Influenza Update #23 - H1N1-(swine)

MedPrep Consulting Group LLC Dr. Stuart B. Weiss INFLUENZA UPDATE #23 WHO PANDEMIC ALERT LEVEL 5 MAY 27, 2009 SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com Has the virus peaked in the U.S.? Perhaps, but watch for flare-ups. The CDC announced yesterday that the number of new cases of H1N1 (swine) have dropped off in most of the U.S. except for NY, NJ and New England. They also cautioned that local flare-ups (like we are seeing here in NY) may still occur through the summer. The WHO continues to move away from the current Phase definitions. Current Situation: The WHO continues to look at its current Pandemic Phase definitions. On yesterday's press conference, the WHO said that a panel of expert scientists would be consulted to help develop a new definition. The WHO reported 12,954 confirmed cases in 46 countries. Remember, in countries with large outbreaks, the absolute number of cases is less important than the disease outbreak pattern. The CDC reiterated that same point, that it is more important to follow patterns of illness than actual numbers. In the U.S., there are 6764 probable or confirmed cases with 10 deaths on the CDC website and 12 deaths listed in various media reports. On Saturday, the CDC posted new interim guidance on the use of facemasks and respirators. You can find this guidance at: http://www.cdc.gov/h1n1flu/masks.htm The number of cases in Australia doubled overnight to 59. This country is being watched closely since the flu season is just beginning in the Southern Hemisphere. The CDC reports that it has not seen any H1N1 (swine) that is resistant to Tamiflu or Relenza. HOUSEKEEPING ITEM: If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to alert@MedPrepGroup.com ANALYSIS: With the number of new cases slowing down in most of the U.S., we may have moved past the peak of an outbreak. Remember that for infectious disease outbreaks similar to flu, the number of new cases follows a bell shaped curve with new cases increasing rapidly until the outbreak comes to a peak and then new cases slow down. This is not true in NY, NJ and New England where new cases of flu continue to be found at a much higher rate than expected for this time of year. The other important characteristic to remember is that we may see flare-ups or local pockets of outbreak even as spread across the country overall slows down. Flu virus is expected to spread somewhat unevenly in different communities. On the WHO press briefing call yesterday, the WHO indicated that it is still struggling to develop more meaningful Pandemic Phase criteria. The WHO will call on an expert panel of scientists to assist them with the development of new criteria which they hope to get out soon. We have spoken to many of our clients about this same issue. As we assist them with the development of their trigger based action plans, several issues have come up. This gets a bit complex so bare with me. As I have written previously, we have been recommending that companies develop a set of triggers with an associated decision matrix that are not directly tied to WHO Pandemic Phases. The decision matrix you develop helps your executives decide which trigger to activate. Built into the matrix are the criteria of viral spread, severity and impact. This matrix must be individualized for each company since corporate impact varies depending on where your facilities are located and what public health infrastructure is present in those areas. Each trigger has a set of actions associated with it that fall into one of five domains: People, Facilities, Communications, Mission Critical Activities and Technology. Within each action, there is an associated policy, procedure and FAQ. So overall, the decision matrix drives the trigger decision. The trigger drives the specific associated actions. And the actions are made up of an associated policy, procedure and FAQ. I hope I haven't confused everyone but this is a process that we go through with our clients over the course of weeks to months depending on the complexity of their corporate structure. If you have any questions about this, please drop me an email. Lastly, as mentioned above, the CDC has come out with new facemask guidance. While there is nothing new or earth shattering about the new guidance, you should familiarize yourself with it. Basically it recommends that for community settings with a new flu virus, no masks are needed. For occupational settings, avoid close contact and practice good cough/sneeze etiquette. If you cannot avoid close contact, wear a mask. There is a good table that summarizes the guidance within the guidance. ADVICE: Develop your action plan with triggers that are based on spread, severity and impact. Don't wait until the new WHO phase definitions come out. Start working on this now. Take this opportunity to uncouple your plan from WHO Phases and build a decision matrix and triggers based on the combination of spread, severity and impact. Expect some irrational behaviors in countries around the globe as they attempt (unsuccessfully) to keep the virus out. Ensure that someone follows the developments of H1N1 (swine) over the summer. This is still an evolving outbreak. No one knows how this virus and the other circulating flu viruses will react. Virtual Medical Director Program: If you don't have a corporate medical director, we can be your medical director. Our Virtual Medical Director service provides you with 24 hour access to physicians and experts trained in emergency medicine, disaster medicine, business continuity, occupational health and mental health crisis management to give you situation updates, analysis and advice. Contact us for further information. 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 MedPrep Consulting Group is internationally recognized as a leader in pandemic, disaster and business continuity planning, training and exercising. We have resources and expertise that you can count on. Ask us about our Virtual Medical Director Program. Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com Stuart Weiss, MD, CBCP MedPrep Consulting Group LLC

Influenza Update #22 - H1N1-(swine)

MedPrep Consulting Group LLC Dr. Stuart B. Weiss   INFLUENZA UPDATE #22 WHO PANDEMIC ALERT LEVEL 5 MAY 22, 2009   SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com   Quick Update: WHO Press briefing The WHO held its first press briefing in a week now that the World Health Assembly, their gathering of all member nations, has concluded. Here's a brief summary of what they said.   The WHO took a significant step away from the current definition of Pandemic Phase 6. While they wouldn't commit to when a new definition would be available, they did say that the new definition would include criteria to determine if there was a substantial increase in the risk of harm to humans. 11,168 confirmed cases in 42 countries. In countries with large outbreaks, the number of cases are less important than disease outbreak patterns. Some countries are moving away from lab confirmation of cases that clinically look like H1N1 (swine). Vaccine development seems to be proceeding on track. No decision from the strategic advisory group yet on how much vaccine to make.   HOUSEKEEPING ITEM:  If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to alert@MedPrepGroup.com       ANALYSIS:    Backing off from the current Phase six definition by the WHO at the press briefing today is not entirely unexpected. All week at the World Health Assembly, the WHO has heard from member countries that severity should be included in the Phase definitions. We've been saying that to you as well. What this means is now, more than ever, you need to develop new triggers for your plans. The Phases, which were initially developed using H5N1 (avian) flu as the model are not necessarily valid anymore. Stay tuned for more, we'll be hearing more about this in the coming weeks or months.         ADVICE: Develop your action plan with triggers that are based on spread, severity and impact. Don't wait until the new WHO phase definitions come out. Start working on this now. Take this opportunity to uncouple your plan from WHO Phases and build a decision matrix and triggers based on the combination of spread, severity and impact. Look at your H.R. policies concerning employees who miss work when schools are closed due to a viral outbreak. On the CDC call today, they mentioned that over 60 schools across the country are closed due to H1N1 (swine), affecting 42,000 students. Some studies in the past have pointed to a 10% increase in worker absenteeism when parents must stay home to watch kids. Take a look at how do your H.R. policies handle this. For clients in the U.S., have a great holiday weekend.     Virtual Medical Director Program:   If you don't have access to timely accurate medical information and analysis, our Virtual Medical Director service provides you with 24 hour access to physicians and experts trained in emergency medicine, disaster medicine, business continuity, occupational health and mental health crisis management. In essence, we function in the role of corporate medical director for those companies who do not have access to that resource in-house. Contact us for further information.     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       MedPrep Consulting Group is internationally recognized as a leader in pandemic, disaster and business continuity planning, training and exercising. We have resources and expertise that you can count on. Ask us about our Virtual Medical Director Program.   Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com   Stuart Weiss, MD, CBCP MedPrep Consulting Group LLC

Influenza Update #21 - H1N1-(swine)

MedPrep Consulting Group LLC Dr. Stuart B. Weiss  IMPORTANT INFLUENZA UPDATE #21 WHO PANDEMIC ALERT LEVEL 5 MAY 21, 2009   Public Daily Brief Call: No call today   SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com   The older, the better?? The new study posted on the CDC website in the Morbidity and Mortality Weekly Report (MMWR) seems to show that older Americans MIGHT have some protective antibodies, but what does that mean? Meanwhile, case numbers continue to rise around the world but may be finally slowing down in the U.S.....maybe.   CURRENT SITUATION: The WHO is reporting that there are now 11,034 confirmed cases of H1N1 (swine) in 41 countries around the world (not including the 54 new cases confirmed in the U.S. today). The top six countries with confirmed cases are US (5764) Mexico (3892), Canada (719), Japan (259), Spain (111) and the U.K (109).   In the U.S., there are 5764 probable and confirmed cases and on today's media briefing, it was mentioned that there may be over 100,000 unconfirmed cases in the U.S. (they assume only 1 in 20 seeks medical care since the disease is mild)  There seems clearly to be sustained community level spread in Japan at this time. This would meet the current definition of WHO Pandemic Phase 6 The WHO is under increasing pressure from its member countries to factor in severity into the Pandemic Phases and not to advance to Phase 6 (a pandemic in progress).   MMWR published some preliminary data showing that older Americans have microneutralization antibodies to H1N1 (swine). You can read the report at:  http://www.who.int/csr/don/2009_05_21/en/index.html Some U.S. national monitoring systems indicate that the number of people seeking medical care for influenza-like illness is decreasing overall. There are still pockets where it is spreading rapidly but this could signal that we have peaked (very early data, not conclusive yet). Spread is uneven across the country as expected. New England, NY, NJ areas are still seeing increasing numbers of cases. Mid-Atlantic, midwest and southwest are down and southeast is about the same.   HOUSEKEEPING ITEM:  If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to alert@MedPrepGroup.com       ANALYSIS:    The MMWR report released today is interesting but must be taken with a big grain of salt for a couple of reasons. The data in the report shows that 33% of frozen, stored blood samples taken from people older than 60 years old who participated in previous vaccine studies seem to have some antibodies that react with the current H1N1 (swine) virus. That could be from having been exposed to some distant cousin of the current H1N1 (swine) virus years ago and still having some "memory" in their immune system. Here's the problems: first, the number of blood samples tested is apparently low so its hard to know if this finding applies to all older Americans or just to the small group that happened to be part of the previous vaccine studies. Second, there is no way to know with this lab result whether it actually applies to people. Sometimes tests done on lab samples do not apply clinically to actual people. There have been many examples in medicine where someone finds something great in a lab only to find that it fails when tested in real living people. So this is an interesting finding that you may read about in the newspaper tomorrow but it may or may not mean anything.   The interesting thing is that we are finding that the majority of confirmed cases are in younger people in the U.S. In the media briefing today, the CDC said that 64% of cases are in people 15-24 years old. Only 1% of cases are in people over 65. This is very different from seasonal flu patterns. So maybe old antibodies are still helping.   The WHO continues to meet with its member countries. There is pressure on them not to raise the Pandemic Phase to 6 and declare a pandemic. This is in spite of the fact that we already meet the current definition for Phase 6. I'm not sure how long they can hold off that decision in face of increasing world numbers and the situation in Japan. The Phases, as they are currently defined, only deal with the spread of a virus, not the severity. Some member countries want severity built in. So the WHO should either revise the Phases again or follow the current definition. The difficulty comes with the inappropriate interpretation of Phase changes that occurs in countries around the world. At this point, closing borders, quarantining people, conducting airport screenings will not stop the spread of disease. So if you have offices around the world and this Phase change does occur, expect inconsistent responses from different countries.   The CDC said today that they are on track for delivering virus samples to vaccine developers by the end of May. This is proceeding on schedule.         ADVICE: Don't get caught off-guard by Pandemic Phase 6. Look closely at your pandemic plans to see what actions are taken at WHO Phase 6. Many of the plans we have audited over the years call for restricting access, limiting visitors, mandatory work-from-home, no travel, etc. Now is the time to address those issues before Phase 6 is declared. Develop your action plan with triggers that are based on spread, severity and impact. Take this opportunity to uncouple your plan from WHO Phases and build a decision matrix and triggers based on the combination of spread, severity and impact. Look at your building lease and see if it meshes with your plans. I was at the NYC chapter of the Association of Contingency Planners (ACP) today and the speaker was from the Building Owners and Managers Association (BOMA). He spoke about people having plans that don't mesh well with building plans or local laws. Some tenants ask for responses that are neither in their leases nor available in the building. He recommended taking a good look at your leases with an eye towards business continuity and disaster planning. Involve your medical director in your planning process. You'd be surprised by how often we hear that the medical director is not integrally involved in the planning process for infectious disease outbreaks like influenza. We recommend that you involve your medical director. If you don't have a medical director, call us and we'll be your medical director (see below)   Virtual Medical Director Program:   If you don't have access to timely accurate medical information and analysis, our Virtual Medical Director service provides you with 24 hour access to physicians and experts trained in emergency medicine, disaster medicine, business continuity, occupational health and mental health crisis management. In essence, we function in the role of corporate medical director for those companies who do not have access to that resource in-house. Contact us for further information.     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       MedPrep Consulting Group is internationally recognized as a leader in pandemic, disaster and business continuity planning, training and exercising. We have resources and expertise that you can count on. Ask us about our Virtual Medical Director Program.   Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com   Stuart Weiss, MD, CBCP MedPrep Consulting Group LLC

Influenza Update #20 - H1N1-(swine)

MedPrep Consulting Group LLC Dr. Stuart B. Weiss  IMPORTANT INFLUENZA UPDATE #20 WHO PANDEMIC ALERT LEVEL 5 MAY 18, 2009   Public Daily Brief Call: No call today   SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com   One Step Closer to WHO Pandemic Phase Six As the number of cases soars in Japan from 5 on Friday to 135 this morning and Japan orders nearly 2000 schools closed, the WHO looks closely at the developing situation in Japan, Spain and the UK to decide on the appropriate WHO Pandemic Phase.   CURRENT SITUATION: The number of cases of H1N1 (swine) in Japan have jumped significantly over the weekend from 5 on Friday to 135 this morning. This has prompted school closures and event cancellations in that country. Most of the cases as near the cities of Kobe and Osaka and are thought to have spread quickly when two High Schools in the area met for a volleyball tournament. Screening programs are established at airports so expect some delays. The WHO is reporting that there are now 8829 confirmed cases of H1N1 (swine) in 40 countries around the world. The top six countries with confirmed cases are Mexico, US, Canada, Japan, Spain and the U.K.   In South America, Chile and Peru announced their first cases over the weekend.  In the U.S., as of Friday, there were 4714 confirmed cases reported in 46 states plus Washington D.C.. Updated numbers come out at 11 AM  Canada reported 496 confirmed cases. In a recent statement, the WHO said that there is still no evidence of sustained community spread outside of North America so the Pandemic Phase will stay at 5. In Europe, Spain has now reported 103 cases and the United Kingdom has report 82 cases. The sixth U.S. death was reported in New York City yesterday in a school principal. New York City has closed 11 schools due to clusters of flu cases. There is evidence that cases of seasonal flu have continued at a higher rate than expected for this time of year in the Northern Hemisphere. Egypt has confirmed a new case of H5N1 (avian) flu in a 5 year old who had close contact with sick or dead poultry. The child has been hospitalized, placed on Tamiflu and is in stable condition.     HOUSEKEEPING ITEM:  If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to alert@MedPrepGroup.com       ANALYSIS:    The spike in cases over the weekend in Japan in teenagers is further evidence on how easily this virus spreads, especially in young people. Japan is already a flu-crazy country due to their aging population and their culture of cleanliness. Over half of all the Tamiflu in the world is used in Japan each year and mask usage on urban trains is commonplace as it is considered impolite to sneeze without wearing a mask. As of Friday, the Japanese thought that they had this contained but things changed significantly over the weekend. The media are reporting that hoards of people are showing up at hospitals to e checked. If you have business in Japan, expect some disruptions as the country reacts to this health threat and schools are closed.   It is important to remember that the number of actual cases around the world is probably much higher than the number of confirmed cases. The first confirmed case in a student who had not been abroad was just announced in Japan on Saturday and today there are 135 cases. This is true in other countries as well. Most cases in Japan and around the world continue to be in teenagers and young adults.   Here is New York City, H1N1 (swine) is on everyone's mind again with the closure of 11 schools and the death of a school official over the weekend. New Yorkers had pretty much assumed the the whole "swine flu" issue was resolved until things heated up again. Although its unclear exactly why there is such high numbers of school clusters in New York City, this is not unexpected as the spread of flu can be unpredictable. These week long school closures have been carefully thought out by the NYC Department of Health but will still have consequences for companies in New York as parents scramble to arrange for child care.     ADVICE: Follow the situation in Japan if you have business there. The situation in Japan is evolving with cases totals changing often. The government has already discouraged unnecessary travel so keep an eye on travel restrictions if you have business in Japan. Review the 4 pillars of Pandemic preparedness: Structure, Plans, Tools and Validation: Structure - how do you organize, manage and communicate Plans - review your tasks, assignments, policies, procedures and FAQ's. Do you have a well thought out trigger based action plan? Tools - what do you have in place to help you manage your structure and implement the plans Validation strategies - how will you validate the plans you have created and the structure you have put into place.   Virtual Medical Director Program:   In response to markedly increased interest, we are expanding our Virtual Medical Director Program. If you don't have access to timely accurate medical information and analysis, the Virtual Medical Director service provides you with 24 hour access to physicians and experts trained in emergency medicine, disaster medicine, business continuity, occupational health and mental health crisis management. In essence, we function in the role of corporate medical director for those companies who do not have access to that resource in-house. Contact us for further information.     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       MedPrep Consulting Group is internationally recognized as a leader in pandemic, disaster and business continuity planning, training and exercising. We have resources and expertise that you can count on. Ask us about our Virtual Medical Director Program.   Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com   Stuart Weiss, MD, CBCP MedPrep Consulting Group LLC

Influenza Update #19 - H1N1-(swine)

MedPrep Consulting Group LLC Dr. Stuart B. Weiss  IMPORTANT INFLUENZA UPDATE #19 WHO PANDEMIC ALERT LEVEL 5 MAY 14, 2009   Public Daily Brief Call: No call today   SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com   The theories fly....and so do the lawsuits A new theory has been put forth by a prominent Australian researcher claiming that H1N1 (swine) is a man-made virus that was created in a lab. This theory will be prominent in the headlines even though the CDC has reviewed his report and has found insufficient evidence to support his claims.   CURRENT SITUATION: The WHO is reporting that there are now 6497 confirmed cases of H1N1 (swine) in 33 countries around the world (up from 5728 in 24 countries 24 hours ago).   In South America, there are now  8 confirmed cases in Brazil, 7 confirmed cases in Columbia and 1 case in Argentina. You can track the cases in South America on the Pan-American Health Organization website at: http://ais.paho.org/flu/sm/en/atlas.html In the U.S. there are now 4298 confirmed cases in 46 states plus Washington D.C.. The only states without confirmed cases are: AK, MS, WV and WY.  Canada reported 398 confirmed cases. In a recent press conference, the WHO said that there is still no evidence of sustained community spread outside of North America so the Pandemic Phase will stay at 5. In Europe, Spain has now reported 100 cases and the United Kingdom has report 71 cases. The Mexican Health Department has released some interesting information on the outbreak in that country. Although there is nothing unexpected, it is interesting to look at. You can find the report at: http://portal.salud.gob.mx/descargas/pdf/influenza/situacion_actual_epidemia_130509.pdf     HOUSEKEEPING ITEM:  If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to alert@MedPrepGroup.com       ANALYSIS:    The theories about the origin of the current H1N1 (swine) virus continue to swirl about the media. The latest has been proposed by a prominent and well respected researcher from Australia who did some of the early work that led to the development of the current anti-viral medications that we use. He and his group looked closely at the publicly available genetic signature and concluded that this virus could have escaped from a lab and did not naturally evolve. His report is not yet available publicly but the CDC has looked at it and concluded that he lacked sufficient evidence to support that claim. The WHO is still looking into it. We have had other theories about how this virus came into being as well. While these investigations are important, nothing is conclusive yet. It will take longer to figure this out and we may never know for sure. Epidemiological and scientific investigations are often slow and thoughtful to make sure accurate conclusions are drawn from the collected data.   That uncertainty has not stopped someone from filing a lawsuit, however. In today's San Antonio Express, they are reporting that a lawsuit has been filed for the wrongful death of the 33 year old woman who died in Texas. Apparently, the owner of the pig farm in the Mexican town of La Gloria where the first person supposedly caught H1N1 (swine) flu is a U.S. company.   During the WHO press briefing yesterday, the WHO discussed producing a severity index. As I have been discussing with you in these Alerts, the Pandemic Phases only relate to how widespread a virus is, not how severe it is. The WHO recognizes that and has been trying to come up with a severity index. Unfortunately, there are considerable difficulties creating a meaningful scale for a worldwide disease outbreak at the WHO level. There will always be considerable variability in different countries around the world. So the WHO seems to be backing away from creating such a scale. You however, should definitely factor severity into your corporate pandemic plan triggers. So lets talk about severity a bit.   The severity of a disease impact is related to three main factors: the virus itself, the vulnerability of a population and the resilience of a community. So lets talk about those for a moment because they are important factors to include in your corporate plans, especially those of you with offices around the globe. First the virus: two factors that are important to look at are how easy does a virus spread from person to person and how bad is the illness that is caused by the virus. Secondly, the population: you must factor in the characteristics of the population that is being affected. Do they have a high percentage of chronic disease or are they malnourished, etc. Finally, the community: how well can a community fight the illness and bounce back. Does a community have a good public health system that can put community measures in place to slow the spread of disease. Are there intensive care beds to care for the severely ill. Does the community have access to adequate anti-viral medications, personal protective equipment, etc. These three factors go into the equation that makes up severity of a disease.   When you are assessing the impact of a disease on your company, you must take these severity factors into account. When you are designing triggers for your Pandemic plan, these factors should go into the decision points you use to decide which trigger to activate. As you can see, this is more involved than just tying your plan to WHO Pandemic Phases. We continue to recommend to our clients that they uncouple their Pandemic plans from WHO Pandemic Phases and instead develop triggers.         ADVICE: Take the time over the summer to continue maturing your plan. Use this time before the next flu season to work on your seasonal and H1N1 (swine) flu plans. Don't forget to communicate with your Southern Hemisphere employees. Make sure that they are aware that you are closely following the progress on of disease. Even though influenza may wane in the Northern Hemisphere, it is just beginning in the Southern Hemisphere.    If you have not already done so, develop triggers that activate different parts of your plan. Build severity factors into the trigger activation criteria that you associate with your triggers. Involve your medical director in this process. If you don't have a medical director, we can serve as your medical director via our Virtual Medical Director program. Email me for more information on this program.   If you have a trigger based plan already, review the triggers and associated decision points with your executive leadership to ensure a thorough understanding of the decisions that need to be made during a pandemic.   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       MedPrep Consulting Group is internationally recognized as a leader in pandemic, disaster and business continuity planning, training and exercising. We have resources and expertise that you can count on. Ask us about our Virtual Medical Director Program.   Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com   Stuart Weiss, MD, CBCP MedPrep Consulting Group LLC

Influenza Update #18 - H1N1-(swine)

MedPrep Consulting Group LLC Dr. Stuart B. Weiss  IMPORTANT INFLUENZA UPDATE #18 WHO PANDEMIC ALERT LEVEL 5 MAY 11, 2009   Public Daily Brief Call: No call today   SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com   As expected, numbers rise around the globe. H1N1 (swine) virus spreads in the southern hemisphere.   U.S. reports 3rd death Cases in the U.S. continue to rise as expected since the U.S. is not thought to have reached its peak yet. As the global numbers rise as well, we are seeing virus activity in more countries in the southern hemisphere as that area begins its flu season.   CURRENT SITUATION: The WHO is reporting that there are now 4379 confirmed cases of H1N1 (swine) in 29 countries around the world (up from 2384 in 24 countries on Friday). Confirmed cases have appeared in Australia, Japan and China.  In South America, there are now cases confirmed in Columbia, Brazil and Argentina. Cases are also confirmed in New Zealand and Australia. In the U.S. the CDC announced that there are now 2532 confirmed cases in 43 states plus Washington D.C.. The only states without confirmed cases are AK, AR, MS, MT, ND, WV, WY. The U.S. had its third death attributed to H1N1 (swine) in a man in his 30's with underlying medical problems. Canada reported 284 confirmed cases. Canada reported its first death attributed to H1N1 (swine) in a woman in her 30"s with underlying medial problems. The vast majority of H1N1 (swine) cases continue to be mild influenza illnesses in young people who recover uneventfully. 90% of Americans report having fever, 84% cough, 61% have a sore throat. These are all typical seasonal flu symptoms. In addition, about 25% report gastrointestinal symptoms such as vomiting or diarrhea which are not typical of seasonal flu. HOUSEKEEPING ITEM:  If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to alert@MedPrepGroup.com       ANALYSIS:    Please remember to send me your "Lessons Learned". We are compiling the responses.   As expected, the numbers of confirmed cases has risen over the weekend. This virus seems to be spreading slightly more easily than seasonal flu. In addition, we have seen more deaths attributed to H1N1 (swine). As we see more cases, expect to see more deaths. So far, all three deaths in the U.S. involved people with underlying medical problems.   The WHO so far has kept the Pandemic Phase at 5 although as we have been saying, that could change at any moment. Spain is now reporting 93 confirmed cases. The UK has 39 and France has 12. The remainder of countries have less than 10 cases. Eventually, the WHO will raise the Phase level to 6.   There was alot of discussion late last week about H1N1 (swine) mixing with H5N1 (avian) virus in Southeast Asia or the Middle East. That is one of the nightmare scenarios. If H1N1 (swine) with its easy transmitability mixes with H5N1 (avian) with its high mortality and a new virus emerges that has both characteristics, we are in for a bad time. This speculation was reported in the media last week and made for interesting reading however, there is no way to know how likely that is to occur. H5N1 (avian) has been circulating in areas with seasonal H1N1 for years without sharing genetic material. So who knows? Mother Nature holds all the cards and makes all the rules at this point. We must continue to monitor the situation closely.     ADVICE: Take the time over the summer to continue maturing your plan. Use this time before the next flu season to work on your seasonal and H1N1 (swine) flu plans.  Use the "teachable moment" to educate your employees. In public health, we have few "teachable moments" where people are focused on public health issues. This is one of those moments so use it wisely. Teach your employees about cough/sneeze etiquette and hand hygiene. You will look like a hero this fall/winter when your efforts reduce absenteeism from seasonal flu.   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       MedPrep Consulting Group is internationally recognized as a leader in pandemic, disaster and business continuity planning, training and exercising. We have resources and expertise that you can count on.   Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com   Stuart Weiss, MD, CBCP MedPrep Consulting Group LLC

Influenza Update #17 - H1N1-(swine)

MedPrep Consulting Group LLC Dr. Stuart B. Weiss  IMPORTANT INFLUENZA UPDATE #17 WHO PANDEMIC ALERT LEVEL 5 MAY 8, 2009   Public Daily Brief Call: Today at 1:00PM Dial-in number: 1-866-315-9606 (no pin required)   SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com   U.S. case numbers have still not peaked and global numbers continue to rise.  With Spain now at 81 confirmed cases, is WHO Pandemic Phase 6 far behind? Cases in the U.S. continue to rise as expected since the U.S. is not thought to have reached its peak yet. With global numbers rising and Spain reporting 81 confirmed cases, we may still have a global pandemic before things quiet down for the summer.   CURRENT SITUATION: The WHO is reporting that there are 2384 confirmed cases of H1N1 (swine) in 24 countries around the world with 2 deaths. This is a 25% increase in a 24 hour period.  In the U.S. the CDC announced that there are now 896 confirmed cases in 41 states. The only states without confirmed cases are AK, AR, MS, MT, ND, SD, VT, WV, WY. Mexico lowered its national swine flu alert from Orange (elevated) to Yellow (medium) as schools and businesses across the country reopened. The number of confirmed cases rose to 1112 with 42 deaths Canada reported 201 confirmed cases. The vast majority of H1N1 (swine) cases continue to be mild influenza illnesses in young people who recover uneventfully. The average age of hospitalized patients in the U.S. is 15 years. Vaccine decisions were in the news again today as CDC and other government officials decide what type and what quantity of H1N1 (swine) vaccine to order for next fall. There were some suggestions that the swine flu vaccine may require an additional two shots above the one seasonal flu shot. A Gallup poll reported that 46% of people would get the extra "swine flu" shot and 52% would not. HOUSEKEEPING ITEM:  We create ALERTS in a timely fashion that reflects the urgency of an evolving public health crisis. If the situation in the U.S. continues to stabilize as expected, we anticipate that the ALERTS will be needed less frequently. We will continue to closely follow news and developments throughout the spring and summer months and will publish ALERTS as needed.   This coming weekend, unless required by new developments, there will be no ALERTS published and we will resume daily ALERTS on Monday.     ANALYSIS:    Thank you to all the people who sent in "Lessons Learned". As requested yesterday, please take a moment and send me some thoughts about what you learned in the past two weeks. We will aggregate and de-identify the lessons and make them available to everyone.   There was much attention paid to vaccines over the past few days. Why is that so important? Its important because the CDC and WHO only get one chance at getting this right. It takes months to create and manufacture vaccine and it is expensive and they have to decide now. It is a hard decision on whether to spend billions on a vaccine that might not be needed if the virus fizzles out versus not having a vaccine if H1N1 (swine) comes back with a vengeance next fall. Also, since there is only a finite amount of vaccine manufacturing capacity in the world, making H1N1 (swine ) vaccine takes away from making seasonal flu vaccine. On top of that is the suggestion that people may require two doses of H1N1 (swine) vaccine in addition to the one seasonal shot. I'm not sure how many people would sign up or follow through with a three shot series. These are the tough vaccine questions that will be decided over the next week.   Its also important to remind you that the WHO may end up raising the Pandemic Phase to 6 in the next week or two signaling that a pandemic is upon us. Remember that this only refers to how widespread a virus is. There will be new headlines and increased governmental activity in some parts of the world. It may require you to adjust some company policies if you have offices or employees in countries outside of North America.    I wanted to mention a few more lessons learned that we have noticed: Governments may take extreme actions during the early part of a disease outbreak and then back off. In the early days of an outbreak when data is not fully available or understood, you will see governments take whatever measures they think are necessary to protect the public. This may be extreme such as the case was in Mexico where the entire country was essentially shutdown and then slowly reopened days later. Or as was in the U.S. where schools were initially shut after a single case and now those recommendations have been relaxed. Different governments will look at the same situation and take drastically different measures. We saw this with some countries closing their borders to Mexican citizens or banning pork products from the U.S. and Mexico. These measures are completely unnecessary yet they are still in effect in some places. Communication to employees is essential. Many of our clients found that efficiently communicating changing travel, attendance and other H.R. policies as well as good hand hygiene and cough/sneeze etiquette to their employees in a timely fashion was much more important than they had imagined. Sometimes local health recommendations differ from CDC recommendations. Some clients found that there was disagreement between what the CDC was recommending and what their local health department was recommending. The bottom line is that the local health department (or the State health department) usually has the final say so make sure you know what they are saying and develop a good relationship with your local health officer now. ADVICE: Continue maturing your plan. Take this opportunity to fill in the gaps in your pandemic plan and then validate your plans through external audits, drills, exercises, etc. Avoid letting the decreasing media attention decrease your pandemic preparedness efforts. We don't know what will happen next fall. 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 or send an email to ALERTS@MEDPREPGROUP.COM       MedPrep Consulting Group is internationally recognized as a leader in pandemic, disaster and business continuity planning, training and exercising. We have resources and expertise that you can count on.   Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com   Stuart Weiss, MD, CBCP MedPrep Consulting Group LLC