Influenza Update #16 - H1N1-(swine)

MedPrep Consulting Group LLC Dr. Stuart B. Weiss IMPORTANT INFLUENZA UPDATE #16 WHO PANDEMIC ALERT LEVEL 5 MAY 7, 2009 Public Daily Brief Call: NEXT CALL FRIDAY, MAY 8 SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com CDC moves further down the road towards a H1N1 (swine) vaccine as world numbers climb. Two new cases of H5N1 (avian) influenza announced. As expected, the numbers of probable and confirmed H1N1 (swine) flu cases have bumped up as states now work through the backlog of samples in their labs. CURRENT SITUATION: The WHO did not yet release an update this morning. Reuters is reporting that the number of confirmed cases increased from 1516 people in 22 countries to close to 2000 people in 24 countries around the world. In the U.S. the CDC announced that there are now 1500 probable and confirmed cases in 44 states. This is made up of about 850 suspected cases and almost 650 confirmed cases. They also said that all states now have testing kits that will allow them to confirm H1N1 (swine) cases. Mexico continues to report a marked drop in the number of people presenting to hospitals with flu-like illness. At the same time, health officials announced an increased in the number of deaths caused by H1N1 (swine) to 42 and the number of confirmed cases to 1070 resulting from testing of the backlog of specimens in their labs. The vast majority of H1N1 (swine) cases continue to be mild influenza illness which people recover from uneventfully Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases said that the CDC is moving down the path towards vaccine development by developing vaccine "seed" samples that can be used to manufacture vaccine. The next steps will be to run clinical trials to verify safety, efficacy and correct dosage (amount and required number of shots). The WHO will hold a vaccine expert committee meeting on May 14th to make recommendations to vaccine manufacturers. Cases in Europe continue to rise. Poland and Sweden reported cases Not a single case has been identified in Africa raising some concerns that many parts of Africa may lack the ability to detect this virus. The WHO reported two new confirmed cases of H5N1 (avian) flu. One case in Egypt in a 34 year old woman and one case in Vietnam in a 23 year old woman. Egypt has had 68 cases with 23 fatalities, Vietnam has had 111 cases with 56 fatalities. Overall, H5N1 (avian) has caused illness in 423 people with 258 deaths (a 61% mortality rate). HOUSEKEEPING ITEM: If you receive this alert indirectly through a mailing list or from a friend or colleague please take a moment and sign up to receive it directly from us by clicking on the button at the bottom of this alert or by sending an email to alert@MedPrepGroup.com with the word signup in the subject. ANALYSIS: I thought today we could take a moment and start to reflect on some of the items that we have learned so far from this outbreak. I'll go through some today and more tomorrow. There was no lead time to prepare. Many planners included the assumption that we would have 6 weeks of notice before a pandemic reached the U.S.. This was based on a pandemic virus emerging in a different part of the world. As we have seen with H1N1 (swine), an efficiently spreading virus can move through the modern day world in a matter of days no matter where it originates. WHO Phases changed much faster than anticipated. Many planners have included a long time period between WHO Phase changes. We have seen this in many plans that we have audited. Actions are taken too late in the plan. We often end up recommending that many actions in a plan be moved to earlier phases because during a public health crisis, things can move very quickly. Uncouple your plans from WHO Phases. It is important to include the WHO Phases or perhaps US Government stages as part of the triggers in your plan but you must remember that they only speak to how widespread a virus is. You must also base your triggers on the impact of a new disease on your business by incorporating the severity or lethality of an outbreak. A simplified formula to remember is Impact = severity x spread (plus some other factors). So build that into your plan triggers. We won't know many details about spread and severity at the beginning of an outbreak. Outbreaks are evolving changing events. At the beginning of an epidemiological investigation of a new outbreak, some of the information is confusing or uncertain or wrong. It takes time to sort things out. ADVICE: Review criteria for returning to normal operations in the U.S. If the disease pattern continues unchanged, companies may consider returning to normal operations in the U.S.. You should be reviewing your de-escalation procedures. It may not yet be time to fully implement that part of your plan (depending on several factors, i.e.where you are located, etc.) but it is certainly time to look at that. This virus is spreading and causing disease similar to seasonal flu. You may consider following whatever policies you follow at the height of flu season. This should include encouraging employees to stay home if they feel sick and to follow good hand hygiene and cough/sneeze etiquette. We should know much more over the next week about the trends in this disease to help you make the decision to return to normal operations. 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. CORRECTIONS: I have two clarifications/corrections to make and I thank the readers who pointed these out to me. The 1957 and 1968 pandemic viruses are thought to be the result of recombination. The 1918 virus is thought to have adapted directly from an avian virus and jumped to humans On the Daily Brief call yesterday we spoke about the U.S. Government stages. While it is easy to find the definitions of the stages, I cannot find the current stage listed anywhere on the CDC, HHS or DHS websites. In addition, I did not hear anyone from the CDC mention the stages on the briefing calls I have been on. If there is a place that lists the current U.S. stage, please send it to me. MedPrep Consulting Group is internationally recognized as a leader in pandemic, disaster and business continuity planning, training and exercising. Let us know if you need help reviewing your plans, designing educational posters, writing FAQ's (frequently asked questions) or policies, etc.. We have resources and expertise that you can count on. 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, disaster and business continuity planning, training and exercising needs. Drop me a note if you want more information about us. Stuart Weiss, MD, CBCP MedPrep Consulting Group LLC