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A Systematic Analytic Approach to Pandemic Influenza Preparedness Planning

  • Daniel J Barnett mail,

    To whom correspondence should be addressed. E-mail: dbarnett@jhsph.edu

    X
  • Ran D Balicer,
  • Daniel R Lucey,
  • George S Everly Jr,
  • Saad B Omer,
  • Mark C Steinhoff,
  • Itamar Grotto
  • Published: November 01, 2005
  • DOI: 10.1371/journal.pmed.0020359

Reader Comments (3)

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Preventing mass deaths

Posted by plosmedicine on 30 Mar 2009 at 23:55 GMT

Author: Charles Johnson
Position: Software
Institution: Valverde Computing
E-mail: CharlesOne@Yahoo.Com
Submitted Date: June 05, 2006
Published Date: June 8, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

To a casual observer, there appears to be a billion young people at risk of death. As several experts have stated the problem, those with strong immune systems are most at risk.

Public Policy and Ethics Questions:

1. If most of those most at risk are between 20-40, representing the inversion of the usual flu deaths of the young and the old (or pregnant women with a death rate as high as 50%) then, rather than simply letting vast numbers of these populations die when the disease is contracted with no vaccine or treatment, is there a last ditch treatment that could save them?

2. If that last ditch treatment was risky and potentially damaging, would it be ethical to prepare it in advance, in large numbers?

Medical Treatment Questions:

1. If the real problem that causes death in these populations is the patient's strong immune system as it over-responds to the virus (which is attacking every organ in the patient's body) to cause death from shock, then is it reasonable to to restrain the immune system as the at risk patient becomes symptomatic, or even as exposure of the at-risk group is encountered?

2. What are the best means of immuno-suppression? Can at-risk patients be treated with just enough immuno-suppression to limit the shock effect, like a 50% reduction in function across the board? Is it possible to prevent organ damage?

3. If the immune system is suppressed, how long would the at-risk patients need to take antibiotics to protect them from opportunistic infections?

4. They give strong immuno-suppressive drugs to prevent organ-rejection in transplants, is this too drastic of an effect? Can it be reduced reliably?

World Health Questions:

1. Since the large numbers of at-risk people around the world are poor, are there immuno-suppressive drugs or environmental (natural) toxins that could be extracted and prepared in large quantities by mass actions (without killing more people than are saved)?

2. Can different treatments potentially be found in the different parts of the world?

Immunosuppressive drugs come in four categories, from (http://en.wikipedia.org/w...):

Immunosuppressive drugs can be classified into four groups:
- glucocorticoids
- cytostatics
- antibodies
- drugs acting on immunophilins
- other drugs

I wonder what the authors would think about this obviously desperate approach?

I can propose desperate measures, because I am a computer systems architect, and am not responsible for anyone's care aside from my own.

Charlie

No competing interests declared.