First Session

Wednesday, September 21, 2011

“The Virus and Its Ravages”

Reading Assignment: Prologue and Chapters 6-8 and 12-19.

Objectives:

  1. Evaluate the professional roles and responsibilities – with particular attention to the ethical dilemmas confronted – of a “medical officer” or practitioner who cared for patients during the 1918 Spanish flu pandemic on the war front.
  2. Describe a typical illness or symptom pattern of a H1N1 virus infection in a human host with attention to possible lethality for the very young, those in early adulthood, pregnant women, or the very old.
  3. Explain the notion that “it [the H1N1 virus] becomes a better and more efficient killer” as the pandemic spreads.
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17 Comments (+add yours?)

  1. Clare Tullock
    Sep 16, 2011 @ 22:28:20

    My name is Clare Tullock and I have worked as a registered nurse for 6 years, 3 of which were in the hospital in acute care, and the last 3 and a half have been in home care. I am looking forward to the discussion on the professional roles and responsibilities. This book has made it very clear that each profession during this time was pushed to breaking point and further in regards to responsibilities. I currently work as a home care nurse so I fully appreciate the gravity of visitng the sick in their homes and providing education and care even when the accomodations are by no means optimal. This does provide an advantage though as we are able to view health habits in the home and educate the entire family as opposed to just the patient. I look forward to listening to what the expectations of a “medical officer” or practitioner were during this time.

    Reply

    • Brittany Fitzpatrick
      Sep 21, 2011 @ 02:14:08

      In response to Clare:

      I think it is invaluable to be able to go into a patient’s home and see how they live. I did a rotation with visiting nurses a few summers ago. It was eye opening. It is essential to be involved with a patient’s family when it comes to health care. By going into a patient’s home you get a look at the bigger picture that is a patient’s life as opposed to a quick snapshot. In an office (or a pharmacy) a patient can be very limited in what they tell a medical practitioner; at home you get to see them in a more comfortable setting. You get better insight into their life.

      Reply

  2. Suja Thomas
    Sep 17, 2011 @ 20:58:55

    My name is Suja Thomas. I work as an Education Specialist/ Patient Care Administrator at St. Peter’s Hospital, Albany. I have been a nurse both in long term and acute care for almost 19 yrs. I also serve as a flu champion for SPH. When Dr. Kelman (my advisor & professor) presented me, “The Great Influenza: The Story of the Deadliest Pandemic in History” written by John M. Barry, seemed quite fascinating to me.
    When I started reading it, I was astonished by the facts the author was describing. It is indeed a study of 1918 Pandemic. He portrayed the influences of power, of war and of social and economic crisis…how it all interrelates. Presumed to have begun when sick farm animals infected soldiers in Kansas, spreading and mutating into a lethal strain as troops carried it to Europe, it exploded across the world with unequalled ferocity and speed. As per author it killed more people in twenty weeks than AIDS has killed in twenty years; it killed more people in a year than the plagues of the middle Ages killed in a century. He described the symptoms of influenza as bleeding from the ears and nose of the victims, who turned blue from lack of oxygen, suffered aches that felt like bones being broken, and died. In the United States, where bodies were stacked without coffins on trucks, nearly seven times as many people died of influenza as in the First World War. According to the historian Barry, the most vulnerable of all, “those most likely, of the most likely”, to die, were pregnant women. Of the pregnant women who survived childbirth, over one-quarter (26%) lost the child. As Claire mentioned I am also looking forward for this class.

    Reply

  3. Premjit Klaipetch
    Sep 18, 2011 @ 00:44:56

    I would like to share my opinion as follow;

    1. Evaluate the professional roles and responsibilities – with particular attention to the ethical dilemmas confronted – of a “medical officer” or practitioner who cared for patients during the 1918 Spanish flu pandemic on the war front.
    From my point of view, the ethical dilemmas that a medical officer or practitioner who took care of patients during the 1918 Spanish flu pandemic encountered included:
    truth telling – To prevent the spread of the pandemic, truth telling was important. The health care providers needed to be truthful with the public in order to ensure that people received accurate information to protect themselves and their family from the infectious disease. Several physicians had tried to provide critical information about the flu to disseminate to the public, but other officials prevented “leaking” much of that information.
    justice – healthcare should be accessible for all people. There was insufficient supplies of vaccination. The physician provided the vaccine to 234 soldiers who had pneumonia. How could he decide which soldier should receive the vaccinations ?
    autonomy and justice for nurses who cared for infected patients. There was an order mentioned “Devoting special personal care to any one patient whose condition is not critical is prohibited” (p. 216). This was an ethical conflict for nurses.

    2. Describe a typical illness or symptom pattern of a H1N1 virus infection in a human host with attention to possible lethality for the very young, those in early adulthood, pregnant women, or the very old.
    Patients who infected by H1N1 virus would shown symptoms with fever, headache, body ache. They would exhibit signs of mahogany spots on their cheek bones. Then the cyanosis spread from the eyes and extended around the face reflecting extreme tissue hypoxia. Patients would have hemoptysis(cough with bloody sputum). Several of them have bleeding from their nose and ears. Many of the patients had delirium. Severe H1N1 infection led to multi organ failure and death.

    3. Explain the notion that “it [the H1N1 virus] becomes a better and more efficient killer” as the pandemic spreads.
    This notion can be explained by the “passage phenomenon”. This phenomenon describes an ability of organism adapting itself to the changing environment. During the way of the organism(virus or bacteria) pass from living animal to living animal, it reproduces more proficiently, growing and spreading more efficiently and the virulence is increased each time. Several passages, from living creature to another creature and another enhance the ferocity of the organism.

    Every feedback are always welcome.

    Premjit Klaipetch
    Graduate Nursing Student, The Sage Colleges

    Reply

    • Emily Mozingo
      Sep 21, 2011 @ 17:59:26

      I am glad you mentioned the role of public officials and the power of the information that the media delivered. I think that in an effort to avoid mass hysteria and fear many public officials ( medical officers included) downplayed the severity of the virus. As a result, cities were not properly prepared for outbreak and fatality resulted.

      Reply

  4. Thochaporn Tesasil
    Sep 18, 2011 @ 01:14:45

    During the past 10 years, I’ve spent my entire nursing career working in the largest hospital in Thailand-“Siriraj Hospital”. As a leading tertiary hospital including a major Thai Medical School, we have encountered several national epidemic episodes: SARS, Bird-Flu, or Swine flu. In our hospital, even without the plague, our 2500 beds are almost always fully occupied. However, after reading several chapters of The Great Influenza, I developed a better understanding of the essential professional roles and responsibilities that were needed to oversee the pandemic event, especially the role in confronting some of the ethical dilemmas which occurred because of limited resources. Under the pressure from the dreadful killer H1N1 disease itself, the lack of adequate medical supplies and health care professionals created a complicated national crisis situation with fragile, almost non-existing resources.
    In these circumstance, I totally agree that a strong collaborative effort among interdisciplinary team is required to manage all available resources and try to meet the health care needs of the public and the sick. I look forward to learning more from our upcoming class discussions. I also believe that this class provides the opportunity for all of us to learn how to better collaborate in order to provide the best care to our patients and the public at large.

    Reply

  5. Dr. Joan Dacher
    Sep 19, 2011 @ 04:56:42

    As I read these comments and reflect on the devastation of epidemics it causes me to pause and think about this taking place within the context of a military war. On page 99 of our text the author writes, ” a virus has only one function: to replicate itself…….it invades cells that have enrgy and then, live some alien puppet master, it subverts thems, takes them over, forces them to to make thousands, and in some cases hundreds of thousands, of new viruses. The power to do this lies in their genes.” This reads like the description of military strategy and we the reader are left to ponder the strength of this viral military offensive and what it would take to defeat it. In 1918 a war was being fought on many stages and fronts, none the least of which was the public health offensive against influenza. This leaves us with many ethical questions to consider with regards to professional obligation, allocation of resources, politics and the role of government as well as the role of nurses and other health professionals in determining priorities. How can we read the story of 1918 to help us better understand all these things within the context of 2011?

    Reply

    • Sarah Botting
      Sep 20, 2011 @ 02:47:21

      In response to the comment left by Dr. Dacher:

      I feel it is hard to compare the effects of a pandemic if it hit our nation today to what happened in 1918. We have grown leaps and bounds forward in not only the medical field, but in the business and manufacturing aspects of our world as well. We have more efficient production capabilities and many supplies due to computers and automated machines. Scientific laboratories have the highest efficiency machines available, along with the supplies needed for them. All of these combined make us more prepared than those back in 1918. While there will always be an issue over funding for scientific studies, those scientists in 1918 had just as many, if not more, problems finding ways to get their laboratory tools.
      What I believe is under the greatest debate are the healthcare policies/insurance care plans and allocation of these resources that we can so readily make. This is what I feel limits our ability to be completely prepared for a pandemic of this magnitude if it hit our nation in the near future.

      Reply

      • Brittany Fitzpatrick
        Sep 20, 2011 @ 16:29:41

        In response to Sarah:

        I too think it would be difficult to compare what would happen if a pandemic occurred today in comparison to 1918. We have truly grown in our knowledge and resources over these last one hundred years. There are so many more tools readily available to us these days. However, we would continue to face many challenges if a time of medical crisis were to arise. I would say that healthcare policies and insurances could quite possibility hinder our ability in a time of pandemic, however the current situation with medication shortages may also cause a large problem. Currently, numerous pharmacy’s have a difficult time stocking certain medications due to the lack of availability. Does anyone foresee this as a possible problem if a pandemic erupted today? Also, if the disease was completely foreign to our knowledge this could provide many obstacles that were reflected in The Great Influenza. We should learn from our past and build off of it.

      • Dr. Kyle Guay
        Sep 21, 2011 @ 00:38:06

        Sarah does bring up some good points in regards to the advances our society has made over the last few decades, however I do have one question- Even with the advances in the medical, business, and political worlds, how has the way of thinking changed? At the end of the day, if immersed into a war like that in 1918, would the resources go to the medical treatment and prevention of an epidemic or toward the military/political powers leading the war? Would public health be any more important/significant now than then? These may be questions that we would not be able to truly answer unless we were experiencing it, I would like to be an optimist and believe that public health would be at the forefront of priorities but would it? Does the past strengthen the necessity to advocate for each one of our perspective professions to become more unified etc….

        Just a few thought questions…

      • Sarah Botting
        Sep 21, 2011 @ 01:18:08

        Dr. Guay,
        I see where you are coming from. Like I said in my longer post below and what is said throughout our text, one may never know how another may handle a situation (especially one of this extreme nature), until they are actually faced with dealing directly with it. There would be in fact no way to know how the nation would actually handle such a devastating situation. I agree that I would be optimistic and hope that the health and wellness of our citizens would be of utmost importance. It would only be to everyone’s benefit if it were the case.

  6. Brittany Fitzpatrick
    Sep 19, 2011 @ 15:46:34

    Hello! I thought I would also respond to the questions posted above!

    1. Evaluate the professional roles and responsibilities – with particular attention to the ethical dilemmas confronted – of a “medical officer” or practitioner who cared for patients during the 1918 Spanish flu pandemic on the war front.

    Ethic was an essential topic on the war front in 1918. For practitioners who cared for patients on the war front, bribes were a very large issue at hand. Visitors and civilians often times tried to bribe practitioners who were healthy to take care of their loved one who may or could possibly fall ill. People were desperate to ensure that their family and friends were taken care of. Ethically, this became a large problem. Staff who had encounters such as this were supposed to report those who tried bribe them. Medical staff were supposed to provide equal care to all of those who had fallen ill. No form of special attention was supposed to be provided, especially in a time where so many people were becoming ill. The neglect of one patient to provide extra attention to another could result in death. Honesty and morality of those who practiced medicine on the war front was crucial in the war against influenza.

    2. Describe a typical illness or symptom pattern of a H1N1 virus infection in a human host with attention to possible lethality for the very young, those in early adulthood, pregnant women, or the very old.

    Those infected with the flu could die merely hours after they started showing symptoms. Victims had days of excruciating and painful symptoms. Patients experienced headache, nausea and vomiting. Their mucosal membranes of their nose and throat became inflamed. They were dizzy. They experienced typical symptoms such as fever and chills. Victims often bled out their ears and nose, and were then found dead. Patient’s had ear infections and perforation. Abdominal pain was extremely common. A very significant complication was bleeding from mucosal membranes, such as the eye, intestine and stomach. Influenza affected the entirety of the body, not just one single system, including the kidney, the heart and the lungs.

    When it comes to viruses such as influenza, it is often found that the very old and the very young are its victims; however this strain attacked both the weak and the strong. It appeared to focus on the strong. It was found that the healthiest people in society, young adults, were killed most often. Pregnant women were considered to be most at risk to die. Pregnant women who became infected with the flu and survived often experienced miscarriages (about 26 percent-page 240).

    3. Explain the notion that “it [the H1N1 virus] becomes a better and more efficient killer” as the pandemic spreads.

    As the virus had more time to spread and infect, it would spread more quickly. It could kill easier. Death found its way into countless families in 1918. I personally found it interesting how The Great Influenza used the phrase “It’s only influenza” several times. It displayed how ironic it was that the virus that caused so many deaths wasn’t caused by something as horrifying as cholera or typhoid. It was only influenza. This influenza spread like wildfire from person to person. Death came so quickly to those who were infected, people often died within 12 hours of showing signs of the flu. The following quote displays how lethal this form of influenza actually was, “The virus was often so efficient at invading the lungs that the immune system had to mount a massive response to it…the killer was the immune response itself” (page 247).

    Not only did it become “a better and more efficient killer”, but I personally believe it resulted in the death of living of those who were actually alive. It hindered daily living. People were terrified to walk on the same side of the street as others, fearing those who could possibly be infected. It destroyed the daily routine of living, healthy people. It was difficult to live life to its fullest in 1918.

    I look forward to our class on Wednesday!

    Brittany Fitzpatrick
    Albany College of Pharmacy and Health Sciences
    Pharmacy Student

    Reply

  7. Sarah Botting
    Sep 20, 2011 @ 02:39:57

    Hello everybody! My name is Sarah Botting and I am a student at Albany College of Pharmacy and Health Sciences.

    I enjoyed reading The Great Influenza because it helped me think deeper into medical ethical dilemmas and allowed me to question my own beliefs and morals. This text led me to think “what would I really do” in a situation like those who lived in the 1900’s encountered. One often wonders about a health care worker’s “professional roles and responsibilities.” While it seems obvious that a doctor, nurse, pharmacist, orderly, etc. would always stand true to their professional oath, we commonly see that they do not. They do not always uphold the values and notions that they promised to carry out. It was a time of war and “Total war requires sacrifice (Page 205)…” There was a never-ending call for doctors and nurses to come out of retirement, sacrifice their freedom, and assist the helpless, yet there was never enough.

    Accounts were documented where physicians would try to lie about their background in order to save themselves and their family from hardship. In the book, Dr. Ralph Marshall Ward stopped his medical practice in order to work on a cattle ranch. “He and his wife made a pact never to utter a word that he had been a doctor (Page 342).” While it upsets me to say this, I understand where he was coming from. Due to the fear the nation felt, he many have assumed he would be one of those bodies getting carried away if he even attempted to treat the deathly ill. By nature, most humans think about themselves first, then others. I do not think that what he did could be considered right or wrong because it is up to an individual to decide what is right for themselves. Luckily enough, when hundreds of Mexicans discovered his capabilities to treat patients, he did attempt to treat them with what little supplies he had on hand.

    The early 1900’s influenza was one that killed many loved ones. The influenza virus mutates rapidly through antigenic drift and shift. It is due to these drifts and shifts that “it [the H1N1 virus] becomes a better and more efficient killer.” We, the supposed “experts” on health and disease, cannot predict how a mutation will result. That is why flu shots are only a prediction of the strains of influenza that will try to invade the population that particular year. The influenza virus is smart, smarter than most people. It can evade those who have studied it for decades.

    Looking forward to meeting everyone!

    Reply

    • Emily Mozingo
      Sep 21, 2011 @ 18:08:48

      Sarah. I enjoyed reading your post specifically the quote that you included. Not only was the nation at war, quite literally, but the United States was also in combat against a rutheless and deadly virus. The role of medical professionals rapidly changed in this ” total war”. Professionals were forced to consider the new responsilbilies forced upon them and not all rised to the occasion.

      Reply

  8. Glenda B. Kelman PhD, ACNP-BC
    Sep 21, 2011 @ 03:56:14

    It has been fascinating to read everyone’s responses and I look forward to our first class together tomorrow night.
    As a faculty member and nurse practitioner, I contend that the “hardships” encountered during the Great Pandemic continue to plague even our Modern World today. We continue to be faced with some of the same ethical dilemmas including allocation and rationing of scare resources not only in our third world countries as we struggle to provide adequate housing, shelter, running water and vaccinations to prevent the spread of diseases that are reemerging, but right here in the Capital District.

    Reply

  9. Emily Mozingo
    Sep 21, 2011 @ 17:31:53

    Good Afternoon Everyone!

    My name is Emily Mozingo and I am a 5th year student (third professional year) in the PharmD program at the Albany College of Pharmacy and Health Sciences. I enjoyed reading The Great Influenza by John M. Barry. The book incorporated my two passions; history and medicine. The Great Influenza provided an in depth and interesting account of the 1918 flu pandemic.
    To begin, I would like to address the questions posed to us at the beginning of this course.
    •Evaluate the professional roles and responsibilities – with particular attention to the ethical dilemmas confronted – of a “medical officer” or practitioner who cared for patients during the 1918 Spanish flu pandemic on the war front.
    The professional roles and responsibilities of the practitioner during the 1918 Spanish flu pandemic were evolving. Most notably, the academic standards and achievements were raised. A student could no longer simply attend a Medical College; pre-requisites were put into place. These standards were modeled after European Medicine. As practitioners, physicians were expanding their scope of practice. Patient care made a transition from tradition to evidence based medicine; although quite slowly. Furthermore, medical doctors not only provided patient care but began to laboratory research and serve as Officers in the military. The medical officer of 1918 had a duty and responsibility to their country to end the epidemic and this meant stepping outside a typical role. In some instances, this meant risking their own personal health or the health of their patients.
    •Describe a typical illness or symptom pattern of a H1N1 virus infection in a human host with attention to possible lethality for the very young, those in early adulthood, pregnant women, or the very old.
    The progression of the flu virus was rapid, enraging a patient’s immune system and vanishing without a trace in 10 days, and left the body defenseless to opportunistic infections. Influenza symptoms and progression can be described as, “Violent headache and body aches, high fever, non productive cough. This was violent, rapid in its progress through the body, and sometimes lethal” (93). A majority of deaths were not directly caused by the Influenza virus but through pneumonia and other such respiratory infections, “…A violent viral pneumonia so damaging that it has been compared to burning the lungs; or more slowly and indirectly by stripping the body of defenses, allowing bacteria to invade the lungs and cause a more common and slower killing bacterial pneumonia” (35). In a typical flu season, the very young and the elderly are most susceptible to a life threatening infection; an infant has a naïve and developing immune system and an elderly patient has a declining immune system. However, the 1918 Influenza pandemic targeted a different population- those in early adulthood. The elderly had developed immunity from a previous flu outbreak but those in young adulthood were exposed and defenseless.
    •Explain the notion that “it [the H1N1 virus] becomes a better and more efficient killer” as the pandemic spreads.
    The H1N1 virus becomes a “more efficient killer” through mutations. All influenza viruses mutate constantly which enables the virus to become more lethal and impact a large population. A person exposed to the flu in one season could be re exposed to a different strain of that virus and become ill once again. Furthermore, by “jumping” from animal host to man and vice versus enhances the efficiency and virulence of the virus.

    Reply

  10. Kristin Pesto
    Sep 21, 2011 @ 20:30:22

    Hello all, my name is Kristin Pesto. I am a 5th year Pharm D student at the Albany College of Pharmacy and Health Sciences. I found “The Great Influenza” to be an interesting account of what happened during the 1918 influenza outbreak. As morbid as it seems, accounts of outbreaks and pandemics peak my interest. I guess it has to do with how amazing it is that something as small as a viral particle can cause such mass destruction and how helpless the human race really is to something so small. I’m very excited to start this class today and see how this format of an interdiciplinary class will develop. I believe the furture of our careers will definitely be the collaboration of medical fields to work together for the good of our patients and society.

    I have read all the responses above and one of the remaining questions I had was: Why was this strain of influenza so deadly to those in early adulthood who were young and healthy? I understand why the very young, pregnant women, and the elderly were affected, but not why young and healthy individuals were dying from the virus. I did some searching and have found that the answer still remains a mystery. There is speculation that because young adults had such healthy immune systems, they had an overreaction to the virus. It is thought that their immune systems had such a strong overkill response, that that is what actually killed the young adults over the viral infection itself. I just thought that was an interesting concept to share.

    I look forward to meeting and working with all of you through this class!

    Reply

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