WHO Europe: Revising Pandemic Preparedness Plans

 

The current WHO phase of pandemic alert for avian influenza H5N1 is 3.

 

# 6725

 

 

While not the damp squib that many pundits have mistakenly called it (see Lancet: Estimating Global 2009 Pandemic Mortality), the 2009 H1N1 influenza pandemic could have been worse.

 

A lot worse.

 

As it was, the Lancet study mentioned above found:

 

We estimate that globally there were 201 200 respiratory deaths (range 105 700—395 600) with an additional 83 300 cardiovascular deaths (46 000—179 900) associated with 2009 pandemic influenza A H1N1. 80% of the respiratory and cardiovascular deaths were in people younger than 65 years and 59% occurred in southeast Asia and Africa.

 

As we’ve seen with some previous pandemics, the greatest burden of illness and death was shifted to those under 65, a reversal of what we normally see with seasonal influenza. 

 

Still, when compared to 1918 – where between 50 and 100 million people died – the pandemic of 2009 was relatively mild.

We may not be nearly so lucky the next time around.

 

Preparations for an H5N1 pandemic – which began in earnest in 2005 – undoubtedly helped the world respond in 2009, but it is quite clear the world remains poorly equipped to deal with a major global health crisis.

 

Earlier this year the World Health Organization  published a 16-page document that looked at the lessons learned from the 2009 pandemic, called:

 

 

While the document goes into considerable detail, the following excerpt lists key areas where changes are recommended.

 

Key changes to national pandemic preparedness plans

 
The changes being made to pandemic plans follow to a large extent the findings from some evaluations performed by countries, as well as the two EU-wide assessments (TOR1 and TOR2) (7), the WHO/Europe evaluation of pandemic preparedness (8), the external review of the IHR (1) and of ECDC’s response to the pandemic (9). The changes address primarily the following areas:

• intersectoral cooperation, collaboration and leadership
• flexibility and adaptability of plans
• strategies for vaccines and antivirals 
• disease surveillance and monitoring of countermeasures
• strategies for exchanging information and communicating risk
• evaluation of the pandemic response and the transition to seasonal influenza.

 

Four countries (France, UK, Czech Republic, Finland) have updated their pandemic response plans since 2009, while many other countries are in the process of working on revisions.

 

You can view the latest versions of European national plans at this WHO Europe web address:

 

National preparedness plans

Follow the links below to view country-specific national pandemic preparedness plans.

• Finland
  Updated in 2012 (in Finnish)
• Czech Republic
  Updated in 2011 (in Czech and English)
• France
  Updated in 2011 (in French)
• United Kingdom
  Updated in 2011 (in English)

(Continue . . . )

 

European pandemic guidance recommendations are being revised to more closely match the WHO global pandemic guidance. These new guidance recommendations will be presented at a WHO workshop in Copenhagen next month for countries of the South-eastern Europe Health Network (SEEHN), newly independent states, Switzerland and Turkey.

 

This from the World Health Organization:

 

 

 

Revising pandemic influenza preparedness strategies

16-11-2012

Evaluations of the response to the 2009 pandemic have shown that the world is ill-prepared to respond to a severe influenza pandemic or to any similar global, sustained and threatening public health emergency.

 

From the lessons learned it can be concluded that existing country pandemic plans have a number of gaps. Member States are in the process of revising their pandemic plans and 4 countries of the WHO European Region have published their revised plans.

 

A key activity of WHO/Europe in collaboration with the European Centre for Disease Prevention and Control (ECDC) is to provide a strong and clear guide, so that all countries of the Region can revise their pandemic influenza preparedness strategies. To this end, the existing European guidance is being revised in line with revisions from the WHO global pandemic guidance. This new version of the European guide will be discussed during a workshop on pandemic preparedness that will be held 5-7 December 2012 in Copenhagen, Denmark for countries of the South-eastern Europe Health Network (SEEHN), newly independent states, Switzerland and Turkey.

 

The meeting is organized in collaboration with the SEE Regional Health Development Centre for Communicable Diseases Surveillance in Tirana, Albania and will be facilitated by experts from WHO collaborating centres at the University of Nottingham, United Kingdom and the University of Geneva, Switzerland as well as WHO headquarters.

 

Experts from ECDC and Centers for Disease Control and Prevention (CDC) Central Asian Region, Almaty, Kazakhstan will also participate.

»» Read More

Pandemic Uncertainties

 

 

# 6416

 

 

Influenza pandemics come in all strengths and sizes - ranging from the relatively mild events of 1968 and 2009 to the horrendous Spanish Flu of 1918 – making decisions over just what we should be preparing for difficult to settle on.

 

Pandemic planning prior to the H1N1 pandemic of 2009 was centered on a 1918-like scenario, with a nervous acknowledgment that an H5N1 pandemic could actually be worse. 

 

Recognizing pandemics come in all shapes and sizes, the HHS created a pandemic severity scale in 2007, much like the one used for hurricanes, to quantify the impact of a pandemic here in the United States.

Pandemics are rated like Hurricanes.  Category 1-5

 

Of course, pandemics are not static events.

 

Like hurricanes, they can fluctuate in strength - often abruptly. In 1918, the first wave (spring) was mild, by October of that year it had morphed into the deadliest pandemic on record.

 

We also know that the impact of the 1918 pandemic varied widely around the world, with Northern Europe apparently being the most lightly affected, and India and many more tropical countries more heavily affected.

 

What may be a CAT 2 in one region could be a CAT 5 someplace else. Or a CAT 5 outbreak could suddenly weaken to a CAT 2 pandemic.

 

But the mildness of the last two pandemics has left many people questioning whether we should be preparing for a truly `worst-case scenario’.  History has shown – that while they can occur – they happen less often than milder events.

 

Today, a study appears in the International Journal of Risk Assessment and Management, that warns that planning for a `less-than-worst-case’ pandemic may leave us dangerously underprepared.

 

Measuring the uncertainties of pandemic influenza

Jeanne M. Fair; Dennis R. Powell; Rene J. LeClaire; Leslie M. Moore; Michael L. Wilson; Lori R. Dauelsberg; Michael E. Samsa; Sharon M. DeLand; Gary Hirsch; Brian W. Bush

DOI: 10.1504/IJRAM.2012.047550

Abstract:

It has become critical to assess the potential range of consequences of a pandemic influenza outbreak given the uncertainty about its disease characteristics while investigating risks and mitigation strategies of vaccines, antivirals, and social distancing measures. Here, we use a simulation model and rigorous experimental design with sensitivity analysis that incorporates uncertainty in the pathogen behaviour and epidemic response to show the extreme variation in the consequences of a potential pandemic outbreak in the USA. Using sensitivity analysis we found the most important disease characteristics are the fraction of the transmission that occur prior to symptoms, the reproductive number, and the length of each disease stage. Using data from the historical pandemics and for potential viral evolution, we show that response planning may underestimate the pandemic consequences by a factor of two or more.

 

 

While the full study is behind a pay-wall, we’ve a press release with some additional detail.

 

Inderscience Publishers

Measuring the uncertainties of pandemic influenza

Public release date: 2-Jul-2012

A major collaboration between US research centers has highlighted three factors that could ultimately determine whether an outbreak of influenza becomes a serious epidemic that threatens national health. The research suggests that the numbers in current response plans could be out by a factor of two or more depending on the characteristics of the particular pandemic influenza.

Researchers from Argonne, Los Alamos, and Sandia National Laboratories, and the National Renewable Energy Laboratory, have used sensitivity analysis to uncover the most important disease characteristics pertaining to the spread of infection with an influenza virus. These are: the fraction of the transmission that occurs prior to symptoms, the reproductive number, and the length of each disease stage. Their use of data from past pandemics as well as information on potential viral evolution demonstrates that current response planning may underestimate the pandemic consequences significantly.

(Continue . . . )

 

Some key findings in this study include that:

 

• A future worst-case influenza pandemic might be 4 times deadlier than the 1918 pandemic.
• Simulations suggest that antiviral drugs may not be as useful as planners hope.
• While a mix of pharmaceutical and non-pharmaceutical Interventions will be needed, social distancing may be the most effective way to contain the spread of a severe pandemic, albeit at a high societal and economic cost.

 

While a worst-case scenario may be less likely than a mild or moderate pandemic - this study concludes that it is not impossible - and recommend that their findings be incorporated into the planning for the next pandemic.

»» Read More

H5N1: Now That They’ve Broken The `Species Barrier’

 

# 6157

 

 

When a pandemic did not erupt in 2006-2007 from the H5N1 virus, many scientists (and media pundits) began to question whether there might be some sort of `species barrier’ that would prevent the H5 virus from ever adapting to mammals.

 

Some researchers took comfort in the fact that - in the albeit short history of influenza virology - only H1, H2, and H3 viruses have been known to effectively transmit among humans.

 

Avian H5s, H7s, H9s, and H11s have only been rarely found in humans, do not appear to transmit particularly well – and with the exception of the H5N1 virus – produce usually mild illness.

 

After the relatively mild 2009 H1N1 Swine Flu pandemic, and since bird flu has failed to adapt to humans, the flurry of pandemic preparedness activity we saw 5 or 6 years ago amongst military, government, and corporate entities seems to have disappeared.

 

Last fall we learned that researchers had successfully created ferret transmissible  strains of the H5N1 virus - breaking this supposed `species barrier’ – and that has set off a firestorm of debate in academia.

 

It’s been a huge story that has deeply divided scientists and policy makers, and has consumed the influenza community for months. 

 

Despite strongly suggesting that the H5N1 virus in nature is likely a bigger pandemic threat than many have previously believed – most of the discussion has been directed at what policies should be adopted for conducting, and publishing, of controversial `life sciences’ research.

 

Admittedly, these are thorny problems, requiring much thought and discussion, and over time, will hopefully produce some consensus.

 

But lost in this discussion have been the practical aspects of pandemic preparedness.

 

It’s as if after the `damp squib’ pandemic of 2009, officials are afraid to voice concerns, and talking publicly about pandemic preparedness has fallen out of favor.

 

 

While I advocate a balanced `All Threats’ approach to disaster preparedness, a severe pandemic represents a huge (and unparalleled) risk to society, the economy, and human health. 

 

It deserves to be talked about - and planned for – every bit as much as do hurricanes, earthquakes, and floods.

 

More so, I would argue, since the kind of preparations recommended for the more likely-to-occur natural disasters (i.e. self-sufficiency for 72hrs) would hardly suffice during a really severe pandemic.

 

 

In 2006-2007, the United State’s government actively urged companies – both large and small - to develop comprehensive pandemic plans. Local communities were told that they should prepare as well - since during a severe pandemic - the timing and availability of Federal assistance would be uncertain at best.

 

If the risk of a severe pandemic has not diminished (and many virologists believe it has not), then we need to seriously revisit and update those preparedness plans that - for the past few years - have been languishing and gathering dust.

 

Rather disappointingly, a number of the preparedness links I’ve highlighted over the years no long work. In some cases documents have been moved to new locations, in others, they appear to have been withdrawn altogether.

 

Undaunted by this, today we’ll take a look back at some of the pandemic planning guidance documents that still remain available for individuals, families, businesses and communities who might wish to prepare.

 

First stop, an OSHA fact sheet from 2009 on protecting employees during a pandemic.

 

 

During an influenza pandemic, transmission of the pandemic virus can be anticipated in the workplace, not only from patients to workers in healthcare settings, but also from customers and coworkers in general work settings. Employers can use a set of occupational safety and health controls referred to as the "hierarchy of controls" to reduce exposures to pandemic influenza in their workplaces. The types of control measures, listed from most effective to least effective, that may be used to protect yourself, your workers and your customers are:

• Engineering controls;
• Administrative controls;
• Work practices; and
• Personal protective equipment (PPE).

 

 

Next a 46-page PDF file from the Department of Labor and the HHS on preparing workplaces for an influenza pandemic.

 

 

The CDC provides the following links for Community Mitigation of Pandemic Flu on their Flu.gov website.

 

Mitigation Guide

Community Strategy for Pandemic Influenza Mitigation (PDF - 10.3 MB)
CDC guidelines on actions, designed primarily to reduce contact between people, that community government and health officials can take to try to limit the spread of infection should a pandemic flu develop. Appendixes 5, 6, and 7 contain information for childcare programs, elementary schools, and colleges and universities.

Plan Now to Be Ready for the Next Flu Pandemic (PDF - 213.55 KB); (DOC - 51 KB)

The Next Flu Pandemic: What to Expect (PDF - 226.83 KB); (DOC - 47 KB)

 

And as a last stop today, a terrific video from the Seattle & King County Public Health Department, followed by an extensive list of downloadable resources.

 

Business Not As Usual: Preparing for a Pandemic Flu

Click link to open streaming video:
Business Not As Usual: Preparing for a Pandemic Flu

Downloadable resources from the DVD

General resources:

• Go-Kits checklist (available in multiple languages). Go-Kits are emergency kits to pack in advance, you just pick up a kit and GO!
• Planning Checklist
• Stopping the Spread of Germs at Work

Business and government preparedness:

• Business Pandemic Influenza Planning Checklist
• Continuity of government issues that should be addressed by local agencies
• It's Not Flu As Usual Brochure
• Guidance on Preparing Workplaces for an Influenza Pandemic
• Preventing the Spread of Influenza
• Guidance for employers on returning to work after influenza illness

Community Based Organization (CBO) preparedness:

• 9 Small Steps that Reap HUGE Rewards
• Business Continuity Template
• CARD Agency Emergency Plan
• It's Not Flu As Usual Brochure
• Pandemic Influenza Emergency Response Manual
• Preventing the Spread of Influenza
• Guidance for employers on returning to work after influenza illness

Personal preparedness:

• Family Health Information Sheet
• How to care for someone with influenza
• Pandemic Flu Planning Checklist for Individuals and Families
• Your Personal Go-Kit

 

While the H5N1 virus is getting all of the attention right now, it isn’t the only virus with pandemic potential.  The next pandemic could just as easily arise from the H9N2 virus, or one of the H7’s, or another reassortant swine flu virus.

 

Given the number of warnings we’ve had, there is no excuse for us to be caught flatfooted by the next pandemic virus. 

 

Yet, if one started tomorrow, I suspect we would find ourselves very much in that most difficult of positions.

»» Read More

WHO e-Atlas Of Natural Disaster Risks To Europe

 

 

# 6024

 

 

Natural disasters can strike anywhere, and just about anytime, but there are some times and places when the likelihood of disaster is greater than others.

 

To help nations, communities, and individuals to prepare, the World Health Organization’s  Regional Office for Europe (WHO/Europe) has released an online-only, interactive e-Atlas of disaster risks for Europe.

 

 

Focusing on five major natural disaster threats (seismic activity, floods, landslides, heat-waves and winds), this e-Atlas maps the relative risks of their occurrence across 32 countries of the European Region.

 

The WHO e-atlas of disaster risk for the European Region. Volume 1. Exposure to natural hazards. Version 2.0

Available in:

English (HTML)

2011
ISBN 978 92 890 0243 1
This publication is only available online.

This e-atlas models the distribution of five natural hazards – seismic activity, floods, landslides, heat-waves and winds – and populations’ exposure to them in 32 countries of the European Region. It provides the baseline data and maps needed to assess where the potential for damage may be the greatest and to underpin the call for more resources to improve emergency preparedness, reduce the health risks to vulnerable populations and aid the emergency response. This information also supports the identification, planning and prioritization of areas for prevention and mitigation activities.

The aim of the e-atlas is to raise awareness of disaster risk among ministries of health and other health stakeholders, and so stimulate improvement in their disaster-management capacity.

 

 

Inside you’ll find interactive maps, like the one below showing relative seismic risks, that allows you to pan, or drill down closer to view areas at most risk.

 

Photo Credit – WHO/Europe

 

You can find similar online e-Atlases available for the Eastern Mediterranean region and for Africa. 

 

 

The WHO e-atlas of disaster risk for the Eastern Mediterranean Region (HTML)

The WHO e-atlas of disaster risk for the African Region (HTML)

»» Read More

UK: Updated Pandemic Influenza Plan

 

 

 

 

# 5952

 

Today the UK government released a 70-page updated pandemic contingency plan which incorporates some of the lessons learned from the 2009 swine flu pandemic.

 

The PDF Document is available for download from the Department of Health.

 

While I’ve only had time to give it a cursory glance, one of the major goals is to reduce the economic and societal impact of any pandemic response. 

 

An excerpt from the plan follows:

 
Business as usual

7.4 During a pandemic, the Government will encourage those who are well to carry on with
their normal daily lives for as long and as far as  that is possible, whilst taking basic precautions to protect themselves from infection and lessen the risk of spreading influenza to others (see Chapter 4). The UK Government does not plan to close
borders, stop mass gatherings or impose controls on public transport during any pandemic. 

 

 

While conceding that pandemic severity is hugely unpredictable, this report shies away focusing on `worst case scenarios’.

 

A couple of examples: They envision no widespread school closings, and a recommend a more conservative approach in the use and distribution of antiviral medications than we saw in 2009.

 

While a mild or moderate pandemic is admittedly the most likely scenario, how well their plans to maintain `business as usual’ would hold up under a severe pandemic conditions remains to be seen.

 

For more on this, the UK Department of Health has a press release  regarding the publication of this new plan.

»» Read More

Beyond Pandemics: A Whole-of-Society Approach to Disaster Preparedness

 

 

# 5835

 

 

The United Nations and USAID – along with other partners that include WFP, WHO, UNWTO , and the FAO – has joined together to create the Towards A Safer World (TASW) initiative, which seeks to `capture the lessons that were learned from preparing for an influenza pandemic, and inspire leaders to apply those lessons and best practices to continuing and emerging threats.’

Later this week (Sept 15 &16th) representatives of various governments, United Nations officials, along with representatives from civil society, the military and the private sector will all take part in a 2-day  TASW conference on pandemic preparedness and approaches to disaster preparedness.

 

In conjunction with this meeting, TASW has released a 176-page book (available as a PDF download), with a forward by David Nabarro, that brings together the experiences of whole-society engagement in pandemic and disaster preparedness.

 

 

I’ve only just had time to glance at this publication, but wanted to pass along the information. The TASW has provided more details in a press statement released today.

 

 

Towards a Safer World Calls for Inclusive, Whole-of-Society Approach to Disaster Management

New book introduced today spotlights benefits of creating strong linkages between partners from different sectors for future disaster planning and response

ROME, Sept. 12, 2011 /PRNewswire/ -- In a new book released today, government, military, civil society, and private sector leaders are challenged to help unify experiences and resources in order to successfully manage and mitigate the impact of future global disasters by learning from recent pandemic response efforts.

 

"Beyond Pandemics: A Whole-of-Society Approach to Disaster Preparedness" outlines the human, economic and societal benefit of increasing collaboration, planning and dialogue across the whole of society. This can include partners in travel, animal health, business, global health and civil-military response teams.

 

"Most authorities agree that the world is not ready for a severe influenza pandemic. The best way to prepare is to engage multiple sectors in order to ensure an effective and timely response," said UN Senior Coordinator for Avian and Human Influenza and author, David Nabarro. "The countries that have done best involve many government departments, a broad range of businesses, and civil society in preparedness planning: their challenge, now, is to sustain this approach for all health-related crises through sustainable, holistic and adequately funded systems."

 

Nabarro continued, "To the best of my knowledge this is the first time that these multiple experiences have been brought together - and analyzed - in one document: it is sure to be useful  to all involved in 'whole-of-society' crisis preparedness."

(Continue . . . )

 

You’ll find more details on this initiative at the TASW website.

»» Read More

UK: Proposed Influenza Pandemic Preparedness Strategy

 

 

# 5432

 

 

The UK’s Department of Health has released a major proposed revision to their 2007 National Framework for responding to a pandemic, incorporating lessons learned from the 2009 H1N1 pandemic.

 

This 71 page PDF document will be open for comment until June 17th, and according to the DOH, is targeted towards:

 

PCT CEs, NHS Trust CEs, SHA CEs, Care Trust CEs, Foundation Trust CEs, Medical Directors, Directors of PH, Directors of Nursing, Local Authority CEs,
Directors of Adult SSs, GPs, Communications Leads, Emergency Care Leads, Directors of Children's SSs, Nurses, Health Visitors, Clinicians, Managers,
Commissioners, Pharmacists, Doctors, Midwives, Paramedics, Dentists  and other specific consultees as listed in the consultation document.

 

 

 

 

UK influenza pandemic preparedness strategy 2011: strategy for consultation

• Launch date:22 March 2011

• Closing date:17 June 2011

• Creator/s:Department of Health, Department of Health, Social Services and Public Safety, Welsh Assembly Government, The Scottish Government

• Copyright holder:Crown

• Gateway number:15774

Pandemic influenza is one of the most severe natural challenges likely to affect the UK, but sensible and proportionate preparation and collective action by the Government, essential services, business, the media, other public, private and voluntary organisations, and communities can help to mitigate its effects.

 

The UK has been preparing for an influenza pandemic for some years. These arrangements were tested by the H1N1 (2009) influenza pandemic although, in comparison with previous pandemics, the effects of the H1N1 (2009) influenza pandemic were relatively mild for the majority of people.

 

This document describes proposals for an updated, UK-wide strategic approach to planning for and responding to the demands of an influenza pandemic. It builds on, but supersedes, the approach set out in the 2007 National framework for responding to an influenza pandemic, taking account of the experience and lessons learned in the H1N1 (2009) influenza pandemic and the latest scientific evidence. A more detailed account of the science underpinning the proposals is being published along with this strategy.

• Download UK influenza pandemic preparedness strategy 2011: strategy for consultation (PDF, 1462K)

»» Read More

Canadian AG Criticizes Govt. Preparedness

 

# 3944

 

 

I’ll leave it to a far more qualified Crof over at Crofsblog to weigh in on the growing debate over the Canadian government’s handling of the H1N1 crisis (and Canadian politics in general).  

 

I have enough trouble ignoring American politics.

 

This Auditor General’s report, however, is certain to add fuel to the fire.

 

 

AG targets weakness in government's emergency preparedness

 

OTTAWA — The federal department charged with disaster planning is itself a disaster when it comes to preparing for emergencies as varied as the swine flu pandemic, floods and terrorist attacks, says Auditor General Sheila Fraser.

 

"We found that Public Safety Canada has not exercised the leadership necessary to co-ordinate emergency management activities," Fraser concluded in her latest report, tabled in the House of Commons on Tuesday.

 

Her department did not study the current H1N1 crisis, but Fraser believes that had Public Safety Canada put pandemic management plans in place, there would have been less confusion.

 

"Certainly an approved plan would have clearly indicated what the role was for Public Safety Canada, what the roles of the other departments and the federal government would be, and would also have brought in the co-ordination with the provinces, municipalities and territories," Fraser told reporters. "So it's important — very important — that the role and responsibilities of Public Safety Canada be agreed to and endorsed in these emergencies."

 

In her report, she highlighted not only H1N1, but also severe acute respiratory syndrome, the 2003 eastern seaboard power blackout massive flooding and terrorist threats as examples of emergencies that fall under the co-ordination of the Department of Public Safety and Emergency Preparedness.

 

Her audit comes amid intense criticism from federal opposition parties and from the general public on the troubled rollout of the H1N1 vaccine, which the federal government purchases and distributes to the provinces.

 

(Continue . . . )

»» Read More

Video: Influenza And Emerging Infections From UCTV

 

 

# 3855

 

An absolutely terrific hour-long presentation on pandemic influenza and other Emerging infectious diseases from the University of California this morning.  This was uploaded only a couple of weeks old, so it is timely.  

 

It is well paced, well produced, and geared largely to health care professionals, but not overly technical either. This program discusses Influenza, SARS, Ebola, MRSA and other emerging infectious diseases.

 

A substantial amount of time is spent on HCW (Health Care Worker) safety concerns and PPEs.

 

Highly recommended.

 

(Dbl Click Image To view at YOUTUBE)

Disaster Preparedness: Influenza and Emerging Infections

From: UCtelevision | October 02, 2009

You cant watch TV these days without hearing about the threat of diseases like swine flu, bird flu or other emerging infections. With so much conflicting information in the media, its hard to discern the facts about these pandemics and how we can best protect ourselves. Join Dr. John Blossom and infectious disease specialist Dr. Christian Sandrock as they talk with disaster response experts about how to recognize, report and respond to these pandemics, and lessons learned from previous experiences. Series: "Disaster Preparedness for Health Professionals" [10/2009] [Health and Medicine] [Show ID: 16928]

 

 

 

This video is just one of a series of presentations for Health Professionals presented by University of California TV.  While I’ve not had an opportunity to screen the other videos, if they are any where near as good as the one above, they are worth your time.

 

Disaster Preparedness

Are you ready for the next inevitable disaster? Whether you're an emergency responder, health care provider, or a community member who wants to know more about keeping your family safe, you'll want to watch this four-part video series from University of California Television and the California Preparedness Education Network. You will hear from noted health care providers and disaster response experts from around California, a state with a well-tested emergency response system that serves as a model for the rest of the country.

 

Free Disaster Preparedness Videos from University of California

UC

 

Disaster Preparedness: Disaster Volunteerism

 

Disaster Preparedness: Influenza and Emerging Infections

 

Disaster Preparedness: Chemical and Biological Agents

 

Disaster Preparedness for Health Professionals Promo 2

 

Disaster Preparedness Health Professionals/Natural Disasters

»» Read More

An Appropriate Level Of Concern (Revisited)

 

 

# 3821

 

Last May, nearly 5 months and 600 blogs ago, I wrote a piece called An Appropriate Level Of Concern, where I attempted to lay out my sense of the seriousness of the emerging H1N1 virus, and what people should be doing to prepare for it.

 

I’ve kept the essay on my sidebar since then, but a lot has happened in the last 150 days.

 

When I wrote that piece, a pandemic had not yet been declared.  We’d not seen how the Southern Hemisphere’s flu season played out, nor had we seen the slow burn north of the equator over the summer.

 

While I believe nearly everything I wrote then still applies, a little updating is certainly in order. 

Therefore, I thought today we’d revisit the subject.

 

 

An Appropriate Level Of Concern (Revisited)

 

It’s question I ask myself every day.

 

Just how concerned should the average (insert your nationality here, AFD gets visitors from more than 100 countries) be about this novel H1N1 pandemic virus?

 

It isn’t an easy question to answer. 

 

Particularly since many people have a bad tendency to either ignore a threat completely, or go overboard in an extreme over-reaction to it.

 

In view of what we’ve seen over the summer months,  I still believe that what is needed is more of a measured `middle-ground’ approach.

 

To date, the H1N1 virus has produced a High Morbidity - Low Mortality pandemic.  It is making millions of people sick, and has sent tens of thousands to hospitals . . . but the number of deaths appears (so far, anyway) to be relatively low. 

 

Distressingly, this flu has a predilection for younger adults and children, which amplifies its impact.  Those over the age of 65 have been largely spared by this virus.

 

That could change, of course. 

 

Influenza viruses are unpredictable, and capable of swift mutation or reassortment with other viruses.  The pandemic we have next month or next year may be far different from what we are seeing today.

 

But for now, 99 out of 100 flu victims are recovering at home, without the need for antivirals or antibiotics.  For the unlucky 1% who see worse symptoms, however, it can be a very serious illness.

 

Governments are beginning to distribute a vaccine, have deployed antiviral stockpiles to each state here in the US, and are handling the `macro’ issues that are well beyond the scope of individual citizens. 

 

They can do a lot, but they can’t do it all.

 

Individuals, families, businesses, and organizations must all do their part to prepare, as well.  And not just here in the United States, but around the world.

 

This blog, of course, continually reminds its readers of the importance of overall preparedness.

   

We live in a dangerous world, where earthquakes, hurricanes, tornadoes, floods  . . . and even more mundane events like auto accidents, or slips and falls at home  . . . can ruin your entire day.

 

As a former paramedic, I can’t stress enough the importance of having a good first aid kit at home, and in your car.  And just as important, learning how to properly use one.

 

 

Taking a first-aid course, and CPR training, are both investments that could pay off big someday, for you, and for your loved ones. 

 

And every home should have no less than a 72-hour supply of emergency food and water, for all of its occupants (including pets!).   This is a bare minimum, but is just the starting point.

 

Here in the United States, the HHS (along with other agencies) recommend that households work towards having `at least’ 2-weeks worth of food, water, and emergency supplies on hand.

 

Other agencies and organizations have proposed 30 days, 60 days, and even 3-months as being prudent.  If not specifically for this pandemic, for disasters in general.

 

Obviously, not everybody can do that.  But anything you do to prepare beats not preparing at all.

 

As Ready.gov, along with FEMA, and a host of other agencies remind us, we all need to be prepared for emergencies.

 

 

You and your family need a comprehensive emergency plan, that covers the big emergencies like natural disasters, or where to meet if you get separated, and one that covers lesser disruptions like school closures.

 

Having alternative child-care arrangements set up in advance this fall and winter could pay huge dividends this school year.

 

If you haven’t downloaded Dr. Grattan Woodson's Home Treatment of Influenza guide, you need to now. 

And then read it.  Before you need it.

While you are at it, take some time to explore his website.  It is chock full of good information.

 

 

If your own, or help run a business, organization, or agency you should also be preparing that entity to deal with any disaster – including a pandemic.

 

 

Ready.gov’s business preparedness site has information to help you prepare to weather many emergencies.  For a a pandemic, however, you need to be doing a bit more.

 

The HHS has a workplace planning page, that gives checklists and advice on things that can help keep your business operational during a pandemic.

 

And once our families, and our businesses are taken care of, it is important to think about our neighborhoods and our communities.

  

Volunteering with the Red Cross, or CERT, your Neighborhood watch, or just checking on your neighbors is a good place to start.

 

And if you aren’t already, try to become a Flu Buddy to a friend, a neighbor, or a co-worker.  A flu buddy is someone who can check in with you if you get sick, fetch medicines or emergency aid if needed, and make sure you aren’t in difficulty if you get sick.

 

The `Flu Buddy’ concept is one that I’ve personally been pushing since about 2007,  and you can find my latest scribe on the subject in my sidebar:

 

 

Karen, aka Readymom has taken that essay and massaged it a bit (and improved it, I think) and has posted it on her SCRIBD account, where anyone can download it for free.

 

 

We are each only as prepared as our neighbors.

 

And of course, we need to follow the advice of our public health agencies and keep washing our hands frequently, using alcohol hand sanitizer, covering our coughs, and staying home if ill.

 

The H1N1 vaccine, which is now starting to become available in the US, appears to be a good match for the virus - and should be no riskier than the seasonal vaccine – which has an excellent safety record.

 

And although seasonal flu strains have yet to make an appearance this year (and may not), it is still probably a good idea to get the seasonal flu shot as well.  If for nothing else, protection against the `B’ strain which generally has its biggest impact in late Spring.

 

The CDC is urging those who are at high risk of pneumonia to avail themselves of the pneumococcal polysaccharide vaccine (PPV).  Incredibly, only about 16% of the target population in the US has taken this protective shot.

 

Although I don’t offer medical advice in this blog, I have long suggested that people consult with their primary care provider about the advisability of taking the PPV – even if you aren’t sure you fall into a recommended category.

 

So . . . what is the appropriate level of concern you should have about this H1N1 pandemic?

 

 

Well . . . if you’ve followed the advice that has been offered by this blog and numerous agencies for the past several years  and . . .

1. have a good family and business emergency plan
2. have acquired at least a 2-week supply of emergency supplies
3. routinely practice good flu hygiene 
4. get the appropriate vaccines when they are available
5. have and are a flu buddy 
6. are looking out for your neighbors and greater community

 

 

. . . . then I think (for now, at least) you can simply keep a wary eye on developments and go about your life.  

 

I see no need to hunker down at home, or to live in fear over this virus.  This is a serious situation, of course. And tragically, this virus will claim thousands of lives over the next few months.

 

It certainly deserves your attention, vigilance, and respect. 

 

But not your fear.

 

Stay informed, of course.  Check back here, with Flu.gov, and with my fellow bloggers often.  It is, after all an evolving, important, and fascinating story. 

 

We are likely to remain at pandemic level 6 for a year, perhaps two.  Maybe longer.   This is the `flu normal’, and we all need to get used to living life in a pandemic.

 

If you’ve done all of these things, and this pandemic hits your community hard (or a hurricane, or a flood, or a forest fire . . . ), you will be about as well prepared to deal with it as you can reasonably expect to be.

 

The point, you see, isn’t to be afraid. 

 

The point is to be prepared.  Then you can sleep easily at night.

 

If you haven’t done these things . . .  well, I’d certainly be concerned enough to start working towards getting them done.

 

The appropriate response right now is to stay informed, get prepared, and plan how you and your family or business will deal if a pandemic wave, or any other emergency, comes along.

 

Try it. 

 

You’ll be amazed how good being prepared feels.

 

 

*************************************************************************

For more preparedness information check out

 

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

READYMOM'S ALLIANCE http://readymoms.org/

For Pandemic Preparedness Information:

HHS Individual Planning Page

For more in-depth emergency preparedness information I can think of no better resource than  GetPandemicReady.Org.    Admittedly, as a minor contributor to that site, I'm a little biased.

»» Read More

Germicidal Maniacs

 

 

# 3809

 

 

There are certainly times, and circumstances, where it makes a lot of sense to disinfect surfaces to try to limit the spread of the H1N1 virus.   

 

When I was at my local Walgreens a couple of weeks ago to get my seasonal flu shot, one of the employees at the Rx window sprayed down the pickup counter with alcohol. It was an area where hundreds of people stood each day, placing their hands on the surface, and probably coughing and sneezing as well.

 

Coming out every 30 minutes or so and giving it a disinfecting wipe down probably makes some sense.   I know I was glad to see them taking this flu virus seriously.

 

This sort of real-time cleaning and disinfecting, while patrons are continually coming and going, could be argued as being a good hygienic practice.

 

But of late I’m reading more and more about schools (and sometimes businesses) that are shutting down, often for days, in order to give them time to perform a `deep disinfecting cleaning’ of the premises - and here the science and logic isn’t quite so clear.

 

A couple of examples from today’s news, then some discussion.

 

Arizona school closes with flu outbreak

(AP) 

HUACHUCA CITY, Ariz. — Health officials suspect an outbreak of swine flu has caused an Arizona school to shut down after more than a third of the students called in sick.

 

Huachuca City Elementary will closed, the rest of the week followed by the regular fall break. Crews will disinfect everything that children put their hands on, from door knobs and desks to restrooms, and the cafeteria.

(Continue . . . )

 

 

Corbin schools cancel class

 

25 teachers call in sick Monday; students resume Oct. 19 after fall break

By Samantha Swindler / Managing Editor
Corbin schools will be closed the rest of this week due to illness, and class won’t be back in session until Oct. 19, following fall break.

<Snip>

“Twenty-five teachers were out also and we didn’t have enough subs to go into six classrooms,” McNeel said.

Corbin Intermediate School had the lowest attendance rate at 84 percent. That’s down from the normal 94-95 percent attendance.

Over the break, McNeel said custodial staff will be disinfecting walls, desks, door handles and other surfaces often touched.

 

This seems to be a common reaction.  Close the school for a week, bring in the custodial staff, and maniacally disinfect all surfaces.

 

I’m sure it is very reassuring to the the students, their parents, and the general public.   It shows the school is concerned, exercising due diligence, and that the health and safety of those in attendance is important.

 

But . . . does it make any sense?  

 

From a scientific standpoint, that is.

 

According to the CDC’s guidance, it doesn’t appear to.

 

Questions & Answers

2009 H1N1 Flu (Swine Flu) and You

September 24, 2009 10:00 AM ET

How long can influenza virus remain viable on objects (such as books and doorknobs)?

Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface.

 

In other words, if school lets out at 3 o’clock in the afternoon, by about midnight each night any viruses deposited on surfaces will have probably died.  

 

Which means that closing a school for days, and bringing in a cleaning crew, is of dubious value at best.

 

Now . . . if the point is to reassure the public, and to show that the school is being`proactive’ and protective of the kids, I suppose it has some `public relations’ value.  

 

But if the point is to protect the students and staff from infection, this would seem to be a less than cost-effective way to go about it.

 

Worse, it may instill in some people a false sense of security.  A belief that since the school has been disinfected, there is no need to take other precautions.

The evidence strongly suggests that most influenza infections are acquired through a respiratory route, and the role of fomites (inanimate objects like books, door knobs, desks) is probably limited.   

 

Those infections that do come from fomites almost certainly come from relatively `fresh deposits’ of viral material . . . minutes or hours old  . . .  not left over from yesterday or last week.

 

And last but not least, even the most thorough deep disinfecting of the school premises can be undone in the time it takes a returning student with the virus to sneeze.

 

All of which calls into question the disinfecting tactics being employed by schools around the country.  The money being spent on deep cleaning of schools would be better spent on more hand sanitizer, paper towels in the bathrooms, and perhaps `real-time’ cleaning of surfaces during school hours.

»» Read More

CIDRAP’s Promising Practices

 

 

# 3800

 

 

CIDRAP’s (Center For Infectious Disease Research and Policy) Promising Practices website is chock full of important information on dealing with a pandemic and highlights programs, resources, and toolkits from projects from all over the country.

 

 

 

It’s been a few months since I last mentioned this innovative website, and since then, they’ve added quite a few new items to their growing list of resources. 

 

You can search by topic, by state, or by key word or phrase.   If you haven’t explored this site before, pack a lunch.  There’s a lot to see.

 

I’ve listed the last dozen updates to the site below, but there are nearly 200 entries to check out. If you are thinking about starting a pandemic project in your community, you may find a blueprint already exists for something similar and is available on this site.

 

 

Recently posted resources

 

Illinois Faith-Based Preparedness Initiative

This partnership between the Illinois Department of Public Health and the Broadcast Ministers' Alliance and Health Care Consortium provides a web site where faith-based organizations...   >> More

Pandemic Influenza Preparedness for Schools (CA)

Note: Several materials on this site were not reviewed for Promising Practices because they were beyond the scope of the project or were not publicly available. This review applies...   >> More

Guide for Including People with Disabilities in Disaster Preparedness Planning

The guide provides recommendations and tools for people with many different types of disabilities. The guide includes sections on outreach and identification, planning, communication,...   >> More

Diabetes Disaster Preparedness Guide (NJ)

Hunterdon Healthcare System developed a Diabetes Disaster Preparedness Guide for diabetes patients who must manage their condition during an emergency. The guide is intended to be used...   >> More

Emergency Preparedness and Special Populations - Community Planning Guide

This three-page guide, created by the Massachusetts Department of Public Health, provides municipalities with useful tips to begin enhancing community emergency management plans by...   >> More

Agency Emergency Plan - COOP planning for CBOs (CA)

CARD ? Collaborating Agencies Responding to Disasters ? is based in Oakland, California. They develop clear, practical preparedness resources specifically for community organizations....   >> More

"When Words are Not Enough" Communications Training Program for Responders (CA)

The Woodside Fire Protection District (WFPD) in Woodside, California, along with the Commission for Disabilities for San Mateo County and the San Mateo County Special Education Local...   >> More

"No Ordinary Flu" Comic Book (WA)

"No Ordinary Flu" is a 12-page comic book that tells the story of a boy learning about his ancestors' experiences during the 1918 influenza pandemic. The boy learns of how churches and...   >> More

Mass Fatality Incident Management: Guidance for Hospitals and Other Healthcare Entities (CA)

Los Angeles County's mass fatality guidance provides detailed tools and recommendations that may assist hospitals and the offices of Medical Examiners and Coroners during an emergency....   >> More

Community Connectors (OR)

The Community Connectors program is a model for how emergency response planners can develop relationships and open lines of communication with diverse members of their community prior...   >> More

Minnesota Pandemic Recommended Actions for Healthcare Facilities by Event Stage

This 10-page, color-coded chart provides detailed recommendations and guidelines for healthcare facilities during an influenza pandemic. The initial chart delineates activities in...   >> More

Set Your Clocks, Check Your Stocks Campaign

The American Public Health Association developed this campaign to encourage emergency preparedness at the high school and community level. Materials use a catch phrase-"Set Your...   >> More

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