The Next Pandemic Blog is a fictional portrayal of a hypothetical pandemic of H5N1 avian influenza – from initial outbreak through mass transmission to global spread.

The blog is told through a fictional character who also appears in the docudrama: Jane MacDonald, a 38 year-old nurse and single mom working in a Toronto hospital ("City General") when crisis strikes.

As with the docudrama, the key elements of this fictional blog are based on the research, modelling predictions and planning assumptions used to prepare pandemic plans by the World Health Organization (WHO), the Public Health Agency of Canada, the U.S. Department of Health and Human Services and the UK’s Health Protection Agency.

THE GATHERING STORM
Outbreak of human-to-human clusters in Thailand

Wednesday January 11, 2006

And so it begins. I saw it on the news tonight. There are cases in Thailand that have crossed over. It’s not just going from bird to human – it’s going from human to human. They’ve had laboratory confirmation.

There's been something like 500 new cases there in the past day.

I don’t know what to say. It’s weird -- there’s kind of an excitement in the way people on the news are talking about it. I bet people will be over the top at work tomorrow too. We’ve been talking about this for so long, like we’ve all been building up to today – racing towards something we’re terrifically afraid of, but also weirdly fascinated by.

I know it’s going to be hell. Every run-through we did at the hospital terrified me. And I know every model, every prediction, every dire warning is nothing compared to what it’s going to be like when it finally gets here. I know I’m hardly going to see my kids. I know I’m going to be terrified of catching it myself – or worse, passing it on to them.

For now, all we can do is hope and pray that it’s stopped before it gets here. It feels so impossible.

Thursday January 12, 2006

Hardly could get through a minute without someone saying the word “pandemic” today. Whether it was the doctors (Dr. XX said “I told you so!” about 1,000 times. He was actually grinning and practically skipping. Jackass.) Or nurses. Or patients. I had a woman in Emerg this morning, coughing and spitting and swearing her neighbour gave her “the pandemic.” It took me two hours to calm her down. Turns out she didn’t even have a cold, she just wanted her husband to come pick her up.

HEY, PEOPLE… this is not a pandemic situation yet. If the governments, WHO, and emergency preparedness folks do their job, it won’t become one – they’ll stop it before it gets out of Thailand. And it looks like those pandemic plans are already in motion. They announced a travel advisory for Thailand late last night.

Let’s keep our heads on.

Friday January 13, 2006

Saw on the news tonight that they’re worried about Thailand not having enough Tamiflu, the antiviral drug. The health minister was on; he said he would be checking Canada’s supplies to see if we have any surplus meds to send over.

It's a bit weird that I have a stack in my medicine cabinet. But I couldn’t send mine to where it’s needed if I wanted to – they’ve drilled it into us that health care workers, "the front line," has to have it on hand.

But if I’m being honest, I have to admit my kids come first.

Monday January 16, 2006

I had a strange thought this morning. Isn’t it odd that all eyes were on Turkey this time last week, when the real story was unfolding thousands of kilometres away in Thailand?

Tuesday January 17, 2006

Canada has decided not to send any antivirals to Thailand. What a terrible decision to have to make. I actually feel badly for the politicians.

They’re not alone though. The EU already said it wouldn’t be sending any over the weekend. Same with the States. It’s worrisome though - this might come back to smack us later on. Being in the ‘have’ position isn’t exactly a noble one if you’re telling the ‘have nots’ that they can fend for themselves.

Thursday January 19, 2006

What a long night. I’m exhausted. There was a terrible accident on the 401 at 7:00 and Emerg was mayhem.

One of the patients is a five-year-old girl. Louise. She’s so much like my Erica. She’s breaking my heart. Both parents didn’t make it and they haven’t told her yet. That’ll come tomorrow.

You can never get used to this – watching how somebody’s life can change in an instant. Especially someone so tiny and sick herself. But I think she has fight in her.

Saturday January 21, 2006

Dr. XX was in a mood today. Apparently there was an emergency conference of hospital administrators, talking about the preparedness plans, what state we’re at, what’s going to happen next if things escalate. He was livid when he came back from it – said someone from the federal level challenged City General’s plan in front of a group of big wigs. Of course Dr. XX was the chief mastermind of our hospital’s plan, so criticizing it is like sticking a fork in his eye.

I, for one (and I’m not alone with this among the Emerg staff), hope this is one time Dr. XX knows what he’s talking about. I think our plan makes sense, I just hope we don’t have to use it.

Sunday January 22, 2006

For the record: you cannot get the “bird flu” from eating chicken. Much as I’d prefer my son never eats deep-fried chicken, as he’s inclined whenever he’s with his father, he can’t catch the flu from eating it. Or any other form of bird.

Granny’s chicken soup is still safe for the sniffles. I promise.

I bring this up, not because I have shares in a fast food chicken outlet, but because my son was teasing my daughter about this tonight. After telling her she’d turn into a chicken because she was eating chicken soup. She’s four, and of course she believed him.

But I’ve had adult patients who believed it too. This is how crazy rumours start. Next thing you know, people will be saying you can catch it from someone over the phone. (You can’t).

Monday January 23, 2006

The debate over whether we should send Tamiflu to Asia is heating up again. There are so many new cases, and hardly anyone there has access to any kind of antiviral. Which just means more people are exposed to catching the flu. It sounds like Canada’s second-thinking its decision. We might send some of our Tamiflu stock after all.

Now the problem is getting it there in time – for an antiviral to work, you have to take it within 48 hours of presenting symptoms. And apparently the new case clusters are happening in more remote areas of Thailand.

Thursday January 26, 2006

Louise, the girl I wrote about last week, is doing well. Obviously she has a lot of work to do when it comes to losing her parents, but physically she’s a little fighter. She had a complete compound fracture of the right tibia and fibula (both bones of the lower leg). She sailed through the procedure without any complications (it took three and a half hours to put a titanium nail was into her tibia).

Wednesday February 1, 2006

A neighbour of mine came home from Thailand last night. He was there working as some kind of computer consultant to the government.

He says things are insane there. First, people tried to get on with things – they still went to work, they went to school, they went to the store… a lot of them just wore masks. Then things got really quiet. He says he didn’t see anyone other than soldiers or police for two days in a row.

He went to the airport on Monday and waited until he could get a flight home. He didn’t even tell his work – there wasn’t anyone to tell. On Friday they just shut down the office and told everyone to stay home.

He’s lucky he got on the flight – there’s rumblings that Canada is going to expand its travel restrictions – rumour has it there won’t be any flights from Thailand accepted, any flights, beginning tomorrow.

Thursday February 2, 2006

There's all sorts of talk in the news that the flu has spread into Laos, Cambodia and southern China. But their governments are denying it. The WHO is sending in extra teams to do secondary analysis of a bunch of cases.

CONTAINMENT FAILURE
Outbreak spreads throughout Asia

Tuesday February 7, 2006

Headline on the front page of the paper today:

"Containment Failure in Thailand: Flu spreads throughout Asia"

The WHO has confirmed cases throughout Asia – they estimate there might be as many as 20 million people infected worldwide (though they’re careful not to say which countries outside of Asia that might include). Everyone’s bracing themselves for the worst now. Or is it the inevitable?

There haven’t been any confirmed cases in Canada. But I hear you could shoot a cannon in a restaurant in Chinatown and not hit anyone. Just like SARS. This morning, on my way to work, a Korean woman sat down across from me on the subway. No one would sit next to her. This city is crazy.

Wednesday February 8, 2006

This morning I accused Hugh (my son) of something terrible. He was messing around with one of our boxes of Tamiflu and I freaked out. I yelled at him that he’d better not be thinking about selling it.

I don’t know where my head’s at. I know he wouldn’t do something like that. But Tamiflu’s like gold right now.

We had a patient in yesterday who had to have his stomach pumped because he took a whole whack of antivirals at once. He thought he’d caught the flu from his uncle, who came from Laos last week before the ban. Trouble is, it wasn’t Tamiflu that he took – the analyst says it was baking soda mixed with rat poison. Rat poison. The guy had bought it online.

Of course there are those who argue Tamiflu and the other antivirals aren’t working anyhow. Maybe not. But I have to admit something -- every morning I open the medicine cabinet and check to make sure our stash is still there.

... later ...

At work tonight there was an emergency meeting – a group from Emergency Preparedness and Response came to walk us through the new regulations for dealing with patients displaying suspect symptoms. And the new regulations for health care workers.

They drew a pyramid with everyone mapped out with their function and their “need to be” (or NTB’s, as we’re now called) at the hospital. Being Emerg nurses, we’re in the top tier – on the front line with doctors, police and military. Frankly, I’m not thrilled about the prospect of being so wanted.

Thursday February 9, 2006

Saw something incredible on TV last night. I couldn’t go to sleep when I got home from my shift – worry, worry, worry keeps the fool up at night! – so I started watching TV. I saw an infomercial for some “do it yourself” flu prevention kit thing. The guy made it sound like he had all of the solutions to the world’s problem on a $9.99 DVD (“complete with handy pocket guide!”).

Please, people, don’t fall for this CRAP. If this late night huckster with a bad toupee had a way to protect people from the flu, he wouldn’t be selling it in the middle of the night on specialty cable.

Friday February 10, 2006

Tick-tock, tick-tock… The waiting continues. We’ve had 14 suspicious flu cases this week. All of them were checked and all of them were (thankfully!) just plain old flu. But everyone’s walking around on pins and needles. Waiting. The mathematical models all say it has to hit North America soon – it’s just a matter of when.

In the meantime, the drug lockup at the hospital is under guard like it’s Fort Knox (an armed security guard is there 24x7. If you’d told me that a month ago I’d have said you were nuts.) The pharmacy across the street from the subway was broken into on Wednesday – but the robbers didn’t get any Tamiflu. There wasn’t any left.

Saturday February 11, 2006

Today Erica was supposed to go to a friend’s house for a birthday party. It was cancelled. Seems the girl’s mom was worried about having so many kids (germs?) in the house. I can’t help but worry that maybe she cancelled because of Erica. She knows I’m a nurse. Does she think I’d put Erica in danger? That if I, for one second, thought I had been exposed to the flu I would go anywhere near my kids?

So Erica and I spent the morning together colouring. It’s funny how kids can shake things so quickly. Show them something shiny and they’re off…

GROWING PANIC
Travel bans and false alarms

Sunday February 12, 2006

The news tonight said they’ll be banning all travel to and from Asia tomorrow. Most of the airlines already stopped flights earlier this week – I guess this is more of an official gesture to show the world that we’re in clampdown. To show that someone has a plan.

In the States, they’re talking about turning Canada, the U.S. and Mexico into “Fortress North America” and closing off all travel and trade to and from anywhere.

I feel terribly for Kim, a nurse I work with, because her family is in India and she’s been told she shouldn’t go to them – and there’s no way they can come to her.

Monday, February 13, 2006

Another day, another false alarm. This morning I woke up to a news bulletin that said there were cases cropping up all through the southern U.S. They interviewed doctors, health officials, some guy on the street – all “experts” on North America’s first outbreak cluster.

Only no one thought to check with the WHO and whether those cases were confirmed. They weren’t. Everyone got all breathless and frantic for naught.

Meanwhile, we had an emergency room filled with patients of all walks that needed help now – to fix a broken arm, to diagnose a case of pneumonia, to stitch up an old woman’s knee after a fall. Sometimes I wish the damn flu would just show up already so we can get on with things.

Tuesday February 14, 2006

Happy Valentine’s Day to me… I did another double shift (Robert had “personal issues” again. Right. He’s been panicked ever since they announced the flu had broken out of Thailand. He told me he felt like he had a target on his back). Hugh and Erica are spending the weekend with my parents, which is probably good for them.

There was a bit of a downtime after supper, so I spent it with Louise. She’s such a cutie. Her parents must have been so proud. She keeps asking when she’ll get her crutches –next week she can start physio. She says she wants to be able to ride a pony. Apparently her grandparents promised her they’d get her one when she moves in with them.

Wednesday February 15, 2006

I heard that in Vancouver the government is setting up roving “test stations” to deal with people displaying suspicious symptoms. They’re in hospitals, airports, bus stations and schools.

Thursday February 16, 2006

There was a march on the headquarters of Roche today. Roche is the pharmaceutical company that makes Tamiflu. The UN is saying they should drop the patent on the antiviral so companies around the world can start making it. 5,000 people showed up on their doorstep to demand they do just that. But getting Roche to drop its patent rights won’t necessarily solve the shortage. The main ingredient in Tamiflu is 'star anise,' and there’s a shortage of that too.

Saturday February 18, 2006

I had my closest call yet today. A young man came in, displaying suspicious symptoms. I followed procedure and was ready to write him off as a ‘remote chance’ case when I got to question 13 in the questionnaire (about whether he’d travelled to any of the affected areas in the past 60 days or had contact within 72 hours with anyone who had). He said ‘no,’ but then paused. ‘Wait a second, my roommate’s girlfriend recently returned from Hangzhou in southern China.’

She’d been teaching English there. A thousand alarm bells went off in my head – I remembered seeing something on the news about an outbreak in a sector of Hangzhou where a lot of foreign teachers lived. My heart was pounding in my throat, but I tried to keep calm. I finished with the paperwork, collected the samples and told him to stay put while I got it to the lab.

Then I rushed like a madwoman to Suspicious Cases Control and handed everything over to the lead there. (She later told me it was the first case that really spooked her too.)

For the next hour and a half I paced around, waiting to hear. Expecting to be told he was confirmed and that, since I was the intake and dealt with him within the proximity range, I was off to quarantine.

But no. Luck was with me. Turns out he just had the regular old flu – nothing three days of rest and plenty of water wouldn’t cure.

Whoever it is that’s watching over me, thanks. By the time I got home the kids were asleep, but I had to kiss them both.

Tuesday February 21, 2006

Read a really interesting article on the vaccination work going on. As soon as the virus re-assorted itself – as soon as it was able to cross from human to human – the world’s virologists went into hyperdrive. For more than a month, they’ve all been working 24x7 on the race to uncover the vaccine.

First, they needed to get a sample of the real virus. That sounds easy enough, but you’d be surprised. Apparently it’s improper in many Asian cultures to disturb the body after death – so the workers have had a hell of a time collecting samples. But they finally did, and those samples were shipped off to the world’s leading virus labs so they could start developing the seed strains necessary for creating the vaccines.

Now they’re doing fancy-pants genetics work, trying to develop the vaccine and the method for recreating a lot of it -- quickly.

I have so much respect for these guys (there are a few gals too). They’re the real front line. And everything, all our hopes, are pinned on whether they’re successful or not.

And I thought my job was pressure.

VIRUS SPREADS ACROSS PLANET
Infections occur in 54 countries, including Canada

Friday February 24, 2006

It's here. It's here, there and everywhere.

This afternoon the WHO’s Global Pandemic Response Headquarters confirmed that the virus has been found in cases in 54 countries, including a poor couple in Thunder Bay who has the dubious honour of going down in history as Canada’s first cluster.

It was strange – I had the day off. The kids were at school. I was home alone, doing a crossword with the TV on in the background for noise. Then that familiar “News Alert” sting and some anchorman saying there were important developments being announced in Geneva.

Dr. Liu (who’s looking mighty exhausted these days) at the WHO announced it himself. Then a line he’d probably memorized weeks ago: “All we can do now is to try to slow the spread and treat the sick.”

And I’ve been called in to work to do just that. I’ll write again when I get the chance, but I don’t know how soon that will be. Keep yourselves and your loved ones safe.

Saturday February 25, 2006

Hundreds of cases already reported in Toronto. An estimated 250 in Vancouver.

Sunday February 26, 2006

Separate outbreaks confirmed in Amsterdam, Paris, New York, San Francisco, Vancouver and Toronto.

Monday February 27, 2006

Saw my first pandemic PSA today. The message has to get out – make sure you and your family spread the word: If you or a family member is sick, call your physician, wash your hands often, and stay home. If you cough or sneeze, do so in a tissue to prevent spread.

Hugh asked me to bring him home a mask from work yesterday. He says it’s the new high school must have accessory. Some of the girls are drawing on theirs with glitter pens.

Friday March 3, 2006

I’ve never been so tired. I’ve worked four doubles back-to-back. I’ve seen my kids a total of 25 minutes all week. They’ve been staying with their grandparents since Tuesday. Erica’s daycare closed – thank God I have someone in the city to watch her. I don’t know what some parents are doing.

I hear some people are refusing to go to work. They’re either telecommuting or just not working at all. I suppose if I was some data entry clerk in some big office tower sharing air with a couple hundred other people, I wouldn’t be too keen either.

But some of us have to go to work. I sneezed yesterday and Dr. XX said something snarky: “Better not get sick or we'll have you walk the plank.” There was a wink and a smile but something tells me he’s not joking.

Tuesday March 7, 2006

Tip of the day: WASH YOUR HANDS.

If you think you’ve washed your hands enough, you haven’t. WASH THEM AGAIN.

WASH YOUR HANDS, WASH YOUR HANDS, WASH YOUR HANDS.

Wednesday March 8, 2006

I heard a terrible story about a man in Montreal yesterday. He was riding the bus and sneezed. A group of thugs beat the crap out of him, so badly he had to get 45 stitches. Kim is a friend of the doctor who was on call at the emerg. She apparently cried the entire time as she stitched him up.

Friday March 10, 2006

Hugh asked me today whether we were going to leave the city. I guess a bunch of his friends’ families have left – gone to their cottages, or to stay with family and friends.

Frankly, I can’t leave. If I left, I’d never be able to come back. At least not to work. And besides, I’m not sure it would help. If we keep on doing what we’re doing, taking precautions where we can, washing our hands obsessively, staying home, we should be okay. At least that’s what they keep telling me. During a pandemic, you’re in danger of catching the flu just by being alive. Whether you're in the boonies or downtown Toronto, eventually you have to go to the store to pick up some milk. And when you do, the virus may be there, waiting...

All of that said, if their father calls and says he wants to take the kids to his brother’s in Parry Sound, I don’t think I could say no.

Sunday March 12, 2006

A quiet day at the hospital. Strange. Compared to the revolving door that’s been Emerg over the past few weeks, it was positively silent.

I spent some time with Louise. She’s hobbling around on her crutches now. Her grandmother sent in a little pink cane with ribbons on it – she should be able to use it next week. I need to make a point of dropping in on her more often. The hospital regulations mean she can’t have visitors.

She’s got a little sniffle – just a cold – but other than that she’s doing remarkably well.

Tuesday March 14, 2006

They’ve closed the schools, which is probably just as well because hardly any of Hugh’s classmates were showing up any more. Teachers have families too; they might as well be home with them like the rest of the damn city.

I'm getting tired of the stench in my garage. We've been keeping the garbage there since the city stopped picking it up. On the upside, I've finally managed to reduce and reuse to a point that seems to satisfy my environmentally-holier-than-thou son.

Wednesday March 15, 2006

I took a break and went for a walk downtown this afternoon, and I didn’t see a single soul. No cars, no bikes, no buses. Not a single store open. It was so creepy.

CONTRASTS OF LIGHT AND DARK
Hope and worry for tomorrow

Tuesday March 21, 2006

What I wouldn’t do for some fresh lettuce. The cafeteria at the hospital comes the closest, with its coleslaw (if you can call it that). But the grocery stores that are open don’t have a shred of produce. Yesterday I bought a big bottle of V8 and gulped the thing down in a minute. I hate V8. But that bottle was delectable.

Saturday April 1, 2006

Terrible news – Louise’s 'cold' has developed into pneumonia. Her doctor told me her case is mild, but he’s worried because she’ll need to go through the regular bout of antibiotics and they’re scarce.

A lot of the flu cases are leading to secondary infections - the flu is wreaking havoc on patient's immune systems, making them susceptible to other problems. Those secondary infections have sucked up the bulk of our available antibiotics. And the normal supply is already scarce because delivery of anything, from groceries to medications, is damn near impossible.

That kid is going to need more than fight to get through this.

Monday April 10, 2006

Another day, another blackout. And the damn water supply stopped again too. When it comes back on I’m filling every damn bottle in the house. There are some neighbourhoods that have had problems with looting and riots, despite the curfew.

The people around here who haven't run for the hills held a meeting at the community centre last night to talk about creating a 24-hour watch. Turns out we have four police officers living in the neighbourhood and they've offered to set up patrol shifts when they're not on duty. That might be a bit extreme, but I can't say I'm against the idea.

Thursday April 27, 2006

Hugh asked me today whether I’ve had any flu patients die. I told him yes, but I couldn’t bring myself to say just how many. Or how they die.

There have been dozens. In the city, the number is well over a thousand. And it is no way to die. In some patients, when their lungs are collapsing, they get bubbles of air trapped just below the surface of their skin, starting at their neck and sometimes spreading throughout the rest of their body. And when those patients move they crackle and pop like cereal in milk.

Wednesday May 10, 2006

Contrasts of light and dark. Louise went home to her grandparents today. Somehow, she pulled through. I said she was a fighter. She’s a remarkable kid – everything she’s gone through… losing her parents, so injured herself in the accident, being holed up in the hospital during a cataclysmic event the world has never experienced before… She’ll have stories that’ll be passed on to her great grandkid’s kids.

And then dark… Tonight on my way home from work I saw a tank on University Avenue. A tank. Why didn’t I send the kids up north when I had the chance? What the hell was I thinking? This city is going to hell and my kids are imprisoned at home. If they were with their father they could be going for hikes in the woods, building tree forts -- playing the way kids are supposed to.

I am a terrible mother.

Thursday May 25, 2006

If you haven’t been in a hospital, and I hope you haven’t, you couldn’t imagine the scene. Pools of blood scattered throughout the rooms from several nasal haemorrhages. We can’t avoid stepping in the mess because the people are packed in so closely together. The floors are slippery and wet. The cries and groans from the terrified add to the confusion. This is hell.

Friday June 9, 2006

Day 150 of the pandemic; an anniversary of sorts, I suppose. There are mass vigils happening around the world. Kim and I are planning to head over to the one at Nathan Phillips Square tonight. Erica asked if she could go with Hugh, but I told her no. I feel a bit like a jail guard, but it’s just so risky to have her out. Not to mention the angry looks I’ve seem people give parents who take their kids out in public.

I’m so worried about the long-term impact this is going to have on her. Not just the constant fear that she’ll get sick, and my constant nagging (‘wash your hands!’ ‘don’t answer the front door!’ ‘stay inside!’ ‘no, you can’t go play with Ruby!’ …).

Everything she’s seen and heard from me in the past five months goes against everything I tried to teach her before. To love life, to embrace change, to rise to any challenge, to help a stranger no matter what … to put down the video game and get outside already!

And here she’s spent the good part of her fourth year on this planet terrified of what’s outside her front door.

And now I’m worried she’s scared of me. I had a bit of a coughing fit last night (nothing to worry about, just a tickle in my throat). Erica started crying. She told me I wasn’t allowed to touch her things anymore because I might make her stuffed animals sick. She said I’ve been coughing all week (I swear I haven’t. I wouldn’t around her.) Then she shooed me out of her room and shut the door.

Everyone says it’s coming to an end. The number of cases has been in a steady decline for more than two weeks. The vaccine is finally taking hold - getting where it’s needed most. The tide has turned and we’re finally winning the fight against this monster.

And then what? How do we rebuild our lives? Will people ever feel safe again? Can I trust anyone anymore? When the inquiry happens into the response, the failures, the absentee frontliners -- who will be blamed?

We’ve all lost someone – friends, family, neighbours. But we’ve lost something else too. I’m not the person I was before. None of us are.

And I’m not sure I’m comfortable in the skin of the person I’ve become.