Influenza Update - Sept 23rd

Novel Influenza H1N1 Update  Dr. Stuart B. Weiss   INFLUENZA UPDATE WHO PANDEMIC ALERT LEVEL 6 Sept 23, 2009   SUBSCRIBE: Click button at bottom or send email to: sweiss@MedPrepGroup.com Most cases of Flu are mild, but should you let your guard down? I don't think so and I'll tell you why.   CIDRAP Pandemic Conference Attendees: To those of you who I had the pleasure of meeting, thanks for coming up to me and introducing yourself. A key point from the CIDRAP Pandemic conference is that influenza viruses are notoriously unpredictable. It is way too early to assume that the current mild trend that we have been seeing will continue.    Current Situation: Outbreaks on college campuses and in schools across the country continue to be widespread. Most cases continue to be mild Vaccine Update: New data points to good immune response to a single vaccination for children 10 years and older. Two shots will still be needed in children less than 10 The U.S. government has increased its vaccine order to 250 million doses and expects the first shipments in a few weeks. The first vaccine to ship will be Medimmune's nasal spray vaccine. By the end of October, the government hopes to have 60-70 million doses shipped. The initial doses will be shipped from manufacturers to the Federal Government who will then distribute it to state health departments. The states will then organize vaccination of the high priority groups. Masks: A new study done in China was presented at a microbiology conference last week. This study showed that N-95 type masks (respirators) provided up to 75% reduction in the risk of catching the flu in healthcare workers while the surgical mask showed no reduction in the risk of catching the flu. The study also found that fit testing did not make much of a difference in the effectiveness of N95 masks. The full study is not yet released so these are preliminary results and should not be used to make policy decisions until the full study is out. There have been some suggestions that there may be problems in the way the study was conducted but these results are interesting. The CDC expects to release updated mask guidance within the next week or two. Health Care Systems Margaret Chan, the Secretary General of the WHO, stated her concern about ICU's being overwhelmed. A surge of patients requiring prolonged ICU care in the southern hemisphere during their flu season was a major problem for healthcare systems. Some hospital systems are already seeing a marked increase in children presenting with flu-like illness. Dell Children's Hospital in Austin, Texas has taken to setting up treatment tents outside to handle the surge of children into their pediatric ED. The CDC is expected to release guidance soon that amends the recommendation for healthcare workers to allow them to return to work once they are fever free for 24 hours without fever reducing medicine. This brings this recommendation in line with non-healthcare worker recommendations. The current recommendation for 7 days for healthcare workers remains in place at this time. Tele-work Program and Corporate IT Security It turns out that the biggest risk to your corporate IT network security from a robust work-from-home program may be from your kids and not some criminal element in North Korea. At the Telework session at the CIDRAP conference, it was discussed that 80-90 percent of corporate IT intrusions are from insiders. Imagine what would happen if bored kids are left in a room with your laptop while you are cooking or shopping. How many would go exploring to see how far they could get inside your corporate network?   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 me at sweiss@MedPrepGroup.com       ANALYSIS:    Its good that vaccine shipments will begin shortly. However, take a good look at the priority groups for the initial doses of vaccine. You will not see the majority of your employees on that list. Even optimistically when there are 60-70 million doses available at the end of October, the vast majority will go to high risk people and healthcare workers. And even if some of your employees do get the shot, it takes about 2 weeks to have a good immune response. So we are talking about mid-November before you will start seeing vaccine protection. Most of you will probably not see significant protection of employees until December. So, if you were depending on the vaccine to take care of your pandemic troubles, you need to reconsider.   I have received some questions about live vaccine vs. killed vaccine. While there are some important differences for people with immune problems and other medical conditions, most young healthy people can receive either type of vaccine without concern. You will need to ask your healthcare provider about this. The nasal flu vaccine spray uses a live markedly weakened virus while the usual shot in the arm vaccine uses a killed virus. I also received some questions about boosting one's immune system and about Vitamin D. While there have been some folks discussing the role of Vitamin D in our immune system, there is no conclusive evidence that Vitamin D will protect you from the flu or make your illness less severe (I know I will receive email on this). There was audience polling conducted at the CIDRAP conference that was not completely scientific but was interesting. Here are some highlights of the polling: Front Door Screening: 28% plan to conduct it, 49% no, 17% considering it Peak percentage of worker absenteeism being planned for during the upcoming flu season: 36% planning for a range of scenarios, 21% planning for 21-30% absenteeism, 13% for 11-20%, 12% for 31-40%, 5% for 0 - 10%, 13% didn't know How many had customers call to ask about ability to provide goods/services during a pandemic: 22% said 0, 15% said 1-5, 1% said 6-10, 23% said 10 and 40% didn't know Did they have defined trigger points for their pandemic plan: 62% yes, 32% no, 6% didn't know What were trigger points based on: 12% said WHO, 9% said CDC pandemic severity scale, 9% said "government authority", 7% said company wide absenteeism, 17% said site specific absenteeism, 8% said security, 20% said other (some of these may have been DC3 - see below) In the H.R. sessions, there was much discussion about pay policies, sending sick employees home, FMLA, HIPPA, EEOC, ADA, Fair Labor Standards Act, and a host of other regulations. I will discuss these in upcoming Business Alerts. One key point involved FMLA. The CDC has been asking employers to not require physician visits in order to return to work after an illness. However, for an illness to be covered under FMLA, it must be a serious health condition involving either hospitalization or ongoing care by a health care provider, thus requiring a physician visit. When the Department of Labor representative was questioned about this, she just acknowledged that this was an inconsistency but did not offer any solutions. Although the employer may waive the documentation under FMLA, they cannot waive the other requirements of FMLA. I am certainly not a lawyer and you need to check with your H.R. folks but this just points to the fact that you should spend some time reviewing your H.R. policies and how they would relate to people who are home sick, people who are home taking care of sick family member, people home watching children and people who stay home from work due to fear, etc.. Another important point was about so called "no fault" absence policies. Some employers have a policies that assigns points to workers if they are late or miss work (even if they are sick) and mandates automatic termination if a certain amount of points are accrued. The recommendation was to consider suspending the accrual of points for H1N1 short term illnesses. The impact on a business should be small and the upside of avoiding grievances and potential lawsuits is big.     ADVICE: If you are depending on vaccine to answer all your pandemic concerns, rethink that strategy. Review your H.R. Policies considering the different reasons people may miss work. Decide if you will pay people who miss work and what acceptable reasons are to miss work. Try to create a culture of worker health that enables workers to make good choices and stay home if they are sick Educate your employees now on what they can do to reduce disease spread, on what to look for to make a choice to stay home from work and on high risk groups that need early protection. Look at your triggers. If you are part of the 50% that base their triggers on government scales or "other" you should immediately rethink that part of your plan. Ask me for a demo of our DC3 software which provides you with informed intelligent triggers. Stay informed. Find a good source of information and follow the course of this virus over the next few months. If you find yourself desperately trying to catch up with pandemic planning for your company, call us. We can help bring you up to speed quickly. Look at our tools listed below.   TOOLS: Virtual Medical Director - If you don't have a corporate medical director, our Virtual Medical Director program may be a good solution for you. 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. We have affordable decision support plans that you can enroll in.   DC3 Expert Trigger Assessment and Readiness Analysis tool will be available next week. This software replaces the old non-helpful WHO Pandemic phases and will analyze your current H1N1 situation from several key perspectives and give you intelligent Organizational Levels to link your trigger based action plan to. DC3 incorporates expert medical opinion that is updated regularly into the logic and will advise you on actions you should be taking and help you assess your readiness.    Global Disease Surveillance - MedPrep has teamed with a global surveillance company to provide geomapped specific surveillance for corporations who want site specific news and information. Through this system, we monitor over 30,000 information sources and provide you with intelligence and analysis on influenza and 259 other infectious diseases.   Pandemic Planning Assistance - We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jumpstart your planning or take a look at your current plans with a fresh set of eyes.         Not preparing now would be a serious mistake.       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 - Sept 15th

Novel Influenza H1N1 Update  Dr. Stuart B. Weiss   INFLUENZA UPDATE WHO PANDEMIC ALERT LEVEL 6 Sept 15, 2009   SUBSCRIBE: Click button at bottom or send email to: sweiss@MedPrepGroup.com More good news about the new influenza vaccine but bad news from the small business sector   DRJ Attendees: I am giving a 1 hour H1N1 update tonight (Tuesday) at 6:00 in Marina-5 room As we continue to monitor sources around the world, we continue to see rising flu cases. In some areas, the flu activity has already reached levels normally seen at the height of the flu season.    Current Situation: Schools and Universities continue to report increasing numbers of cases. The American College Health Association reported that for the week ending Sept 4th, there was a large increase in the number of cases (105% increase from the week before) and 170 new institutions joined the list of locations with suspected or confirmed cases. There is continued good news from vaccine manufacturers and government studies. The National Institutes of Health (NIH) vaccine studies as well as study results from Sanofi and Glaxo indicate that a single dose of vaccine produces good immune results in "non-elderly" adults. Studies are still underway in children and should be out in about two weeks. There is still a chance that children will require two doses of vaccine. Lastly, the government announced that vaccine may be released a week earlier than previously thought and the first doses will go to healthcare workers.  The CDC reported that from April 26 to August 29th, 47 children have died from laboratory confirmed H1N1 infection. This past week, Cornell University reported the death of a 20 year old student and three days ago, an 11 year old child died in Mesquite, Texas. A Harvard Business School study reported that 25% of businesses in their study do not offer paid sick leave, 65% do not offer paid time off to care for sick family members and 79% do not offer paid leave to care for children home fro school. These results are slightly improved from US Department of Labor statistics from several years ago that pointed to 48% of paid workers without paid sick leave. On a conference call for clinicians last week, the CDC spoke about revised guidance for treatment which stresses early treatment for people who are hospitalized even if flu is only suspected but not confirmed. In these cases, physicians should not wait for laboratory confirmation but should start Tamiflu or other antiviral treatment immediately. This should also be done in sick high risk persons including children less than 5, elderly adults, pregnant women and people under 19 years old on chronic aspirin therapy. On the conference call it was recommended that physicians also be very proactive with patients who have neuromuscular disease perhaps giving them a prescription in advance to be filled immediately if they have any symptoms of the flu. They also discouraged routine preventative use of antiviral medications at this time except in specific circumstances (healthcare workers without personal protective equipment, persons at high risk in households with a sick person). On a lighter note, civility may be a casualty of the new H1N1 flu. Last week, the French Health Ministry began recommending that "la bise", the French cheek to cheek little kiss that is used to say hello and goodbye, should be discouraged. And today, USA Today is reporting that the NCAA has suspended the mandatory pre and post match handshakes required in Volleyball matches (the other college sport with required handshakes is wrestling and no decision has been made there yet).   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 me at sweiss@MedPrepGroup.com       ANALYSIS:    Its good news that single dose vaccination is producing good immune results for several reasons. First, if only one dose of vaccine is necessary, more people can get the shot, there will be more to go around. Second, from a public health perspective, it is much easier to get people in for one shot than to get them in for a first shot and a second one 3 weeks later. This is especially true with young adult, college age people.   The rise in case numbers in some parts of the country to almost maximal levels normally seen only during the height of flu season is very concerning. This may lead to a severe strain on our healthcare system and much anxiety and concern within society.   One of the national experts on the behavioral aspects of disease, Steven Crimando, is part of our team. He often reminds business planners that the psychological effects of an event may greatly overshadow the effects caused by the actual disease. If we look back over past disasters with a disease or medical component, there can be hundreds of psychologically affected people for every one person actually affected by the illness. These psychologically affected people or "worried well" show up in emergency departments and utilize resources. Their bodies may be reacting to stress and producing symptoms similar to common flu symptoms (fatigue, not feeling well, diarrhea, chest tightness, etc.) Some of these people will be your employees so it is important to consider the psychological aspects of the pandemic when designing your pandemic plans. Steven is available to assist you in this area.   As the temperature continues to drop across the US and conditions favoring viral survival and spread continue to improve (influenza viruses survive longer in colder weather), we will continue to see increasing numbers of flu cases across the country. We will see large numbers of people getting sick and if the southern hemisphere gives us any clue, we will see disruptions in production and supply chains due to worker absenteeism. New models have been recently reported on worker absenteeism. The British have moved their estimate of worker absenteeism down to about 15%, folks at the CDC speak about 20-25%. We are recommending that businesses plan that 20% of their workforce will be absent for 3-5 days over the course of the next 6 months. That's a good starting place to do planning with the caveat that this number may rise or fall depending on what the virus does.     ADVICE: If you are a small business, you must do some pandemic planning or at least pandemic thinking now. Recent media reports suggest that large numbers of small businesses have done little to no pandemic planning. Small businesses with a single person in a critical job, and no redundancy, face significant issues if those critical people become ill and there has been no planning. Look at your H.R. policies and how you create a culture of worker health. Do you enable workers to make good choices and stay home if they are sick or do they get penalized for making a good choice? The statistics on paid sick time are not particularly encouraging in this area. It will serve you well to enable sick employees to choose to stay home and not come to work but this may require tough decisions that have financial impact. Pay attention to your high risk employees. Early data clearly links pregnancy, obesity and diabetes to severe illness and death. Focus employee education program on this high risk group. Plan for the psychological effects of this disease outbreak. Review your plans from this point of view. If you need assistance, we have experts in this area that can help. If you find yourself desperately trying to catch up with pandemic planning for your company, call us. We can help bring you up to speed quickly. Look at our tools listed below.   TOOLS: Virtual Medical Director - If you don't have a corporate medical director, our Virtual Medical Director program may be a good solution for you. 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. We have affordable decision support plans that you can enroll in.   DC3 Expert Trigger Assessment and Readiness Analysis tool will be available next week. This software replaces the old non-helpful WHO Pandemic phases and will analyze your current H1N1 situation from several key perspectives and give you intelligent Organizational Levels to link your trigger based action plan to. DC3 incorporates expert medical opinion that is updated regularly into the logic and will advise you on actions you should be taking and help you assess your readiness.    Global Disease Surveillance - MedPrep has teamed with a global surveillance company to provide geomapped specific surveillance for corporations who want site specific news and information. Through this system, we monitor over 30,000 information sources and provide you with intelligence and analysis on influenza and 259 other infectious diseases.   Pandemic Planning Assistance - We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jumpstart your planning or take a look at your current plans with a fresh set of eyes.         Not preparing now would be a serious mistake.       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 - Sept 7th

Novel Influenza H1N1 Update  Dr. Stuart B. Weiss   INFLUENZA UPDATE WHO PANDEMIC ALERT LEVEL 6 Sept 7, 2009   SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com Hang onto your hats....flu is here already! We monitor many information sources across the country and the world and we are getting clear reports that the flu is here and the number of cases is rising.    Current Situation: Since schools and universities have been opening for the school year, there have been many reports of children and young adults with influenza like illnesses. There have been reported cases of outbreaks or clusters over the past two weeks in 11 states. For example, in the State of Washington, reports indicate that as many as 2000 students at a university have reported influenza-like illness. There are also sporadic case reports of outbreaks in K-12 schools, especially in the southeast. Some emergency physicians are reporting seeing cases of flu-like illness in the emergency department. One physician in Texas wrote that a third of the patients he saw in the emergency department a few days ago had flu. Another physician from Massachusetts also is seeing patients already. The vast majority have routine symptoms of flu and do not require hospitalization. The CDC reported on Sept 4th that there is increased flu activity in the nation, especially in the southeastern states where many school districts resumed classes on August 10th. Vaccine for the new flu strain should be approved and available in the US in October. Early data from a study at Novartis showed that 80% of test volunteers had a good immune response after only 1 shot of their Celtura vaccine. China announced that it has approved a single dose vaccine made by Sinovac. The WHO reported that novel H1N1 influenza outbreaks in the southern hemisphere have started to wane. Looking back, most cases were mild but there were cases of severe viral pneumonia in previously healthy young people (similar to what was seen in April/May at the beginning of this pandemic) The WHO published a lessons learned briefing note on August 28th that summarizes the findings from the southern hemisphere (see below) Health Experts are predicting that up to 1/3 of the world's population (2 billion people) may contract this new flu.   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:    On August 28th, the WHO published a briefing note that summarized the findings from the experience in the southern hemisphere over the past few months. Here are their findings and our comments on what was observed: Novel H1N1 is the dominant virus strain in most parts of the world overtaking seasonal strains. There was not alot of co-circulation although there was some and we will have to monitor this closely in the northern hemisphere The virus has not mutated to a more lethal form and the overwhelming majority of sick people experience mild illness (that keeps them out of work for an average of 3-5 days -sw) Even if the disease stays mild, such large numbers of people are susceptible to the virus that it could still severely impact society. Healthcare systems may be overwhelmed by people requiring ICU care. For people who develop severe viral pneumonia, prolonged intensive care is required and in the US, we do not have a large reserve of ICU beds. Many hospitals function at close to capacity in their ICU's especially in the winter. In the southern hemisphere, for our healthcare clients, problems included ICU personnel shortages (due to illness), ventilator shortages, ECMO shortage (for treatment of ARDS), ICU capacity shortage. In addition, significant utilization of pediatric emergency departments was seen in April/May and should be anticipated this winter as well. Drug resistance to Tamiflu is not a problem so far. There have been sporadic cases reported but that is completely expected and very rare. Acquisition of Tamiflu resistance by sharing of genetic material between seasonal H1N1 (which is almost 100% Tamiflu resistant) and pandemic H1N1 has been a concern. One study in Ferrets suggested that novel H1N1 doesn't seem to share genetic material well with seasonal H1N1 so perhaps we won't see widespread Tamiflu resistance emerge. Pattern of illness points to a younger population for novel H1N1. Most people who catch this are younger than 50 years old with deaths in elderly rare. Most cases of severe illness are in younger people compared with seasonal influenza. A report in August 2009 analyzed 574 fatal cases worldwide and found the average age was 37 and 51% of the deaths were between 20-49 years old. About half of the deaths were in patients with underlying medical conditions. While obesity and diabetes were the most common conditions identified it is not clear whether these were contributing factors themselves or whether people with diabetes and obesity have more heart disease and lung disease making them more susceptible. Other factors included asthma and heart disease. Pregnancy is a consistent risk factor for severe disease across many countries. HIV and novel H1N1 - studies from two countries seem to indicate that people with HIV who are on HIV medications are not at increased risk for severe or fatal illness.   ADVICE: Schools are reopening and we are seeing a resurgence of flu cases. It is really important for you to have looked at your human resource policies and your supply chain. Since pregnancy is a consistent risk factor, you must plan for protecting your pregnant employees. As I wrote in the last update, there are nine areas that we advise our clients to look at: HR, Corporate Governance, Incident Management, Security, Communications, Finance, Operations, Corporate Services and Information System. For each of these areas, take a look at your policies and procedures from the point of view of worker absenteeism. How will these areas function if large numbers of people are out for 3-5 days during October through February/March. Look upstream at your suppliers and downstream at your distributors to develop work-around solutions should they experience interruptions from absenteeism. TOOLS: Virtual Medical Director - Ensure that you have medical decision support if you do not have an in-house medical director. Look into our Virtual Medical Director program. We have affordable decision support plans that you can enroll in.   DC3 will be available next week. This is the software we have been busily designing over the past two months. It will take the place of the WHO Pandemic Phases and give you intelligent Organizational Levels to link your trigger based action plan to. DC3 incorporates expert medical opinion that is updated regularly into the logic and will advise you on actions you should be taking and help you assess your readiness. Drop me a note if you would like to see it.   Global Disease Surveillance - MedPrep has teamed with a global surveillance company to provide geomapped specific surveillance for corporations who want site specific news and information. Through this system, we monitor over 30,000 information sources and provide you with intelligence and analysis on influenza and 259 other infectious diseases.   If you need last minute pandemic planning help, drop me a note. We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jumpstart your planning and initiative or take a look at your current plans with a fresh set of eyes.     Virtual Medical Director If you don't have a corporate medical director, our Virtual Medical Director program may be a good solution for you. 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.       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