Influenza Update #9 - Swine Flu

MedPrep Consulting Group LLC Dr. Stuart B. Weiss  IMPORTANT INFLUENZA UPDATE #9 WHO PANDEMIC ALERT LEVEL 5 April 30, 2009 DON'T BE SURPRISED WHEN YOU READ THAT THE U.S. GOVERNMENT HAS MOVE TO STAGE 4 OR 5  As most of you know, the WHO moved the world to Pandemic Alert level 5 last evening. The Unites States Government uses a slightly different scale to rate pandemic activity and based on the definitions, we should be at U.S. Stage 5 by now. That announcement has not happened yet so don't be surprised when it does.     CURRENT SITUATION: Mexico is in shutdown mode. The Mexican government has taken the significant step of ordering suspension of all non-essential Federal Government and private business activity. Mexican President Calderon has asked Mexicans to stay in their homes until May 5th. All schools are closed until May 6th In the U.S., 11 states now have at least one confirmed case of H1N1 swine flu. These states are: Texas, California, New York, Maine, Massachusetts, Michigan, Kansas, Arizona, Nevada, Indiana and Ohio with many more states reporting suspected cases. ABC News and CNN are reporting that an estimated 160,400 school children will be home today as various schools in 14 States are kept closed today Vaccine development is continuing and HHS predicts that the first test vaccine may be available in the Fall (vaccine development takes 3-6 months)   ANALYSIS: This situation is highly fluid as details continue to emerge.    All I can say this morning is WOW. In all the pandemic exercise scenarios I have written over the years for companies, I never imagined that the world would progress from Pandemic Alert Phase 3 to Phase 5 in just 5 days. This is a pretty intense roller coaster ride that we are on at the moment and its not possible to know what's next. Remember, although we are now at Phase 5, one step before a full blown Pandemic, we do not know many important pieces of information about this virus. We do not know whether this virus will just remain a minor illness as it has been for the vast majority of people in the U.S. or will it become more serious as it evolves. We do not know the rate of spread of this virus although we are starting to figure that out. We do not know if it will follow the seasonal pattern and quiet down over the summer only to reemerge in the fall.    There are many unknowns yet there are some business relevant things that we do know. The virus is clearly spreading human to human as most cases now are not from people who have travelled to Mexico. We can see the drastic steps taken by public health in Mexico to slow the spread of the virus. They have essentially shut down the country affecting all government and private sector activities. Here in the U.S. schools across 14 states will be closed today. There are some studies out there that estimate that school closures will result in a 10% increase in your employee absenteeism rate as parents are forced to stay home to watch their kids. If this pattern continues, that will impact your business even without people getting sick themselves.   With growing numbers of cases across the U.S. (as we discussed yesterday, this is expected), creating a safe workplace will be critically important for the physical and mental wellbeing of your employees. On our Daily Brief call today, we will discuss this. Take a moment and think about your workplace from an infection control standpoint. This virus, if it behaves like other influenza viruses, can be spread by touching contaminated surfaces. So, you want to encourage behaviors that limit the spread of the virus. Make boxes of tissues available for employees to use and put trash cans out so people can thrown the tissues away after use. Make waterless hand sanitizer available especially in areas where soap and water (the best preventative method) is not readily available. This includes on the way into the cafeteria. If people just washed their hands before eating, we would cut down on all sorts of illnesses. Start thinking about how you would institute social distancing (maintaining 6 feet of separation between people) in buildings where people must ride in elevators. These are some of the questions you should be acting upon now.       ADVICE: Each day, I will focus on issues from a pandemic planning area that we have found during pandemic plan audits that we have performed for our clients. Review your cleaning procedures. Take a look at the cleaning procedures used in your office. You may want to increase the frequency of cleaning of high touch, high traffic areas like bathrooms and break rooms. Take a look at the contact time for the cleaning solutions you use and make sure people understand how to properly use the cleaning solutions. As opposed to what you see on television, cleaning agents do not instantly kill germs. It takes time, usually from a minute to up to 20 minutes to kill germs, depending on the solution. The germs must remain in contact with the solution to be killed for a certain amount of time and this is called contact time.  So if your cleaning folks use a solution with a 10 minute contact time and you see them wipe solution on a desk and then immediately wipe the desk dry, almost no germs have been killed. You can get this information off the bottle label or from the product website. Look for contact time or "kill time" for influenza viruses. Monitor bathrooms and break rooms for soap, towels and tissues. Make it easy for employees to follow good hand hygiene and sneeze/cough etiquette. Place these items around the office within easy reach. Put some signs up reminding people to cover their cough and wash their hands. It is generally recommended that you wash your hands for 20 seconds with soap and water to clean them. One way to do that is to sing Happy Birthday to yourself (quietly) twice as you wash your hands. Add extra cleaning to high touch areas. Since influenza viruses can survive on surfaces for hours to days depending on temperature, humidity and how porous the surface is, add extra cleaning to door handles, elevator buttons, intercoms and other high touch items. ANSWERS TO QUESTIONS YOU HAVE ASKED ME:   I received a number of questions about air travel. Right now there are no travel restrictions for air travel in the U.S.  While there is CDC guidance for airline crews and flight deck folks at www.cdc.gov/swineflu/aircrew.htm, it doesn't speak to the risk to passengers. At this point, your individual risk during a flight is still quite low but there is no way to tell for sure. So at this point, clearly you should avoid traveling to areas with high outbreak levels and poor public health in other parts of the world.  We will keep our eyes out for any government guidance on domestic travel. If you are traveling and feel uncomfortable, check with your airline about wearing an N-95 masks during the flight. I know I'm hedging a bit on this but there is no good science that I can find to back up a recommendation at this point. Not preparing now would be a serious mistake should things worsen quickly.      If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com   SUBSCRIBE TO ALERTS by clicking the button below.    Dr. Stuart Weiss is a nationally recognized pandemic planning expert and CEO of MedPrep Consulting Group. MedPrep can assist you with your pandemic planning, training and exercising needs. Drop me a note if you want more information about us.            Stuart Weiss, MD, CBCP MedPrep Consulting Group LLC

Influenza Update #8 - Swine Flu

MedPrep Consulting Group LLC Dr. Stuart B. Weiss  IMPORTANT INFLUENZA UPDATE #8 WHO MOVES TO PANDEMIC ALERT LEVEL 5 April 29, 2009 WHO TO RAISE PANDEMIC ALERT LEVEL TO 5 We have just been informed that the WHO raised the Pandemic Alert Level to PHASE 5. We do not have additional information at this time. ANALYSIS: This situation is highly fluid as details continue to emerge.  When they make this move to Pandemic Phase 5 it is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.   World Health Organization director-general Dr. Margaret Chan raised the pandemic threat awareness level to 5, meaning the world is at imminent risk of a pandemic from H1N1 swine flu. "I have decided to raise the level of influenza pandemic alert from phase 4 to phase 5," Chan told a news briefing More analysis later.   Not preparing now would be a serious mistake should things worsen quickly.      If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com   SUBSCRIBE TO ALERTS by clicking the button below.    Dr. Stuart Weiss is a nationally recognized pandemic planning expert and CEO of MedPrep Consulting Group. MedPrep can assist you with your pandemic planning, training and exercising needs. Drop me a note if you want more information about us.            Stuart Weiss, MD, CBCP MedPrep Consulting Group LLC

Influenza Update #7 - Swine Flu

MedPrep Consulting Group LLC Dr. Stuart B. Weiss  IMPORTANT INFLUENZA UPDATE #7 WHO PANDEMIC ALERT LEVEL 4 April 29, 2009 SWINE FLU CAUSES FIRST DEATH IN THE U.S.  AS EXPECTED, NUMBER OF CASES IN THE U.S RISES This morning, the CDC confirmed the first death in the U.S. related to swine flu in a 23 month old child in Texas. The number of cases in the U.S. has risen to 66 (as per the NY Times) or 64 (as per the CDC website updated yesterday). The Food and Drug Administration (FDA) issues Emergency Use Authorizations for masks and antiviral medications   CURRENT SITUATION: This morning, Dr. Richard  Besser, acting director of the CDC confirmed the first death in the U.S. in a 23 month old child in Texas during an interview on CNN. No other details were given The number of cases in the U.S. has risen to either 64 or 66. The NY Times is reporting 66 confirmed cases and the official CDC website that was last updated yesterday still says 64. Confirmed cases come from California, Kansas, New York (New York City), Ohio and Texas. The Commission of Health for New York City stated that many hundreds of school children are sick at the school where cases have been confirmed Mexico case totals have risen to 2498 illnesses and 159 deaths While some countries have issued travel advisories and travel bans to Mexico, the World Health Organization (WHO) says these will not help (I agree, its too late for containment) The WHO says it could take 4-6 months for a vaccine to be developed President Obama asks for $1.5 Billion to flight flu. This will be used for antivirals, vaccine development, disease monitoring and assisting international efforts The FDA issued Emergency Use Authorizations (EUA) for masks, antiviral medications and Flu testing kits. For more information please see: www.cdc.gov/swineflu/eua/ This has the following effect: The use of N-95 masks in occupational and non-occupational settings is permitted without fit testing and training Expanded use of antiviral medications without the usual labeling requirements, the use in children less than 1 year of age and the use of medication that has its expiration date extended The use of flu testing kits that have not been officially FDA approved. THERE ARE RESTRICTIONS AND OTHER DETAILS ON THESE EUA's so be sure to go to the website for further information   ANALYSIS: This situation is highly fluid as details continue to emerge. Although the news today is concerning, this is consistent with the normal progression of an outbreak. The announcement this morning of a death in the U.S. was to be expected as is the rise in the number of cases. I want to reiterate that this is still a very fluid situation that could go a number of ways. The virus could continue to spread, could stabilize and then simmer at low levels through the summer and reemerge in the fall or it could fizzle out completely. Which ever way this goes, you must be finalizing plans and implementing some parts of your pandemic plan now.   Let me talk about a couple things related to disease outbreaks such as this one. First, an outbreak of an infectious disease usually follows a bell-shaped curve in which the number of cases starts off slow and then builds to a peak and then falls off. Its not certain whether this disease will follow this pattern but its a good bet. That pattern together with the increased amount of surveillance will lead to more cases detected in the U.S. As we have more cases, the probability that we will see fatalities increases so it is not unexpected that we would have fatalities in the U.S. The CDC has been speaking about that for a few days now.   It will be important to watch what happens with the number of cases over the next few weeks. Influenza spread typically slows and then stops in the northern hemisphere each May only to pick up again in the fall. The swine flu virus is an influenza virus so it may follow that pattern as well. No one knows yet. If we look back at the 1918 pandemic which killed millions of people, that virus followed this seasonal pattern. It was very mild in the spring and then came back in a much more serious form in September.   The Emergency Use Authorizations that were issued by the FDA are important for businesses to look at if you plan to use masks or antiviral medications. Please be certain to look at the complete guidance at the web address listed above.   Now is not a time to panic but instead, its the time to continue preparations. Even if the virus outbreak stabilizes, it will be months until we can say with certainty that this was not the beginning of a pandemic.       ADVICE: Each day, I will focus on issues from a pandemic planning area that we have found during pandemic plan audits that we have performed for our clients. Outsourced Processes. Take a close look at the processes you have outsourced to other countries. How would you handle these processes if the contractor was unavailable. For example, we have done alot of work within the healthcare community in parts of India. I can tell you that the public health infrastructure there is much less robust than in the U.S. and would have a very hard time responding to get antiviral medications to the population. Without being politically incorrect, the chance for failure is high. This is the same in other outsourcing countries. So take a look at how you would absorb critical processes should those foreign contractors fail. Critically review your plans to identify gaps. Now is not the time to be doing big extensive long term audits but having a team quickly review your current plans for gaps is a good idea. Use a group from within your company or use us but have someone with a different perspective review the plan. At one of our current clients, we are helping them with a process of quick one hour meetings with each individual business unit to review business unit plans. They are asked some very specific questions: Have you updated your contact list Have you completed all current planning tasks What are the major tasks to be completed should things get worse What do you need to buy now for preparation and what expenses will be incurred should things get worse and we have to change our business practices What help do you need to complete the preparation process Communicate with your employees. I know I keep saying this but it is crucial that you maintain an open and clear line of communication with your employees during this crisis. The channel you open now with your employees will help you weather the storm should things get worse. You should also be updating your message maps outlining key messages you would put out during a pandemic. If you need more information about mesage mapping, please email me.   ANSWERS TO QUESTIONS YOU HAVE ASKED ME:   You cannot catch swine flu from properly cooked pork. The incubation time for illness appears to be 2-7 days It early to know with certainty but it is generally thought that virus spreads through the air for a distance of about 6 feet and can survive on surfaces. This is the way influenza viruses usually act.   Not preparing now would be a serious mistake should things worsen quickly.      If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com   SUBSCRIBE TO ALERTS by clicking the button below.    Dr. Stuart Weiss is a nationally recognized pandemic planning expert and CEO of MedPrep Consulting Group. MedPrep can assist you with your pandemic planning, training and exercising needs. Drop me a note if you want more information about us.            Stuart Weiss, MD, CBCP MedPrep Consulting Group LLC

Influenza Update #6 - Swine Flu

MedPrep Consulting Group LLC Dr. Stuart B. Weiss  IMPORTANT INFLUENZA UPDATE #6 WHO PANDEMIC ALERT LEVEL 4 April 28, 2009 WHO CHANGES ALERT LEVEL DEFINITIONS AND MOVES THE WORLD TO PANDEMIC ALERT LEVEL 4 Last evening, the World Health Organization declared a Level 4 Pandemic Alert after reviewing the data on the spread of swine flu. This follows a change in the definitions used for the alert levels (see below). This indicates that the world is one step closer to a pandemic but it still does not mean that a pandemic is inevitable.   CURRENT SITUATION: On the advice of the World Health Organization (WHO) emergency committee, the Secretary General of the WHO moved the world to Pandemic Alert Phase 4. At the same time, the Secretary General recommended that countries do not close their borders or restrict travel. The U.S. Department of Homeland Security has issued a warning to Americans to avoid unnecessary travel to Mexico The European Union's health commissioner has urged Europeans to avoid unnecessary travel to affected areas in Mexico and the U.S. Mexico has closed all schools across the country until May 6th. The new numbers being reported from Mexico are 149 suspected swine flu deaths, 1995 people admitted to hospitals with serious pneumonia. Number of confirmed cases in the U.S. rose to 40. In addition, New Jersey announced yesterday that there are 5 probable cases being investigated. 4 of those people traveled to Mexico and one traveled to California. Minnesota also reported 2 suspected cases. On the CDC conference call yesterday, the CDC announced that they have posted recommendations on anti-viral use, safety, infection control and non-pharmacological community mitigation strategies on their website. They will be issuing interim recommendations as the situation evolves. Go to www.cdc.gov/swineflu for more information   ANALYSIS: This situation is highly fluid as details continue to emerge. The move to Pandemic Alert Level 4 under the new definitions means that there is sustained "community level outbreaks" not just heightened human to human spread. The new definitions make Phase 4 much more significant. The time you have to do planning is rapidly diminishing. We urge you to diligently work on reviewing and updating your plans now. Some companies have already begun implementing some of the early actions in their plans.   It is important to reiterate that we still do not know which way this will go. The virus could continue to spread and end up causing a pandemic, stabilize and cause just local outbreaks throughout the summer and reemerge in the fall (similar to the 1918 pandemic) or fizzle out completely.  The WHO could move the world back to Phase 3 or up to a higher phase in the future. This lack of clarity however should not encourage you to delay planning and implementing your plan. As you have seen, this is a rapidly developing situation. You may not have much time between Phase 4 and a full blown pandemic. As we have been saying over the past few years, just because we were at Phase 3 for a decade does not mean that the transition from Phase 4 to Phase 6 will take very long. We just don't know at this point. I suspect that things will become clearer over the next week.   NEW WHO PANDEMIC ALERT LEVELS The WHO changed the alert levels two days ago issuing new definitions for the levels and adding two new categories. These new definitions are grouped differently as well. I have summarized the changes below. For the complete  definitions, go to: www.who.int/csr/disease/avian_influenza/phase/en/index.html The new groupings are: Predominantly Animal Infections (Phases 1-3) Sustained Human to Human Transmission (Phase 4) Widespread Human Infection (Phases 5-6, Pandemic) Post Peak (Possibility of Recurrent Events) Post Pandemic (Disease Activity at Seasonal Levels) The new definitions are (summarized): Phase 1: No viruses circulating in animals that cause infections in humans Phase 2: Animal virus is circulating that is known to cause human infection Phase 3: Animal or human-animal reassortment virus causes sporadic cases or small clusters of disease in people but not sustained community level outbreaks Phase 4: Verified human-to-human transmission of a virus that is able to cause community level outbreaks and marks a significant upward shift in the risk for a pandemic Phase 5: Human-to-human spread of virus into at least two countries in one WHO region. This is a strong signal that a pandemic is imminent Phase 6: Pandemic phase Post-peak: Pandemic disease levels in most countries with adequate surveillance have dropped below peak levels Post-pandemic: Influenza disease activities has returned to levels normally associated with seasonal influenza Looking at these new levels, you may wonder, why aren't we already at Phase 5 since we have infections in both the U.S. and Mexico. That is due to the U.S. and Mexico being in different WHO regions and the U.S. cases are still small clusters or sporadic. This could change quickly if the number of cases in the U.S. continues to rise.     ADVICE: The Time for Planning is essentially over. You are rapidly running out of time to do planning. At this point, everyone should have reviewed their existing plans or developed quick interim plans as discussed in Saturday's alert (If you need a copy, send me a note, my email address is at the bottom of this alert). Implement the initial parts of your plan. Carefully review those parts of your plan that require significant lead time. You may want to implement some of those steps now. For example, if you plan to have your workforce work from home, now is the time to buy items such as laptops and printers to enable that, clearly outline changes to network structure that will allow that to happen and train employees on how to work effectively from home. If there are processes that will be suspended during a pandemic, finalize how that will happen. It is not time to actually shut down business processes but that time may come quickly should this virus continue to spread. Suspend company travel to Mexico. While there are no travel restrictions to Mexico in place at this time, you should consider not traveling to Mexico until we know more about the outbreak. The next week will be important as new information emerges. Review your Anti-viral decision. If you have been considering utilizing anti-viral medications as part of your pandemic response, you MUST sign up now. If you wait until Phase 5 or 6, you will not be able to obtain medications. The process of obtaining antiviral medications requires a medical screening exam, employee education and a prescription for each employee. There are several companies that can assist you with this process. Send me an email if you want more information about this. Communicate with your employees. Inform your employees about company preparedness efforts. Remind employees about family preparedness.  Remind your employees about hand hygiene and cough/sneeze etiquette. Influenza spreads through the air by droplets. It is important to remind employees that hand washing and covering their cough/sneeze can go a long way to limit the spread of flu. There are good materials available on this that we can share with you. It is time to purchase hygiene supplies like hand sanitizer and tissues, for example.   Lastly, in response to several questions, you cannot catch swine flu from properly cooked pork.   Not preparing now would be a serious mistake should things worsen quickly.      If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com   To add your email address to our email alert mailing list (if you received this when someone forwarded it to you) click the button below.    Dr. Stuart Weiss is a nationally recognized pandemic planning expert and CEO of MedPrep Consulting Group. MedPrep can assist you with your pandemic planning, training and exercising needs. Drop me a note if you want more information about us.            Stuart Weiss, MD, CBCP MedPrep Consulting Group LLC

Influenza Update #4 - U.S./Mexico Situation

MedPrep Consulting Group LLC Dr. Stuart B. Weiss  IMPORTANT INFLUENZA UPDATE #4 US/MEXICO SITUATION April 26, 2009 U.S. Public Health Emergency declared WHO still holds at Pandemic Phase 3. YOU SHOULD BE AT WHO PANDEMIC PHASE 4  (For the benefit of those people who are catching up, we advised on Saturday  that you should treat the current swine flu situation as a WHO Pandemic Alert Phase 4 event (see analysis below)).   In separate news conferences yesterday, the U.S. Government declared a public health emergency and the World Health Organization (WHO) left the Pandemic Alert Phase at 3 despite mounting evidence of "increased" human-to-human spread.   CURRENT SITUATION: Currently there are 20 patients with confirmed swine flu H1N1 illness in 5 states across the United States (NY, OH, KS, TX, CA) The U.S. Government yesterday declared a Public Health Emergency that frees up state and local resources to deal with the current situation. It also allows the movement of and access to anti-viral medications in the National Pharmaceutical Stockpile. The WHO stated in a news conference that it needs more information before raising the Pandemic Alert Level from 3 to 4 So far, illness seem to primarily affecting people in their 20's, 30's and 40's While there are no travel restrictions to or from Mexico, several large U.S. airlines have waived change fees for travelers changing their travel plans Canada reports 6 cases in 2 provinces of Canada Israel reports one case in a traveler who had recently returned from Mexico Suspect cases continue to be investigated in New Zealand, Spain and the United Kingdom ANALYSIS: This situation is highly fluid as details from Mexico and the U.S. are emerging. As we continue to advise, this is the time to prepare and you should consider the world at WHO Pandemic Phase 4 even though the level itself has not been raised.    You may be asking why hasn't the WHO raised the Pandemic Alert level from 3 to 4 since there is mounting evidence of increased human-to-human spread. We gained some insight into the decision process from Dr. Fukuda of the WHO at yesterday's press conference. He said "If WHO makes a decision that the phase has changed, this is really a very serious signal to the world. I have no doubt that many countries are already taking these actions, but it does send a signal, so we want to make sure we're standing on pretty good solid ground". Their next committee meeting is Tuesday but you SHOULDN'T WAIT for that.   In audits that we have done of corporate pandemic plans, we routinely see a trend towards taking actions too late in the game. People plan to test IT systems too late, train employees too late, practice working from home too late. It is critical that you avoid these mistakes. The earlier you practice these important components of your plan, the more likely you will be successful.   As you can see from the current situation, conditions change rapidly during the early days of an outbreak and it is impossible to know which way this will go. Will things get rapidly worse, stabilize or fade away? In our opinion, it would be a mistake to wait for the WHO to raise its Pandemic Alert Level. Now is the time to review your plans and implement those initial steps that can be turned off if this stabilizes or fades away.   I like to use an example that others have also used of hurricane preparations. If weather forecasters are predicting that a hurricane will hit your area, most people and businesses will take precautions even though hurricanes sometimes change directions. Its the same with the current swine flu situation. Its early in the disease outbreak but there are potential storm clouds on the horizon. They may blow over but what would you do if tomorrow the storm got much worse.   ADVICE: Continue to closely follow the news. News stories about this will continue to appear on all major news outlets. Remember that we expect to see more cases pop up as surveillance around the world is stepped up. Also, from a statistical standpoint, it would not be unexpected to see some deaths in the U.S. if the number of cases continue to rise. NOW IS THE TIME TO REVIEW YOUR PANDEMIC PLANS. I know that I keep saying this but I can't stress this enough that it is time to consider what would happen if this virus turns more serious in the next few months and you had a 30%-40% reduction in your staff. Develop travel plans for employees going to Mexico. While there are no travel restrictions to Mexico in place at this time, you should consider not traveling to Mexico City or the surrounding areas until we know more about the outbreak. The next week will be important as new information emerges. Stay Home if your are sick . Encourage a corporate culture which promotes staying home if an employee has flu-like symptoms. In many company cultures, employees come to work when they are feeling sick. In this situation that behavior should be discouraged. Review your health benefit policies. There are several key medical benefit issues that you should look at. For example, if this situation gets worse, can you waive out-of-network benefit restrictions to allow employees to seek care from available out of-network providers? Will your pharmacy benefits plans allows employees to obtain more than 60 or 90 days worth of prescription medications? These are some of the issues our clients plan for. Communicate with your employees. Inform your employees about company preparedness efforts. Remind employees about family preparedness. For example, who would watch the children if schools were closed tomorrow? Remind your employees about hand hygiene and cough/sneeze etiquette. Influenza spreads through the air by droplets. It is important to remind employees that hand washing and covering their cough/sneeze can go a long way to limit the spread of flu. There are good materials available on this that we can share with you.   Not preparing now would be a serious mistake should things worsen quickly.      If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com   To add your email address to our email alert mailing list (if you received this when someone forwarded it to you) click the button below.            Stuart Weiss, MD MedPrep Consulting Group LLC

Influenza Update #3 - U.S./Mexico Situation

MedPrep Consulting Group LLC Dr. Stuart B. Weiss  IMPORTANT INFLUENZA UPDATE #3 US/MEXICO SITUATION April 26, 2009 As number of cases grow, the WHO declares a Public Health Emergency of International Concern As new cases are identified in New York City and Kansas. the World Health Organization (WHO) declares a "Public Health Emergency of International Concern".   CURRENT SITUATION: After convening a meeting of an expert panel, the WHO Director General declared the swine flu outbreak as a Public Health Emergency of International Concern as defined by the 2005 International Health Regulation. She has recommended countries around the world intensify surveillance. The WHO stopped short of changing the Pandemic Phase as the committee waits for more data from Mexico NYC Department of Health has determined that at least 8 of the more than 100 school children in a private school in Queens, NY that have been sick with flu like symptoms over the past few days have swine flu. Samples have been sent to the CDC for confirmation. Some family members of the school children have also come down with symptoms. All symptoms have been mild, none have required hospitalization. Kansas Department of Health has confirmed two cases of swine flu in adults in the same household. One had recently traveled to Mexico. British health authorities are reporting that one British Airways flight attendant is undergoing tests in a hospital after becoming ill with flu like symptoms after returning from a flight to Mexico.  Three teachers and 22 students in Auckland, New Zealand are being tested after becoming ill following a three week trip to Mexico.  The number of cases in Mexico is now reported as 81 deaths and 1324 sick. The President of Mexico has assumed new emergency health powers to facilitate the quarantine and treatment of sick people. ANALYSIS: This situation is highly fluid as details from Mexico and the U.S. are emerging. As we advised yesterday, this is a time to prepare and you should consider the world at WHO Pandemic Phase 4 even though the level itself has not been raised. Yesterday the CDC said "Cases are now mild, that may change. This is the time to prepare."   It is not unusual to see more cases reported as states and countries increase their surveillance. Cases that otherwise would have been considered to be seasonal flu will now be scrutinized and may turn out to be this new swine flu. As you can imagine, there is considerable interest in why cases in the U.S. seem to be mild while cases in Mexico seem to be more serious. This could be due to the small numbers of cases in the U.S. so far compared to the large numbers in Mexico. Remember, it is still unknown exactly how many cases there are in Mexico.   It is important to remember that the 1918 Influenza Pandemic started with mild cases and then as the virus moved through the population, it changed into a form that caused more serious disease. While it is impossible to know if this virus will follow the same path or just burn itself out, it is important for you to plan now for the possibility of worsening conditions.   ADVICE: Continue to closely follow the news. News stories about this will continue to appear on all major news outlets. Remember that we expect to see more cases pop up as surveillance around the world is stepped up. Watch for an increase in severity of illness. NOW IS THE TIME TO REVIEW YOUR PANDEMIC PLANS. I know that I keep saying this but I can't stress this enough that it is time to consider what would happen if this virus turns more serious in the next few months and you had a 30%-40% reduction in your staff. If you don't have a plan, brainstorm on a quick down-and-dirty list. If you don't have a pandemic plan in place, brainstorm a quick list of critical business processes you need to maintain your business viability and then create a list of people who will perform those tasks and from where they will do them. If you need help with this, we can help. Send me an email. Communicate with your employees. Establish early on that you are a credible source of information about your company preparedness. The common misconception that you don't want to frighten your employees by discussing this issue is incorrect. Your employees have already seen the news. It is important to show that you are closely following the issue and present the steps you are taking to prepare. Remind your employees about hand hygiene and cough/sneeze etiquette. Influenza spreads through the air by droplets. It is important to remind employees that hand washing and covering their cough/sneeze can go a long way to limit the spread of flu. There are good materials available on this that we can share with you.   Not preparing now would be a serious mistake should things worsen quickly.      If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com   To add your email address to our mailing list (if you received this when someone forwarded it to you) send an email to mailinglist@MedPrepGroup.com             Stuart Weiss, MD MedPrep Consulting Group LLC

Influenza Update #2 - U.S./Mexico Situation

MedPrep Consulting Group LLC Dr. Stuart B. Weiss  IMPORTANT INFLUENZA UPDATE #2 US/MEXICO SITUATION April 25, 2009 Are we at WHO Pandemic Phase 4 already? While the epidemiologic studies and public health work is continuing in the U.S. and Mexico the World Health Organization (WHO) is holding an emergency meeting of top experts to consider what actions to take.   CURRENT SITUATION: As was mentioned yesterday, the viral strain afecting people in the U.S. and Mexico are the same. The virus is a novel form of H1N1 with a mixture of pig, avian and human genes in a combination not previously seen. With over 900 people affected in Mexico and people infected in the U.S., sustained human-to-human transmission is the most likely method of spread. This swine H1N1 IS SUSCEPTABLE to Tamiflu and Relenza but resistant to Adamantane class of drugs. Although the data is very limited, it appears that vaccination with this year's seasonal influenza vaccine does not protect against this new strain of flu. The CDC is putting out interim guidance on their website. For the latest information, go to: www.cdc.gov/swineflu/investigation.htm Because of the widepsread nature of the outbreak, the liklihood of containment at this point is little to none. There is still CONSIDERALE UNCERTAINTY about whether this will progress to a pandemic, stablize and simmer for a long time or burn itself out. The cases in the U.S. were all mild while some of the cases in Mexico were much more severe and lethal. Bloomberg is reporting that the WHO may declare this "an International Public Health Emergency"   ANALYSIS: This situation is highly fluid as details from Mexico are emerging. The fact that there has been such widespread disease reported makes human-to-human transmission "increased". This MEETS THE CRITERIA for WHO Pandemic Phase 4. It is challenging to make this statement ahead of the WHO however there are many political and economic reasons why the WHO might delay that annoucement. Remember, this does not mean that a pandemic is right around the corner or inevitable. What this does mean is that the risk is higher than it has been for a pandemic and you should not treat this as business as usual. Your activities should be more urgent as you review your pandemic preparedness. It is important to discuss with your leadership that although preparations might be reviewed and some may be implemented, this is a fluid situation.   ADVICE: Communicate with your employees. Your employees have seen the news reports that have been splashed across television, radio and newspapers. Now is the time to communicate with your employees on company preparations and personal preparations that should be undertaken. Remind them where they can get reliable sources of information (i.e. CDC, WHO, etc.) Employee Protection Strategies. Carefully consider how you will keep those employees that must come to the workplace safe during a pandemic. Will you provide masks or antiviral medications and if so, do your have sources to get these items? Review Workplace Personal Hygiene Practices. Now would be a great time to role out a hand hygiene program and a sneeze/cough ettiquette reminder. The CDC has good materials on these topics and we can help you with this as well. Review IT Capabilities. If you plan to have many employees work from home, you must seriously work though how that will happen. Carefully analyse what equipment these people will need to work from home and schedule some tests of these capabilities. Some companies have already practiced by having a work from home day once a month. Make a Quick List of Critical First Steps. If you have a pandemic plan that is well developed, then this is already fleshed out but if you do not, then take a moment and write a quick list of the critical actions you would need to take to keep your business going during a pandemic. This obviosly does not take the place of comprehensive pandemic planning but it is a start if things get bad quickly.   The WHO is having a conference call at 4PM today and we might find out further information or not. Either way, you should think about the current situation as if we are already at WHO Pandemic Phase 4. I am not recommending that you implement your full pandemic plan at this time but it is time to take a close look at your plan and implement some of the early steps. Not preparing now would be a serious mistake should things worsen quickly.      If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com             Stuart Weiss, MD MedPrep Consulting Group LLC