13 October 2009

I get to be part of the (Pandemic) club

It's been sort of weird the last few weeks. There has been so much noise in the media about the H1N1 influenza outbreak. I've been reading about overwhelmed ERs, triage in the parking garages, twenty-year olds on ventilators. It's scary stuff. One ER friend tells me his department volume is up 40% due to H1N1. We've dusted off the disaster plans and have been ready to go for a while now.

But instead: nothing. We sat in our near-empty department and stared at one another wondering when the tidal wave was going to hit. It's been a little like working New Years Eve, or during the Super Bowl. You know you're going to get crushed but you don't know exactly when or how bad it's going to be. Frankly, I was starting to feel a little left out, as everybody else got into the game and we were left on the sidelines.

No more. The other shoe has now hit the floor. We are off the tenterhooks. The suspense has ended and the pandemic has officially hit our corner of the Northwest. Surprisingly, it hit abruptly. One day I saw zero influenza-like illnesses. The next day they represented 50% of my cases. Strangely, I feel relief. It's game time.

On another note, I came into my shift today and the nursing station was consumed by a vigorous debate over whether we should "take" the H1N1 vaccine. There's no obligation to do so at our hospital, but the infection control people are being quite diligent in trying to get through to everybody. And this just freaking blows my mind. We are health care providers. We are supposed to be smarter than this. When you have thought leaders in the field of health care writing op-eds in the New York Times practically begging caregivers to get the vaccine, and still there is widespread uncertainly whether it would be a good idea or not, then we've lost. It's official, folks: Jenny McCarthy and Oprah have won. Vaccines are the agents of the devil; science and evidence-based medicine have been once and for all repudiated. When the debaters asked me whether I thought we should get vaccinated, I perhaps a bit too caustically opined that it was either embrace the vaccines or give up the ghost and go back to bloodletting and purging evil humours.

Maybe we'd be better off with homeopathic vaccines. They're injections of water, but they were once near someone who had had the flu.

Seriously folks, get the fricking vaccine. It's safe -- much safer than the influenza, and far far less miserable. I had the misfortune to get H1N1 in May, and it was the sickest I have ever been in my adult life. I was prostrate for five days, and there are long spans of time that I just don't remember. Especially if you or a loved one are high-risk: very young, very old, or pregnant. Get the damn shot.

Frankly, though, I have no sympathy for any health care provider who chooses not to get immunized. I hope they do get influenza. They will deserve it. Hopefully they won't get too many of their co-workers and patients sick along with them.


  1. I was expecting the pandemic to start here as soon as PAX ended. Was it not the vector for infection I thought it would be?

  2. I've spent the last two weeks in an N-95 mask because of H1N1. So far, I'm flu free but I'm breaking out like a teen with raging hormones.

    And I agree with you - getting H1N1 was quite simply the most awful experience in recent memory. I'll be cursing the family that gave it to me for quite a while...

  3. I am a well-respected instructor at a Portland Metro area community college. I have done as much research on the vaccine as I am able to. I have a 3.5 year old and a wife. None of us are going to be vaccinated, as I simply cannot find irrefutable proof that the vaccine will help us more than not getting it will harm us. I cannot see a consensus reached that the vaccine does not have the potential to be harmful in itself, especially if a pandemic does not occur. One thing I am sure of is that you sound bitter and fairly heartless, and I hope you are never my doctor.

  4. Anonymous, it's hard to prove a negative. Do you have any proof that the vaccine WILL harm you more than it will help?

  5. Okay, Im calling my doc tomorrow and making an appt for the vaccine. COPD here
    Thanks !

    What upsets me is that my daughter is sitting on the fence about getting her one year old the flu shot because of all the "Jenny no vaccine" media.
    She would never miss a necessary vaccine for my grandson. I know she'll do the right thing next week when she talks to his pediatrician.

    To tell you the truth this flu has been jacked up by the media and has confused mothers,grandmothers and most people outside the medical community.

    Our Perspective: It all started with a name change from "swine flu" to the "alpha and numbers" thing. Swine Flu I could understand.

    First it was the killer flu from Mexico, then it wasnt the killer flu from Mexico and it was (comparable to any flu)?, Oh Yeah, and the vaccine was an over kill. Then the vaccine wasnt safe. Now the flu is serious and the vaccine is safe. I'm not even going to bring up the tamiflu stuff.

    No wonder civilians like myself might get caught in ER or is it ED ? sick and minus our vaccine.

    Gosh its so hard to be living on this side of the computer all alone not knowing what to do.

    Wait, I think I might be in the majority.

    I'm the very young looking grandma waiting to see whats going on. Just had a flash back of that song by Marvin Gaye "What's Goin' On" love Motown.

    Thanks so much for this wonderful blog, I read it daily.


    PS Number three son had it, the swine flu. Hes 25 and was pretty sick. So I am thinking maybe it was really H1N1.

    Thanks Again

    A Mom/Grandma in Detroit

  6. Anon 9:08,

    You may instruct something, and you may even be "respected" by someone, somewhere. But it's a display of staggering arrogance, ignorance, or some combination of the two to think you can substitute your internet research for the combined expertise of every single fricking epidemiologist in the country and the CDC to boot.

    Look, the CDC is not in this to make money off vaccines. They are in it to promote public health. It's kind of their job and they are good at it. They've done the math, and the data is quite clear that the benefits of the H1N1 vaccine far outweigh the risks.

    But you want "Irrefutable proof." Bull. Just like the birthers want proof the Obama was really born in the US, and the moon hoaxers want proof that Neil Armstrong really walked on the moon. You, like they, are quite content to ignore the mountains of evidence (and expert opinion) in favor of your predetermined conclusion.

    Good luck, and be sure to take plenty of ibuprofen when you get the pandemic (and yes it already *is* pandemic) influenza.

  7. I've noticed the same thing in Australia. The vaccine has come late for us, we've already been hit by the pandemic during the winter months. Many staff have been saying, "well I've probably already been exposed." During seasonal influenza only about 3% of influenza-like illness is actually influenza. During the pandemic in Australia it has been about 10%. I've looked after enough otherwise young fit and healthy people with 2009 H1N1 on ECMO for many weeks now. I got my vaccine as soon as I could - I'd hate to pass on a bug to someone and be responsible for their death.
    Get vaccinated!

  8. You, like they, are quite content to ignore the mountains of evidence (and expert opinion) in favor of your predetermined conclusion.

    I attribute a lot of it to people of my generation not really believing that these type of epidemics/pandemics really "exist", at least in the Developed Nations. They've never had to worry about smallpox, polio, diptheria, and so forth, in the way our parents and grandparents did.

    That, combined with the "natural = good" pseudoscientific mentality that's sprung (witness the whole range of "alternative medicine"), gives them a kind of jaded-ness about the big risks, and an overhyping of the small ones.

    The real victims, of course, tend to be the kids, particularly when enough of these clowns get in a single area and drop the herd immunity, allowing diseases extinct for decades in the population to come back (like measles in the UK).

  9. My autistic son get a seasonal flu shot last month, and had the least down time of all us five last week when we got probable H1N1. My girls were suppose to have gotten their seasonal shots last week, but got the bug first, so the shots got posponed.

    Our phiosophy of vaccinaton is if there is a non-mercury option of that vaccine, we take that, otherwise we take what is available.

  10. Childrens Hospital of Cincinnati OH told its staff they'll get both vaccines, or they'll take a 5 day unpaid suspension immediately and have their work contracts terminated at the first of the year.

    You wouldn't think you would need to enforce such a thing at a place set up to take care of already sick kids, but there have been staff complaining about their employer making their medical decisions for them. Kind of a disconnect going there about the nature of their work as service providers, in my opinion.

  11. "natural = good"

    Especially pseudo-scientific, since it is a provably false statement. Since, if it were true the following would also be true.

    Arsenic = good.
    Lead = good.
    Mercury = good.
    Thimerosal = good (see previous).
    H1N1 = good.
    Polio = good.
    Small pox = good.
    HIV = good.
    Anthrax = good.
    E. Coli = good.

  12. Anonymous @ 9:08:

    If I were to let my visceral impulses get the best of me and allow my emotions to steer me into the realm of add hominem character assaults I'd say that you are a worthless, scientifically illiterate douche, a criminally incompetent father, and a pathetic, cringeworthy caricature of all of the attributes that non-retarded community college professors have been ceaselessly toiling to eradicate from their public image for decades.

    Since I have more self command than that, allow me to say that I fully support your decision to refrain from vaccinating yourself, and hope that other "well respected" individuals like yourself refrain not only from any and all vaccinations, but refuse each and every treatment and therapy that scientific medicine has delivered to humanity for the past 125 years. I think that leaves you with leeches. The sooner that you and your ilk have to personally confront the very real consequences of your rhetoric, the better IMO.

    I am not sure that I'll be able to contain myself when it comes to the mortal risks that your poor, innocent, non-consenting son is going to have heaped on his tiny shoulders as a consequence of the absurd conceits flittering about in the small, festering, patchouli-addled excuse for a brain that fills your cranium.

    Your presumption that your status as a "well respected" instructor at a community college leaves you in a position to question the totality of the scientific, clinical, and analytical that have built the overwhelming edifice of irrefutable evidence for the safety and efficacy of vaccines that's been painstakingly constructed by hundreds of thousands of scientists and physicians over the past two-centuries-and-then-some that have transpired since Jenner's experiments is a gesture of such staggeringly misfounded hubris and cosmologically significant idiocy that one has to reach to the heavens to find a metaphor sufficient to describe it's scale and grandeur. Trillions of black holes collapsing upon one another at the core of a galaxy so vast that light itself grows faint and weary at the thought of every traversing it...falls short as a starting point with which to describe the sublime dimensions and magnitude of the stupidity, and the boundless recklessness of the irresponsibility that fused into the adjective-defying idiocy of your decision not to vaccinate your little son.

    The sentencing meted out in the story below is, sadly, the exception in cases of children who suffer entirely preventable illness and death as a consequence of their parent's monstrously selfish idiocy. Here's to hoping that their sentence, at a minimum, becomes the norm.


  13. http://www.smh.com.au/national/jail-for-parents-who-allowed-daughter-to-die-20090928-g8x2.html

  14. They thought the flu shot was a pretty good idea in 1976 too.

    More people died from the shot than from the swine flu that year.

  15. Scalpel,

    Yeah, they thought rotating tourniquets were a good idea in 1976 as well.

    Things change.

    This ain't 1976.

  16. Scalpel: 300 is a smaller number than 30,000. More people died from influenza than from the vaccine, even in the worst (only!) year of GBS association.

  17. There have already been several H1N1 cases at my boys' schools. Fortunately, the children have all recovered--they were mild cases.

    But here's the thing: one can't always predict how one's own body (or that of one's child) is going to handle the virus. Nor, as Shadowfax points out, can one predict if being in a state of immune onslaught while exposed to other pathogens will leave one with additional, truly serious infections. Numerous pregnant women have died from this strain, too.

    I read and research vaccines and medicines as much as possible, especially when I'm giving them (or allowing them to be given) to my sons. Invariably, it comes down to the math: yes, there is almost always a small chance that any vaccine or medication will cause harm. But the chance that one will be harmed--or killed--by the disease itself is greater by orders of magnitude, as it is with H1N1.

    And although I support permitting people to make their own decisions about what they take and don't take, I would hope that those who refuse H1N1 vaccinations stay the hell away from hospitals, doctors' offices, and other places where innocent people with less-than-robust immune systems go for help. I also hope that if these people as much as suspect they're falling ill, they stay far, far away from supermarkets, Targets, Baby Gaps, and anywhere a pregnant woman might innocently go and be unwittingly exposed to this serious virus. Would that my faith in human nature were as robust as my boys' current good health, but sadly, I fear there are many deeply selfish individuals out there, even working in schools and hospitals.

  18. Grandson will get his vaccine this Friday. (Sent her a link to your blog) THANK YOU

    Linked your article all over J&F

    Thanks Again

  19. But the chance that one will be harmed--or killed--by the disease itself is greater by orders of magnitude, as it is with H1N1.

    This is a good point. To compare it, think about the Smallpox vaccine. A certain number of people were more or less guaranteed to get either seriously sick or die from the vaccine out of a million people getting the vaccination, but we still did mass smallpox vaccinations. Why? Because the dangers of a smallpox epidemic were much, much greater.

  20. Matlawhatever,

    Only one person died of swine flu in 1976, but 25 died from the vaccine.

    You must be confused with the "regular flu," which like this year was worse than the dreaded swine flu (despite the media hype).

  21. Those of us concerned about Thimerosal in vaccines don't get our data from the Internet (ok, well some do). All you have to do is search PubMed and you'll find research stating no known danger, and other research stating there are harmful effects. I'll grant you the research is probably 80% in favor of the no "known" danger, but it's not by any means conclusive. We know thimerosal is harmful to animals, and there is some evidence it is harmful to humans. It's a legitimate concern.

    Just because you are MDs doesn't mean you know everything. Good grief. Read your PubMed journals and please don't be so arrogant to everyone who disagrees with you.

  22. precordialthump:

    I had the same experience as you during our flu season.

    Last week I was asked by my mother whether she should get H1N1 vaccine. I mentioned that I wasn't getting it, and that I thought that the risk of her getting H1N1 flu (she already had seasonal flu vaccine) was not particularly high.

    I usually get the seasonal flu vaccine, except I didn't this year because we were too busy for me to get vaccinated (yay for NSW Health protecting its employees).

    I don't trust Panvax. This is a gut feeling and has nothing to do with my opinion of vaccines in general (I got a new Boostrix this year, for example), but there's a degree of mistrust over a vaccine which for which my MDO has issued special advice, and for which they were originally not going to cover me.

    The ATAGI advice regarding risk of Guillain-Barre attributable to seasonal flu vaccine is a maximum of 1 case per million. The most recent surveillance data is 2 ICU admissions in the past week in a nation of 20 million, or 1 in 10 million, with a death rate of about 15% of that, or 1 in 60 million per week.

    As for having been exposed - I've definitely been exposed to PCR-confirmed H1N1. I had a flu-like illness of quite short duration; I don't know if I have seroconverted.

    Now, I will be keeping an eye on the surveillance data, as well as the casual surveillance and ICU trash talk at work, and if there looks like a second wave I'll definitely reconsider, but for now I have declined. I don't think that the vaccination providers at work are able to give proper informed consent (they are RNs, and although I have every respect for RNs doing RN work, I find infection control RNs to not be as up on the evidence as the infectious diseases physicians who back them up).

    Note that this calculus is specifically for Australia, for my particular vaccination scenario, and does not in any way apply to the US, or to non-doctors in Australia, nor does it support an antivaccine stance.

  23. WA Student who wants a vaccine10/23/2009 1:13 PM

    Thank you for advocating on behalf of the vaccine.

    If only I could find a place to get it I'd be all set. I'm in a small city/big down in the northwest, and as a college student with pretty icky asthma (who always gets sicker then she's supposed to) am definitely part of a risk group. But I had to take a quarter off of school to work (tuition hike) and my campus is only giving the H1N1 vaccine to people who are not in a risk group. My boyfriend plans to get the vaccine because he lives with someone in a risk group (me, and its been suggested that people who would be likely to transmit to somebody who'd have an adverse reaction get vaccinated too), but the two vaccination dates for our campus happen during times when he is in class.

    We're looking for other alternatives, but we're both busy and college-poor and its autumn (textbooks we're bought in the last month, wiping out any extra resources we might have had, and I had to pull out of class after the return deadline).

    Is there a state-by-state or regional place to find information about where to get vaccines? I'm in Washington, and it feels as though there has been little information in this part of the state about the impact of flu in the region or what to do if you're in one of the risk categories other then "pregnant women" and "elementary school kids".

    Your "about" section said you were in the NW, so I figured you might be a good person to ask about placed to go for regional information.


  24. WA Student,

    Not knowing what county you're in, but you can try this as a starting point:


    Good luck.


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