Influenza Update H1N1-(swine)

MedPrep Consulting Group LLC Dr. Stuart B. Weiss   INFLUENZA UPDATE WHO PANDEMIC ALERT LEVEL 6 June 26, 2009   SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com So what's going on in the Southern Hemisphere? The H1N1 (swine) flu season continues in the Southern Hemisphere where case numbers continue to rise however, flu continues to spread in the Northern Hemisphere as well.    Current Situation: The WHO reports 55,867 confirmed cases in 109 countries. Remember, in countries with large outbreaks, the absolute number of cases is less important than the disease outbreak pattern. In many parts of the world, there is insufficient public health infrastructure to accurately test or count new cases. Leaders in case counts in the Southern Hemisphere are: Australia, Chile and Argentina with 421 new cases in Australia and 203 new cases in Argentina in the past two days. On Thursday, the CDC posted new interim guidance for businesses. It outlines guidance for preventing flu in "low risk" employees (i.e. office employees) You can find this guidance at: http://www.cdc.gov/h1n1flu/guidance/workplace.htm Spread within U.S. summer camps has caused several to close already and has raised concerns of outbreaks this summer at camps. Egyptian health authorities warn pilgrims to Mecca (Saudi Arabia) of the dangers posed by H1N1 (swine) and suggest that pilgrims will be quarantined upon return. There are issues in China with travelers showing even a minor elevation in temperature being quarantined in less than hospitable locations.   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 Influenza falling out of the media throughout most of the U.S.. its easy to forget that it is spreading and causing concern through much of the world. As expected, the number of cases in the Southern Hemisphere has continued to rise however the number of cases in other parts of the world also continues to rise. Its an interesting pattern. We continue to have cases in the U.S. and the CDC reported recently that 99% of the cases of influenza-like illness are now caused by the new flu virus. As expected, seasonal flu has died way down, but the H1N1 (Swine) continues.   As discussed earlier there are a couple of possible scenarios for the fall. I'd like to go over them again since I was asked about them on a recent conference call. The first scenario is that the H1N1 (swine) doesn't change much but returns with increased circulation next fall, at the same time that seasonal flu begins to circulate again. Since the two viruses seem to affect different populations and having one doesn't seem to protect you from the other, we may see the two become additive. H1N1 (seasonal) affecting infants and older people and H1N1 (swine) affecting young adults. That could lead to a really bad flu season with twice as many deaths and hospitalizations. This would completely overwhelm our healthcare system and lead to significant increase in employee absenteeism. The second scenario is that the H1N1 (swine) acquires Tamiflu resistance from the H1N1 (seasonal) virus and comes back but now we can't treat it as easily. That would lead to more deaths and a still worse flu season. The last scenario is the really bad one where the H1N1 (swine) mixes with Avian H5N1 and gains its lethality. This is least likely due to several missing factors in the H1N1 (swine) virus but if it happened, it would lead to a highly lethal rapidly spreading virus.   Regardless of which scenario occurs, we will have disruptions this coming fall. It would be wise to plan over the summer for worker absenteeism. You can be certain that if H1N1 (swine) affects children and causes deaths, parents will be quick to keep their children home from school. In the early days of the H1N1 (swine) outbreak, back in May, one bank on Texas reported to us that they had up to a 70% absenteeism rate due to schools being closed.   So don't take your eye off this dark cloud on the horizon. We will continue to help you follow this evolution over the summer.       ADVICE: 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.  Communicate with your southern offices. If you have offices or employees in the Southern Hemisphere it is very important to communicate with them. They are going through the worry and stress over H1N1 (swine) that we went through in May. Share with them strategies to prevent the spread of illness (hand hygiene, cough/sneeze etiquette, social distancing, etc.). Let them know that you are concerned about their wellbeing and are following the situation. Communicate with Employees traveling to China and parts of the Middle East. We have seen reports that China is screening travelers and quarantining people with even minor elevations of temperature in location lacking clean food and water. There are also reports of other countries that are also screening travelers and mandating quarantine. Continue your planning efforts. Over the summer, you should be planning for continuity of operations during a significant employee shortage and with interruptions in supply chain. Even if flu just comes back in its current form with two strain circulating simultaneously, it will be a bad flu season and we will have interruptions. Take time to look at HR policies on sick time and return to work. Look at how you will handle employees that come to work sick or are exposed to sick workers. There is some CDC guidance on this or you can contact us for assistance. Take time to figure out how you will implement social distancing and hand hygiene. Think about your cleaning needs. Revise your triggers for your trigger based action plan. If you have linked your plan activation to WHO phases, it is time to uncouple those plans and design new triggers. Be certain that your triggers take into account information not only on the disease but also on community resilience, corporate resilience and corporate impact. We have developed a formula for htis which I will write more about in the next Influenza Update. Develop a trusted source for important medical information and analysis. If you have a corporate medical director, include them in the planning process. If you do not have this resource in-house, find someone now that you can call on. We can serve as your Virtual Medical Director if you wish. See below for information.   Virtual Medical Director If you don't have a corporate medical director, we'll 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

H1N1 Influenza Update #26

MedPrep Consulting Group LLC Dr. Stuart B. Weiss INFLUENZA UPDATE #26 WHO PANDEMIC ALERT LEVEL 6 June 9, 2009 SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com WHO Raises Pandemic Alert to 6 (Pandemic Phase) The WHO has just raised the Pandemic Phase level to 6 indicating a global Pandemic is occurring. This has been expected since the spread of illness in Australia has been on the community level. . Analysis: Remember, this change only relates to the amount of spread of the new H1N1 (swine) virus and not to the severity. Dr. Margaret Chan, the Secretary General of the WHO, emphasized that we do not know how this virus will behave in the developing world. She also stressed that countries must prepare for additional waves of influenza in countries as this pandemic runs its course. Advice: Brief your executives to this change and its meaning Continue to refine your plans over the summer time in the Northern Hemisphere. Develop a new decision matrix based on a combination of factors including spread, severity, corporate impact, threat, human behaviors and other factors Refine your trigger based action plan with the new assumption that there may be limited to no advance warning before the virus arrives at your doorstep. Virtual Medical Director Program: If you don't have a corporate medical director, we'll 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

H1N1 Influenza Update #25 (B) - WHO Info

MedPrep Consulting Group LLC Dr. Stuart B. Weiss INFLUENZA UPDATE #25 (B) WHO PANDEMIC ALERT LEVEL 5 June 9, 2009 SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com WHO Update I know you recently received an update but today's WHO press briefing was very interesting and yielded some new information. The press briefing was held with Dr. Keiji Fukuda, the WHO Asst. Director General for Health Safety and Environment. The two points he made were: Changing Pandemic Phase Definitions: The decision was made to stay with the current Pandemic Phase definitions but to augment any announcements on phase changes with additional information on severity and how countries should tailor their responses. Moving the Phase 6: Today Dr. Fukuda said that the WHO is "very close" to declaring a Pandemic (Phase 6) due to activity in Australia. In Victoria, Australia, there are the expected outbreaks in schools and institutions and additional outbreaks in people who are not students or involved with the institutions. This signifies community level activity and meets the definition of a pandemic (sustained community level outbreaks in two WHO regions). 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: Don't be caught off guard when the WHO moves to Phase 6 in the next day or two. Remember that this doesn't mean anything about severity or worsening of the disease in any way. It just speaks to spread, which was the original intent of the pandemic phases in the first place. With that said, watch for unexpected reactions by some governments around the globe. ADVICE: Brief your executives on what a move to Phase 6 would mean for your company. Virtual Medical Director Program: If you don't have a corporate medical director, we'll 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 #25 - H1N1-(swine)

MedPrep Consulting Group LLC Dr. Stuart B. Weiss INFLUENZA UPDATE #25 WHO PANDEMIC ALERT LEVEL 5 June 9, 2009 SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com It ain't over yet! Even though some folks in North America are relaxing and we now have a Lessons Learned report from the Trust for America's Health, things are still heating up in other parts of the world. Current Situation: The WHO reported 25,288 confirmed cases in 73 countries. Remember, in countries with large outbreaks, the absolute number of cases is less important than the disease outbreak pattern. In many parts of the world, there is insufficient public health infrastructure to accurately test or count new cases. In the U.S., there are 13,217 probable or confirmed cases with 27 deaths in all 50 states plus the District of Columbia and Puerto Rico. Australia continues to lead the pack with the most cases outside of North America. The case count continues to grow at a rapid pace. A prominent infectious disease specialist estimated that were were many more unconfirmed cases India reported its first confirmed case in New Delhi and reports a total of 10 cases across the country (see analysis below). India also reported that two travelers to Hyderabad are in isolation with confirmed H1N1 flu. Cases numbers continue to grow in South America. Chile is up to 411 cases, Argentina reports 202 cases. There are also smaller numbers of cases in other South American countries. The Trust for America's Health published a lessons learned report last week. You can read it at: http://healthyamericans.org/report/64/pandemic-flu-frontlines 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: Lessons Learned reports are typically published after an event has resolved when folks have a chance to relax and reflect on what occurred. So when the Trust for America's Health (TFAH) report came out, we heard a sigh of relief from some planners. Things must be resolving, they said, I don't see H1N1 in the media and now we have lessons learned. Its an easy trap to fall into. The key to being ready for whatever our fall flu season looks like is to use this outbreak as a dry run. We must learn as much as we can and use that knowledge to improve our preparedness for the fall. The TFAH report had some good points in it. There are ten lessons and ten gaps: The lessons are straightforward and should not come as a surprise to any of you: Investments in pandemic planning and stockpiling antiviral medications paid off Public Health departments did not have enough resources Response plans must be adaptable and science-driven Providing clear, straightforward information to the public was essential School closings have major ramifications for students, parents and employers Sick leave and policies for limiting mass gatherings were problematic Even with a mild outbreak, the healthcare system was overwhelmed Communication between public health and health providers was not well coordinated WHO pandemic alert phases caused confusion International coordination was more complicated than expected The gaps include core areas that must be addressed to improve U.S. preparedness: Maintain the Strategic National Stockpile of antiviral medications Enhance vaccine development and production capability Ensure that all Americans could be vaccinated in a short period of time Improve planning and coordination Improve strategies for school closings, sick leave and community mitigation Global coordination - build trust, technologies, and policies internationally to encourage science-based, consistent decision making Provide enough funding for on-the-ground response Stop health department layoffs Improve healthcare system surge capacity Ensure that all Americans will receive care during an emergency There was also discussion this week about increasing swine surveillance. Previously, almost all resources were directed to monitoring bird populations for avian influenza. Very few programs monitored pigs for influenza and most swine farmers ignore influenza outbreaks since it doesn't usually cause significant illness in pigs. As I have written about previously, pigs serve as a great mixing vessel for viruses so more surveillance will be a good thing. This disease continues to be a disease of young people. 60% of cases and 42% of hospitalized cases are in people 5-24 years old. With this pattern, even if the virus doesn't become more lethal when it returns in the fall, it may still cause significant impact in businesses as parent stay home to care for sick kids or young employees in their early twenties become ill. Lastly, a comment about the numbers coming in from countries around the world. People seem to be erroneously putting much emphasis on these case numbers. Remember, in Australia, which is a main WHO collaborating center for Flu, it was estimated that for every one confirmed case, there are between 2-10 unconfirmed cases. In the U.K, the estimates are at least 2x as many cases as are confimred. Now apply that to a country like India. We recently did work in Mumbai where 60% of the city's population live in slums without electricity, running water or health care. Its difficult to imagine that public health officials would have any idea of what is actually going on with flu cases. Its a similar case in many countries with gaps in their public health infrastructure. So remember to look at disease patterns and not just case numbers to follow this outbreak. ADVICE: Practice Employee Protection Strategies over the summer. Use this time to practice good social distancing and hand hygiene. Try a "Social Distancing" day in which employees do not shake each others hand, or don't come closer than 6 feet to each other. Its actually harder than it seems. Another idea is to teach employees to clean their workspaces. One company has developed a strategy called "Wipedown Wednesdays" in which cleaning supplies are available each Wednesday for employees to clean their workspaces. Remember, the three germiest areas of your workspace are usually your phone, keyboard and mouse. 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. Arrange for a medical advisor before next flu season. Regardless of how H1N1 (swine) evolves, it will be back in the fall. You will need to make medical decisions on how best to protect your employees and keep your business going. Involve your medical director in your planning efforts. If you don't have a medical director, sign up for our Virtual Medical Director Program and we'll be your medical director. Continue your planning efforts. I know I keep repeating this but now is the time to write missing policies, test plans, run exercises. Consider this H1N1 (swine) outbreak as a dry run for a worse fall flu season. Virtual Medical Director Program: If you don't have a corporate medical director, we'll 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 #24 - H1N1-(swine)

MedPrep Consulting Group LLC Dr. Stuart B. Weiss   INFLUENZA UPDATE #24 WHO PANDEMIC ALERT LEVEL 5 June 1, 2009   SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com So what's going on in the Southern Hemisphere? As flu season gets underway in the Southern Hemisphere, things heat up in Australia and South America. Will this push the WHO to declare a pandemic?    Current Situation: The WHO reported 17410 confirmed cases in 62 countries. Remember, in countries with large outbreaks, the absolute number of cases is less important than the disease outbreak pattern. In many parts of the world, there is insufficient public health infrastructure to accurately test or count new cases. In the U.S., there are 10,053 probable or confirmed cases with 17 deaths in all 50 states plus the District of Columbia. On Saturday, the CDC posted new interim guidance for businesses. You can find this guidance at: http://www.cdc.gov/h1n1flu/guidance/workplace.htm The number of cases in Australia has risen significantly and now doubles about every two days. The head of public health at the University of New South Wales said that the virus has clearly gained a foothold in Australia and is spreading through various communities. It was estimated that fro every confirmed case in Australia, there are between 2-10 unconfirmed cases.  Cases numbers continue to grow in South America. Chile is up to 276 cases, Argentina reported 35 new cases over the weekend for a total of 115. There are also new cases in Brazil and Peru. 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 Influenza falling out of the media throughout most of the U.S. and with numbers of new cases slowing down across much of the country, its easy to take your eye off this ball. That would be a mistake. This is a new virus that is just now entering into its favorite season in the Southern Hemisphere, namely winter. With that in mind, it is not unexpected that cases in Australia would double every 2 days or that cases in South America would continue to climb. It will be important to follow the evolution of this virus over our summer to anticipate what our next flu season will look like. Most flu experts expect this strain to play a major role in next winter's flu season. So the unanswered question remains......will it turn more deadly or stay the same. At this point, nobody knows. We must also remember that for people with underlying medical problems or pregnant women, the current form of the H1N1 (swine) virus can cause serious illness. So don't take your eye off this dark cloud on the horizon. We will continue to help you follow this evolution over the summer.       ADVICE: 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.  Arrange for a medical advisor before next flu season. Regardless of how H1N1 (swine) evolves, it will be back in the fall. You will need to make medical decisions on how best to protect your employees and keep your business going. Involve your medical director in your planning efforts. If you don't have a medical director, sign up for our Virtual Medical Director Program and we'll be your medical director. Continue your planning efforts. I know I keep repeating this but now is the time to write missing policies, test plans, run exercises. Consider this H1N1 (swine) outbreak as a dry run for a worse fall flu season.   Virtual Medical Director Program:   If you don't have a corporate medical director, we'll 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