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