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