maurice Cullity issued separate rulings Tuesday allowing both suits to go ahead.

By mid-August 2003, 44 people in the Toronto area had died of SARS.

Finn dAbuzz wrote:

JTT wrote:

I'm no doctor/scientist but I think that a new bug that is able to create a pandemic is going to worry much about a list. By its nature, it'll get those, strong or weak, that don't have the necessary stuff inside to fight it.

It's gonna get a lot of us, no doubt, in more ways than our health. Just imagine for a moment how it's going to affect the economy.

My grandpa nursed a lot of his family thru the 1918 outbreak. He was the only one who didn't get sick. and now that I think about it caused the death of any of my family back then. That seems odd, given how bad it was. More research needed.

The original question assumes that there is something doctors can do to either cure or increase the chance of survival for a given patient.

If nothing can be done for anyone, then of course each individuals natural immune system will determine his or her fate.

Admittedly, that was the question, Finn. Is there anything that can be done in the short term, save for palliative care, for these new strains that will inevitably cause a pandemic?

How quickly can shots be developed and how long does it take for those to be effective after an injection? Currently, shots are given before the flu season, are they not? Does this mean that there is a considerable lag time before immunity is boosted to an effective level?

Paper No. 10-0
PANZOOTICS, PARSIMONY, AND PALEONTOLOGY: CAN DISEASE CAUSE EXTINCTION?
MACPHEE, Ross D.E., Division of Vertebrate Zoology, American Museum of Nat History, New York, NY 10024, [email protected].

During the late Quaternary, mammalian faunas were affected almost worldwide by an unusual series of extinctions that were highly regionalized and temporally disjunct. Thus, about 11,000 bp in the Americas 130+ species (including mammoths, mastodonts, "ground" sloths, sabertoothed cats, and many others) disappeared very suddenly, perhaps in the space of 400 yr. Similar but smaller losses occurred in Australia/New Guinea ~ 50,000 bp, in the West Indies ~ 5000 bp, and in Madagascar ~ 1000 bp. These extinctions are widely believed to have been anthropogenic in nature, and thus represent the "first" biodiversity crisis forced by our species. But what is the evidence for this conclusion? Overhunting is frequently mentioned as the leading cause, but for several reasons it is highly improbable that primitive peoples could have induced so many species losses in this way. Climate change is even more unlikely. As an alternative, I propose that most features of late Quaternary extinctions can be explained by inferring that the principal agency of loss was infectious diseases introduced into immunologically naive populations by colonizing humans or their commensals/synanthropics. The "hyperdisease hypothesis" potentially (1) explains differential losses in K-selected vs. r-selected taxa (both young and old animals highly susceptible to disease, causing catastrophic depression in rate of natural increase in larger taxa); (2) requires no ad hoc explanations for the absence of mass kill sites in affected areas (mass kill sites absent because losses attributable to human hunting were usually negligible); and (3) accounts for pattern change in the character of anthropogenic extinction after first-contact losses. Recent successes in utilizing "ancient DNA" techniques for recovering evidence of viruses in fossils will be discussed.

GSA Annual Meeting, November 5-8, 2001
General Information for this Meeting
Session No. 10
The Emerging Discipline of Medical Geology
Hynes Convention Center: Ballroom B
8:00 AM-12:00 PM, Monday, November 5, 2001


--------------------------------------------------------------------------------
© Copyright 2001 The Geological Society of America (GSA), all rights reserved. Permission is hereby granted to the author(s) of this abstract to reproduce and distribute it freely, for noncommercial purposes. Permission is hereby granted to any individual scientist to download a single copy of this electronic file and reproduce up to 20 paper copies for noncommercial purposes advancing science and education, including classroom use, providing all reproductions include the complete content shown here, including the author information. All other forms of reproduction and/or transmittal are prohibited without written permission from GSA Copyright Permissions.

An international campaign has been launched to help save the world's amphibians from extinction.

Amphibians are under threat

Amphibians have thrived for hundreds of millions of years but as many as half of all species could perish unless a solution is found. The spread of the parasitic fungus amphibian chytrid, which has proved deadly for hundreds of amphibian species, may have been made worse by the effects of global warming. The disease has so far proved unstoppable in the wild and can kill 80 per cent of native amphibians within months once it has taken hold.

Amphibians are important as an 'indicator species' - similar to canaries in a coal mine - who serve as a warning when there is something wrong with the environment. Now 2008 has been designated Year of the Frog by conservationists to raise awareness of the plight of amphibians and to raise the funds needed for a concerted worldwide effort to save them.

The Amphibian Conservation Action Plan (ACAP) aims to protect the habitat of the amphibians while at the same time finding answers to the environmental problems they face.

The biggest initiative will be an amphibian version of Noah's Ark costing an estimated £30m where the most vulnerable species will be moved into protected areas in zoos, aquariums and other institutions around the world so their future survival can be guaranteed.

advertisementThe ambitious rescue plan is being organised by the IUCN/SSC Conservation Breeding Specialist Group, the IUCN/SSC Amphibian Specialist Group, and the World Association of Zoos and Aquariums (WAZA).

"Widespread extinction of amphibians would be catastrophic," said Jeffrey P. Bonner, chairman of Amphibian Ark and president and CEO of the St. Louis Zoo.

"In addition to their intrinsic value, they offer many benefits and are a critical part of a healthy world. They play an important role in the food web as both predator and prey, eating insects which benefits agriculture and minimizes disease spread. Their skin also has substances that protect them from some microbes and viruses, offering promising medical cures for a variety of human diseases.

The conservation groups hope the captive management plan will buy time for the most endangered species which will eventually be reintroduced back into the wild once the threats they face have been removed.

It is hoped the Year of the Frog campaign will raise awareness of the crisis among media, educators, corporations, philanthropists and governments and will generate the funding needed to make the campaign a success.

Sir David Attenborough, who is patron of the campaign, said, "The global zoo and aquarium community has taken on this challenge with enthusiasm and is providing appropriate facilities and breeding grounds within their institutions. But implementation calls for financial and political support from all parts of the world. Without an immediate and sustained conservation effort to support captive management, hundreds of species of these wonderful creatures could become extinct in our own lifetime."

Amphibians are severely affected by habitat loss, climate change, pollution and pesticides, introduced species, and over-collection for food and pets.

Jörg Junhold, Ph.D., chair of the Amphibian Ark Year of the Frog campaign and director of Zoo Leipzig, said: "It is of utmost importance to raise awareness among national governments, world media, school educators, corporations, philanthropists, and the general public about the fragility of amphibians and the enormous responsibility that each of us has in trying to rescue the amphibians in danger."

"The outcome of the Amphibian Ark project will be that we will have saved hundreds if not thousands of species from extinction. We also will have developed a capacity both within our institutions and globally to continue to provide amphibian species with care and protection when needed, formed a true partnership between offsite and onsite components of conservation, and demonstrated to the world that zoos and aquariums are essential conservation organizations."

We believe this is the first definitive report of an infectious disease causing the extinction of a species.

As for those who seems to be suggesting that a highly lethal pandemic is somehow a good and natural response to over-population, I doubt they will be so clinical when they, like your grandfather, watche it exterminate their families.

dlowan wrote :

Quote:

I assume that life-support measures like breathing support, intravenous fluids, temperature control etc. will have some benefit to those fighting the disease, as will anti-viral drugs for some people.

as the medical community in toronto found out when there was a SARS outbreak in 2003 , doctors and nurses were at a loss to know what exactly the right response should be to combat and contain the outbreak .

to cite just one example from a lenghty report isued after the sars outbreak . this section of the report deals with what mask would give adequate protection .

Quote:

The big surprise came when we tested masks being used by those most at risk ?- health care workers. A procedure mask ?- similar to a surgical mask has been deemed acceptable for protection against SARS by Health Canada and the Ontario Ministry of Health.

The procedure mask scored 34 per cent. The surgical mask filtered out 62 per cent of the particles ?- much better than the dust mask or bandana.

But even health care workers are wearing surgical masks to protect from the risk of SARS. Ever since the scare first hit, Ugis Bickis has been saying they don't work. He's angry that this is the frontline protection for many health care workers.

"Particularly health care workers or family members of people who are sick and who are trying to protect themselves, really deserve better protection that a surgical mask," Bickis told Marketplace.

One piece of good news: the masks that all health officials recommend as the best protection against SARS did well in our test. They are called N95s ?- and they more than live up to their name. The three kinds we tested filtered out between 97 and 99.7 per cent of all the virus-like particles.

One thing we didn't test for was how these masks fit. Bickis says that's a big concern.

"What happens when I put this mask on, and again if I were to tie it up…there would be some kind of gap between the mask and my face, and when I inhale, some of the air would come in through that gap. That means that there is no filtration offered."

These masks don't usually work for children or men with beards.

Bickis is dismayed by the lack of information.

"I think people are very seriously misinformed. Those who are advising on what kind of protection to wear simply don't have the necessary knowledge to do so properly."

Our tests suggest the N95 might offer the best protection against SARS. But there's another worry: if people who don't really need them keep buying them, there might not be enough left over for those in real danger of being exposed to the virus.

as you can see , even just finding the right mask was no easy task !

eventually it was determined that full body suits should be worn by those dealing directly with the patients - but there are only a limited number of those suits available since they are quite expensive (which brings us back to square one : MONEY !) .




you can find the full report at this website :

SARS REPORT

finally , i should mention that numerous lawsuits were launched - mainly by nurses and patients that had become infected with SARS .

Quote:

SARS lawsuits against Ontario get the go-ahead
Last Updated: Tuesday, August 23, 2005 | 7:18 PM ET
CBC News
An Ontario judge ruled Tuesday that two lawsuits launched over Ontario's handling of the SARS crisis two years ago can proceed.

Both lawsuits charge that the government put the province's economic interests ahead of the safety of its nurses.

One suit is a $600 million class action by Andrea Williams, a nurse who became infected with SARS on the verge of a second outbreak in May 2003. Williams was exposed to SARS while undergoing a surgical procedure at North York General Hospital in Toronto.

The other is a $12 million suit brought by the family of nurse Nelia Laroza, who died in June. Laroza was an orthopedic nurse at the same hospital.

Both nurses became infected during a second wave of the disease.

Ontario Superior Court Justice Maurice Cullity issued separate rulings Tuesday allowing both suits to go ahead.

By mid-August 2003, 44 people in the Toronto area had died of SARS.

Finn dAbuzz wrote:

As for those who seems to be suggesting that a highly lethal pandemic is somehow a good and natural response to over-population, I doubt they will be so clinical when they, like your grandfather, watche it exterminate their families.

Your specious moralizing does nothing to change the underlying facts that a globally needless excess of population in unhealthily close quarters is an accident waiting to happen. Let alone the fact that your preoccupation with the straw man logical fallacy deflates your assertions to the level of a fart in the wind.

With 6 billion people on earth I wouldn't worry about saving people. The over population brings about disease due to waste production and the resulting unsanitary conditions. Scarce resources brings about war, famine, starvation and pandemic diseases. It is natures way of culling excess humans.

Pandemics could not happen in modern day life as we now have indoor plumbing and rather clean street. The last pandemic in 1918 happened because they were no indoor plumbing. People used to go to outhouses and street drains used to contain urine and faeces.