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