Aug 26, 2004 (CIDRAP News) – Federal health officials today released a lengthy plan for dealing with the potentially overwhelming threat of an influenza pandemic like those that occurred three times in the last century.A flu pandemic today would find the nation unprepared to respond immediately with an effective vaccine or adequate supplies of antiviral drugs, says the plan released by the Department of Health and Human Services (HHS). Such an event could put a crushing burden on the healthcare system and disrupt transportation, business, and public safety, the document states.The draft plan describes numerous steps to take before and during a pandemic. “This plan will serve as our roadmap on how we as a nation, and as a member of the global health community, respond to the next pandemic influenza outbreak,” HHS Secretary Tommy Thompson said in a news release. “Our proposed strategy draws upon the wealth of experience and knowledge we have gained in responding to a number of recent public health threats, including SARS and avian influenza.”Flu pandemics struck three times in the 20th century, the release notes. In 1968 the Hong Kong flu caused close to 34,000 deaths in the United States, and in 1957 the Asian flu killed about 70,000. The most deadly pandemic, the Spanish flu in 1918 and 1919, sickened 20% to 40% of the world’s population and killed about 675,000 people in the United States alone, according to HHS.Flu viruses change slightly each year, requiring annual modifications in the vaccines used against them. In contrast, HHS says, “A pandemic influenza virus is one that represents a major, sudden shift in the virus’ structure that increases its ability to cause illness in a large proportion of the population.” Disease experts fear that such a shift could occur if the H5N1 avian influenza virus currently circulating in East Asia combined with a human flu virus, spawning a new variety that could spread easily from person to person.The Pandemic Influenza Preparedness and Response Plan, as it is called, includes a 55-page main document and 12 “annexes,” which provide guidance for state and local health departments and private healthcare organizations as well as technical information on various preparedness topics. HHS is inviting the public to comment on the plan within the next 60 days.The nation’s first pandemic preparedness plan was developed in 1978, not long after the swine flu cases and vaccination campaign in 1976, according to the document. The plan was last updated in 1993. HHS calls the new plan an “evergreen” document—one that will be constantly modified as new developments warrant.The report cites five grim characteristics of a flu pandemic that guided the planning: simultaneous outbreaks in communities nationwide; an overwhelming burden of ill persons requiring hospitalization or outpatient medical care; likely shortages and delays in the availability of vaccines and antiviral drugs; disruption of national and community infrastructures including transportation, commerce, utilities and public safety; and global outbreaks.The plan says it’s impossible to predict the overall impact of a pandemic on the nation. But it cites estimates published in 1999 of 89,000 to 207,000 deaths, 314,000 to 733,000 hospitalizations, and 18 million to 42 million outpatient medical visits.Vaccination is the primary tool for fighting a flu pandemic, but it takes 6 to 8 months to produce a vaccine for a newly identified flu virus, the document says. Thus it’s not likely that a vaccine will be ready when a pandemic first emerges. In the early stages, the nation will have to rely on antiviral drugs, “quality medical care,” and infection control measures to keep the virus from spreading.Antiviral drugs such as amantadine and oseltamivir can reduce the severity of flu when used preventively or given within 48 hours of illness onset. But, the plan says, the supply of these is limited and cannot be rapidly expanded because there are few manufacturers and the production process is slow. Oseltamivir was added to the Strategic National Stockpile of drugs last year, and HHS is continuing to study how best to use antivirals in a pandemic, according to the plan.Once a vaccine does become available in a pandemic setting, the demand is likely to far exceed the supply at first, the document states. Consequently, the vaccine initially will have to be reserved for certain groups, such as healthcare workers, people providing essential public services, and those with certain medical conditions. Other decisions about who should have priority for vaccine will depend on the pattern of the pandemic and may not necessarily be the same as for annual flu vaccination.HHS expects that in a pandemic, vaccine shortages could spawn a “gray market” with high prices for some vaccine doses, as has happened in some recent years. The agency is considering several options for buying and distributing vaccine. The government could buy all the available vaccine and then distribute it to state and local health departments, or the country could rely on a mixed public-private system or on the present, primarily private system of vaccine purchasing and distribution.The plan says disease-control measures other than vaccines and antivirals could also be used to fight a flu pandemic. For example, usual infection control measures would be helpful in hospitals. However, because people can carry flu viruses without being sick, efforts to keep the viruses out of the country or limit spread in the community are not very effective. On the other hand, if a new virus strain didn’t spread quite as readily, measures such as screening travelers, closing schools, and quarantining exposed people could help, the report states.The plan says that HHS must help state and local governments and the healthcare system plan for a pandemic in view of the likelihood of illness among healthcare workers and shortages of hospital beds and medical equipment and supplies. “Health care facilities may need to be established in nontraditional sites to help address temporary surge needs,” the plan states.The document recommends taking numerous preparedness steps during “inter-pandemic” periods. For example, in the vaccine arena, the plan calls for developing libraries of novel influenza strains that could cause a pandemic and preparing reagents to diagnose infection. The plan also calls for efforts to develop a vaccine targeting an unchanging portion of the flu virus, which would sidestep the need to modify the vaccine every year and possibly permit the establishment of a vaccine stockpile.Some of the other recommended measures include:Strengthening global human and veterinary surveillance of influenzaIncreasing US influenza surveillance to a year-round effortDeveloping investigational vaccines for selected novel influenza strains and evaluating them in clinical studiesDisease expert Michael T. Osterholm, PhD, MPH, director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of this Web site, said he hopes the new plan will spur state and local officials and the healthcare system to recognize the serious threat of a flu pandemic. He said he has contributed to federal preparedness efforts for pandemic flu over the years but was not directly involved in producing the latest plan.”The important message is that this plan lays out in substantial detail what needs to be done at the federal, state, and local level to better prepare us for a potential pandemic of influenza,” Osterholm said. “It really calls upon state and local officials, together with healthcare providers and the healthcare system, to come together and take this seriously—that in fact a pandemic is going to occur.”We’re talking about the possibility of 3% to 5% of the population getting ill and dying. Even with this plan, will we be able to get the kinds of hard-to-conduct planning activities moving in state and local areas? It would be unfortunate if state and local officials say, ‘Here’s a federal plan, we don’t have to do any more.’ This is just a start.”See also:Aug 26 HHS news releasehttp://archive.hhs.gov/news/press/2004pres/20040826.htmlMain body of preparedness planhttp://www.flu.gov/planning-preparedness/federal/hhspandemicinfluenzaplan.pdf
Topics : Japan also imposed the TRQ policy on Indonesia’s tropical fruit products such as fresh pineapple and banana, with the latter providing free entry for up to 1,000 metric tons per year for five years, IJEPA Annex 1 shows.Besides greater market access for export products, Made said the government was also lobbying to include travel workers into an article on the movement of natural persons, which allows entry and temporary stay permits for Indonesians workers in Japan.“As the Japanese government is currently focusing on tourism, Japan needs workers that can provide services to their tourism. We do have trained workers that could cater to that,” she said.IJEPA currently only provides entry and extendable one-year stay permits for skilled medical workers such as nurses and elderly care workers, outside of professional services workers and businesspeople, according to the agreement’s Annex 10.Indonesia has sent 622 nurses and 1,494 elderly care workers during the first 10 years of IJEPA’s implementation, Trade Ministry data shows.The ad interim charge d’affaires of the Indonesia Embassy in Tokyo, Tri Purnajaya, hopes that IJEPA would boost trade and investment between the two countries. The embassy is currently vying to establish a travel corridor for Japanese businesspeople to travel to Indonesia.“We are currently working with the Japanese government to promote easing travel restrictions, so we could facilitate more business travel between the two sides,” he said.IJEPA was implemented by the two countries in 2008 and was reviewed in 2013 based on Article 151 of the agreement, which mandates a general review in the fifth year since the agreement took effect.However, IJEPA’s general review [GR-IJEPA] negotiation effort was stalled in 2016 due to disagreements over automotive products and steel tariffs. It was then resumed in the following year, with the GR-IJEPA report concluded in 2019. The government is seeking to expand access to the Japanese market, reduce tariffs and liberalize the movement of workers in tourism through Indonesia-Japan Economic Partnership Agreement (IJEPA) renegotiations.According to the Trade Ministry’s bilateral negotiations director Ni Made Ayu Marthini, the government is focusing on expanding its market access and reviewing Japan’s Tariff Rate Quotas (TRQ) for Indonesia’s agricultural products.“In regard to market access, some of our fishery products still have higher tariffs to enter the Japanese market, including canned products. We would also like to secure the fruit market in Japan, and Japan currently implements the TRQ for Indonesia’s [products],” she said during an online webinar held by SSEK Legal Consultant on Tuesday. Greater market access for Indonesia’s products would boost trade between the two countries, Made said, as Japan is Indonesia’s third-largest export destination and second-largest import source.The total value of trade between Indonesia and Japan reached US$31.56 billion in 2019, a slight decrease from $37.44 billion in 2018, according to Trade Ministry data. Indonesia also posted a trade surplus of around $320 million in 2019.Under IJEPA, fresh and chilled fishery products from Indonesia, including salmon and trout, are excluded from tariff reduction commitments alongside canned tuna products. Meanwhile, other canned fishery products are subject to further negotiations, according to the IJEPA’s Annex 1.“We want 0 percent tariff on [canned fishery] products because we think it will be a win-win situation. Japanese consumers will have the products and there are many Japanese investors who are investing in Indonesia to produce them for the Japanese market,” Made said.
“When I was in Germany, sometimes we sent short messages (to each other),” he said. “From my side, I am full of respect for his work. I think if you are not a journalist or a referee he can be a nice guy, and I am not one of these so we have a good talk. “I like to meet people and he is a nice guy and he was really full of respect during the game. “He is emotional, I am emotional but we are full of enough respect after the whistle that normal life starts again and you can talk normally about things that happen and that is what we did. “Everything is okay with us, no problem.” Press Association Liverpool manager Jurgen Klopp insists Chelsea counterpart Jose Mourinho is a nice guy – providing you are not a journalist or a referee. The Portuguese, already appealing a £50,000 fine and suspended one-match stadium ban for suggesting officials were “afraid” to award his side decisions following the October 3 defeat to Southampton, was this week charged with misconduct after being sent off at West Ham last weekend. Mourinho has raged against authorities and the media for much of the season but Klopp, who knows the Chelsea boss from Champions League encounters when the pair were in charge at Borussia Dortmund and Real Madrid, insists his public persona is not a true representation of him as an individual.
Associated Press Television News Last Updated: 25th December, 2019 12:40 IST Jalen Ramsey Out For Rams’ Season Finale With Knee Injury Los Angeles Rams cornerback Jalen Ramsey will not play in the season finale against Arizona on Sunday because of a knee injury. SUBSCRIBE TO US Written By First Published: 25th December, 2019 12:40 IST LIVE TV Los Angeles Rams cornerback Jalen Ramsey will not play in the season finale against Arizona on Sunday because of a knee injury. Coach Sean McVay said that Ramsey is out after sustaining a knee injury in the 34-31 loss at San Francisco on Saturday that eliminated the Rams (8-7) from playoff contention.“He had a Grade 2 sprain of the LCL and will be out for the game,” McVay said Tuesday. Ramsey should recover in 4 to 6 weeks and is not expected to require surgery, McVay said. Ramsey had 33 tackles, one interception and one forced fumble in nine games with the Rams after being acquired from Jacksonville in a trade on Oct. 15. WATCH US LIVE COMMENT FOLLOW US
After just a 6-3 New Orleans Saints halftime lead it became the Drew Brees show in the second half. Brees was 34 of 44 for 305 yards for the game, but 22 of 24 in the second half with a fourth quarter touchdown pass that lifted the Saints to a much needed victory while dropping the Steelers into a first place tie with the Baltimore Ravens at 5-2.No one on offense had an outstanding game. The line was terrible, Ben Roethlisberger was 17 of 28 for just 195 yards, and Rashard Mendenhall had just 71 yards on 15 carries with the bulk of that coming on a 38-yard touchdown run in the fourth quarter.“We knew what a big game this was,” said Brees. “There was no better way to get back on track than to beat these guys. I felt like we played as complete a game as we’ve played all year, especially in the second half.”Brees’ first TD went to Marques Colston for 16 yards and the second went for 8 yards to Lance Moore with 2:37 left, breaking open a defensive struggle in which neither team scored a touchdown through three quarters. Leigh Torrence then intercepted Roethlisberger to seal it for the Saints (5-3), who were coming off an embarrassing 30-17 loss at home last week to the scuffling Cleveland Browns.“This is definitely a gut check for us,” Roethlisberger said. “We got knocked down a little bit tonight and now it will be interesting to see how we bounce back.”The Saints came in ranked third in total defense and lived up to it, forcing two turnovers and stopping the Steelers on a goal-line stand in the first half.The Saints struggled to run against a Steelers defense that came in ranked first in the NFL against the run and allowed New Orleans only 30 yards on the ground. Brees was sacked twice and intercepted once, giving him 11 interceptions and matching his total from last season.After falling behind by 10 early in the fourth, the Steelers went 68 yards in only four plays to make it 13-10, capped by Mendenhall’s scoring run. Suddenly, both offenses were rolling in time for an action-packed finish. When Brees hit Robert Meachem for a 50-yard gain into Steelers territory, it appeared the Saints would quickly extend their lead again. Then cornerback Bryant McFadden sacked and stripped Brees, and Pittsburgh’s Lamarr Woodley recovered on the Steelers 27.Pittsburgh quickly moved across midfield, only to lose the ball when tight end Heath Miller fumbled on a head-on hit by linebacker Marvin Mitchell. Sharper scooped it up, returning the ball 11 yards to the New Orleans 45.With the acquisition of Terrell Owens this season to go with Chad Ochocinco the defending AFC North champs were supposed to be a powerhouse this season. But instead their 22-14 lost to the Dolphins last week dropped them to 2-5, making them one of the worst teams in the NFL. But for some reason they seem to always play their best football against the Steelers, which they will have to do because another defeat will just about eliminate them from any chance of a playoff berth.Dan Carpenter kicked five field goals for the second game in a row—a rare feat—and the Dolphins overcame another goofy play Sunday, beating the Bengals.The Bengals (2-5) failed to get a first down in the third quarter and were shut out in the second half. Their final chance ended with Carson Palmer’s interception with 2:43 to go, sending the defending AFC North champions to their fourth straight loss and a share of last place with the Browns.It’s Cincinnati’s worst start since 2008, when Palmer was sidelined with an elbow injury.“It is amazing,” said Palmer, who was 17 of 38 for 156 yards. “It’s embarrassing. It’s depressing. It’s every negative word you can think of that we didn’t do our job.”Owens and Ochocinco combined for just 8 catches for 99 yards, and Cedrick Benson had just 69 yards on 20 carries. The Bengals simply haven’t played very well on either side of the ball this season. They were expected to be among the elite this season.This is a must win for the Steelers as well, because they face the red hot New England Patriots (6-1) and Oakland Raiders (4-4), winners of four in a row, after the Bengals. They could very easily be 5-5 after this stretch if they lose to Cincinnati. THE GANG’S ALL HERE—Pittsburgh Steelers quarterback Ben Roethlisberger (7) is sacked by New Orleans Saints’ Will Smith (91) Alex Brown (96), Pierson Prioleau (31) and Darren Sharper (42) during the first quarter of an NFL football game at the Louisiana Superdome in New Orleans, Oct. 31. (AP Photo/Patrick Semansky) What was supposed to be a high scoring game ended up being a classic defensive struggle until Drew Brees put together a classic display of passing while the Steelers offense continued to struggle in the New Orleans Saints 20-10 victory over the Steelers. The Steelers are hoping that this is not a repeat of last season going into the Cincinnati Bengals game this weekend. The Steelers jumped off to a 6-2 record last season only to lose 5 in a row behind an inconsistent offense.