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Thursday, May 14, 2009

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
 
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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: 
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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
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