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