| 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 | | | | | 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. - 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 | | | | |
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