Stock up for the flu, officials say

    Published: Wednesday, February 7, 2007

Stock up for the flu, officials say
If a pandemic spreads, you might be left stranded at home for days.

By Sharon Salyer
Herald Writer






If a flu pandemic spreads to Washington, three days of emergency supplies just won't be enough.

Prepare yourself and your family to be on your own for a week or more, advise state Department of Health officials, who are launching a campaign today to tell people to be prepared.

"One week is what we consider to be the minimum," said spokesman Donn Moyer. "More is always better. But in a case like this, something is better than nothing."

Suggested supplies include everything from headache remedies and Gatorade-type sports drinks to extra food, water, blankets and toilet paper.

The public should take extra steps to prepare because a flu epidemic would cause problems that other emergencies don't, Moyer said.

Major flu epidemics, or pandemics, can spread around the world within a year. The Spanish flu of 1918 and 1919 killed an estimated 675,000 people in the United States and up to 50 million worldwide, according to the federal Centers for Disease Control and Prevention.

Since worldwide flu epidemics occur periodically, health officials worry that a similar epidemic could be triggered by bird flu.

So far, however, the number of cases tracked by the World Health Organization has been small, with 166 deaths reported since 2003.

The big difference between emergencies such as a major storm or preparing for a flu epidemic is government services and businesses could be disrupted for a long time, Moyer said. "You've got to be as independent as possible."

In Snohomish County, up to 200,000 people could become sick and as many as 6,000 people could die, health officials estimate. As many as one-quarter of workers could be off the job.

The result: Schools could close. Businesses could be disrupted. Local governments might struggle to provide police, fire and other services. Hospitals and health care clinics could be overwhelmed.

Home preparedness doesn't only mean having enough water and food for survival but taking steps to be able to care for yourself and sick family members at home, health officials say.

Learn how to care for someone with a fever and body aches, they advise. Be on the alert for signs of dehydration, such as weakness, fainting and dry mouth, which can be caused by influenza.

Stock basic health supplies, such as fever-reducing medications, said Nancy Furness, a special assistant for emergency preparedness for the Snohomish Health District.

Beyond the basics of food and medical supplies, family emergency plans also should be developed to tackle questions such as what to do if both parents are too sick to take care of children or who will care for children if child care is closed, she said.

Longer-term disruptions, such as those that could be caused by a flu epidemic, require the public to take a different approach to disaster planning, Moyer said.

"It's not a little different; it's a lot different," he said.

Flu preparedness checklist


The basics
A one week or more supply of food that will keep for a long time, such as canned meats, vegetables and soups; peanut butter; dried fruit; protein bars; baby food; canned juices; and bottled water.


Prescriptions
Ensure you have at least a week's supply.


Basic health supplies
These include nonprescription medications for fever (such as ibuprofen and acetaminophen), stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins. A thermometer, cold packs, blankets and humidifiers also are recommended.


Basic hygiene items
Soap, shampoo, toothpaste, toilet paper, tissue, disposable diapers and cleaning products.


Cash
Banks may not be open and cash machines may not always work or may run out of cash.


Pet supplies
Such as food, water and cat litter.


Other supplies
An old-fashioned manual can opener, in case power is disrupted; a portable radio; batteries and flashlight; and large garbage bags, since collection may be delayed.

Take precautions
To limit the spread of germs and prevent infection:

Children and adults should wash wash hands frequently with soap and water. Don't touch your eyes, nose or mouth. The flu virus is often spread when a person touches something that's virus-infected then touches these areas of the face.

Cover coughs and sneezes with tissues or cough into your arm. When sick, stay home from work and school.

Sources: Centers for Disease Control and Prevention and Washington State Department of Health

This is a great article. Finally they're slowing breaking the news to the public that you may be on your own for awhile. I have a feeling over the next 4-5 weeks we're going to see a lot more of this. Hopefully people will get the hint.

Penham wrote: That's great. I would love to see something like this in our newspaper.

Okay, I'm bragging, but this was in our local paper yesterday.

    Flu Pandemic Prep
With the possibility of a deadly flu pandemic-today's worry being avian flu-good planning may be the best medicine. Is your school prepared?
By Ron Schachter
February 2007 Printer-Friendly Page
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The prospect of an avian flu epidemic in the near future makes most disaster films pale in comparison. As a newly mutated form of the H5N1 virus spreads rapidly from human to human, public transportation comes to a sudden stop, public events are canceled, and public schools-and many workplaces-shut down.

Within weeks, the ill overwhelm any medical facilities within reach, while others become prisoners in their homes and watch the 24-hour TV coverage, as officials plead for calm and health experts warn of the high mortality rate and the millions who could die worldwide in a matter of months. Those predictions begin to come true, as emptied schools and commercial buildings turn into makeshift morgues.

Now, the avian flu has not yet mutated into a form that spreads easily among humans. No pandemic is imminent, and the nightly news has been covering the concern but not consistently. Yet a growing number of colleges and universities are taking the threat of a "bird flu" pandemic seriously, writing their own scripts about what it could mean to them, and getting ready in ways they have never before had to consider.

Whether the bird flu strikes or not, college and university officials say that the preparations they are making will serve them well. "I think our plan would be very adaptable if there were similar kinds of crises," says Jim Osteen, assistant vice president for Student Affairs at the University of Maryland, which completed its own plan last June.

Getting a Head Start
Some schools, including the University of Minnesota, Twin Cities, have emerged as leaders in anticipating the avian flu in human form. "Pandemic influenza has been on our radar screen for a long time," says Jill DeBoer, the director of the Office of Emergency Response at the university's Academic Health Center.

Besides building a detailed plan around 10 main areas of concern-from vaccine distribution to student housing and health care, to contact with public health departments (see page 43)-DeBoer and her colleagues on a special planning committee have run simulations of a flu outbreak on campus and built a comprehensive website. They regularly share ideas with other Big Ten institutions, too.


At other institutions, facing the possibilities of a flu pandemic has taken longer. "At first, I thought planning for the avian flu was farfetched," admits Maryland's Osteen. "I was not enthusiastic about coming to the table. But over the course of preparing, I've changed my mind. If the flu becomes as bad as it was in 1918, we want to be ready."

The "Spanish Flu" of 1918 is estimated to have killed more than 50 million people worldwide and was particularly virulent in young adults. Incidentally, the 1918 outbreak had its origins in an avian strain. The historical facts caught the attention of John Sheffield, the director of Safety and Risk Management at the University of Richmond (Va.). "I began to research the 1918 flu, and the more I learned, the more I became concerned," he says. His university formed its planning committee in January 2006.

When it comes to assembling planning committees, these officials agree, the more representatives from the school community, the better. "A pandemic would impact every aspect of a college or university," Sheffield explains. At Richmond, everyone from the director of campus police and the vice president of facilities to the VPs of information technology and business has joined the planning process.

"We thought we could get a few people to write a plan," says Osteen, who adds that the committee at Maryland quickly grew to more than two dozen members. "Having them all at the table-while less efficient-helped us get a better product," he insists.

Lessons from the Past
As schools try to find the answers to the questions of what precautions to take, when to cancel classes and close down, how to treat the sick and house the well, and how to stay in business during an extended epidemic, past medical crises offer only limited guidance.

During the SARS outbreak several years ago in Asia and in Canada, Maryland's Osteen recalls, people entering the school's health center were asked to put on protective masks if they had traveled to those locations. And Sheffield recalls a meningitis scare earlier this decade during which people avoided public events on the University of Richmond campus and some parents even summoned their children home. "The big lesson that we learned is that we would have a big fear factor to deal with," he says.

While the University of Minnesota beefed up its emergency planning in the aftermath of 9/11, past practices have been able to only go so far, says DeBoer. "It's really important for us to raise the unique issues, which include an event of long duration that may happen everywhere at once and for which we can't count on neighbors helping," she cautions.

The Trigger Point
One of the most vexing issues to administrators is choosing a trigger point to put any emergency plan into action. Many-including the University of Maryland-may take action when the World Health Organization confirms human-to-human transmission of the virus among localized clusters of people anywhere in the world. "We would want to err on the side of beating the panic rather than getting caught in the middle," says Osteen, who would begin issuing alerts to the university community.

With the confirmation of a North American case, the university would cancel classes. Over the next three to four days, the campus would be evacuated and closed down, a process facilitated by Maryland's largely in-state and regional student population, who could return home without much problem.

"One of the triggers we're looking at is any case discovered at an international airport in a major American city," says Anita Barkin of Carnegie Mellon University (Pa.), who also chairs the pandemic planning task force for the American College Health Association. Barkin, who is director of Student Health Services at CMU, agrees that getting ahead of any general outbreak could prove critical.

"I began to research the 1918 flu, and the more I learned, the more I became concerned." -John Sheffield, University of Richmond
"I think it could sneak up on us," Barkin warns. "How do you monitor the travel of every faculty and staff member as well as every student? They could get the virus on a plane and be shedding that virus before showing any symptoms. And once you have an attack rate of 1 percent, any public health strategy loses effectiveness."

Barkin, Osteen, and other planners predict considerable pressures to stay open if there are only isolated cases reported in distant places, and they say that decision-makers will find themselves in a dilemma. "It's sort of like canceling classes for a snowstorm," suggests Jo Williams, who has been leading the planning process at Nichols College (Mass.). "You're damned if you do, and damned if you don't."


And it's not out of the question, Osteen theorizes, that the first case in the region or local area could occur on campus. "We could end up being told not to move anybody," he says.

Tending the Sick, Housing the Well
Maryland's plan to evacuate its 33,000 students represents a change of course, Osteen continues. "We started by thinking, 'How can we batten down the hatches and ride out an epidemic?' But why help bring people together when some are contagious?" Even so, Maryland is expecting hardship cases for which the university health center could be converted into a temporary infirmary with 40 beds. A series of university apartments could house the healthy left behind.

Other schools cannot depend on sending virtually all students home. Of the 3,500 enrolled at the University of Richmond, almost 200 come from foreign countries and another 10 percent may live too far away in the United States to make it home if the transportation system fails or authorities impose travel restrictions.

"If we eliminate anyone in the Eastern and Central time zones, we're still left with 800 students," calculates Carnegie Mellon's Barkin. Even a state school like the University of Minnesota could be left with 400 to 600 stranded students.

And at Boston University, with 29,000 students, as many as 4,000 may have to remain behind because of travel restrictions, estimates Peter Schneider, the executive director of the Office of Environmental Health and Safety. A new sports arena on campus could hold large numbers of cots, he adds, although a 1,600-room dormitory complex might work better to isolate or quarantine people.

Complicating the picture are the unknowns of a mutated H5N1 virus. "The question is," asks Barkin, "will it be severe like the one in 1918, or milder like the ones in 1957 and 1968?" She is not taking chances and figures that 50 percent of those left on campus will be infected. A third of them would require infirmary level care, Barkin adds, an additional problem in an age of disappearing in-patient facilities on campus. "A lot of schools have closed their infirmaries," she says. "We're talking about reinstituting something that went by the wayside a long time ago."

Carnegie Mellon is prepared to make do with a force of five registered nurses, three nurse practitioners, and four physician's assistants, along with doctors from the university's medical center. While they would handle the most severe flu cases, volunteers who have already recovered from the flu-and have antibodies to the virus-could be trained to provide bedside care to the less ill.

The University of Minnesota, meanwhile, has an auxiliary health force already in place. Two years ago the school joined the federal Medical Reserve Corps with a 900-volunteer unit of doctors, nurses, epidemiologists, and pharmacists drawn from its professional schools. The group has already seen action in the Southern states ravaged by hurricanes Katrina and Rita. "We learned a lot from our work in Louisiana, especially the value of interdisciplinary teams," DeBoer says.

Staying in Business
For all their concern about the well-being of students, faculty, and staff, university leaders face the longer range challenge of continuing their educational and business operations. "We're a small, tuition-driven college," says Williams of Nichols College. "We can't just shut down and hand back that tuition."

With that problem in mind, Williams asked the Nichols faculty to come up with their own continuity plan in the event of a pandemic interruption, and to develop several solutions that would work across the board. The full faculty participated in two workshops during this past fall. Among their suggestions: making complete course packets for every class available through the college website; transmitting lectures via podcast; and allowing students flexibility in completing their assignments.

"It's really important for us to raise the unique issues, which include an event of long duration that may happen everywhere at once and for which we can't count on neighbors helping." -Jill DeBoer, University of Minnesota, Twin Cities
"There are a lot of really creative professors here," Williams says, "so why not take advantage? They buy into the process and that can make things a lot easier in the long run."

Richmond's Sheffield points to other sides of the business. "If you're closed for months at a time, will laboratory research-and the grants funding it-be able to continue?" he asks. "And then you have to look at who gets paid, the essential employees or everyone. And should the essential employees get paid more?"


Works in Progress
Above all, say these pandemic planners, their efforts are works in progress. "You can't figure everything out at once. You do it in stages," says Boston University's Peter Schneider. And the stages are ever evolving, notes DeBoer, who says her committee at the University of Minnesota is constantly "chipping away at action items. You mark off one, and in the process you find five additional items."

"I know some schools in their 10th, 12th, 15th revisions as new information comes along," adds Richmond's John Sheffield.

Much of that information can come from conducting pandemic simulations. Last March, Carnegie Mellon gathered its key players for a "tabletop" exercise. "We said, 'This is the scenario. What are we going to do?' " Anita Barkin explains. After their initial response, the participants continued to interact at hypothetical five-day intervals, with an eye to testing their planning, coordination, and communication.

"We debrief on what we do well, what we do not so well, and where the gaps are. Then we enhance our emergency plan to address them," says Barkin, who plans a similar drill in several months.

These universities also have begun to educate their students on the possibilities of a flu outbreak and its consequences. Carnegie Mellon distributed a campuswide e-mail announcing that the school was making an emergency plan. At the University of Richmond this past fall, health officials took advantage of the seasonal flu season to put up posters from the federal Centers for Disease Control and Prevention, promoting good cough etiquette to prevent the spread of germs. They also installed eight hand stations around campus to dispense antibacterial hand soap.

Eventually, officials at schools undergoing preparations for a health crisis say they plan to engage students actively in any evacuation plan, asking them to consider in advance how they would leave campus and what they would take with them. Students from across the country or from other countries will have to identify nearby relatives or family friends who could accommodate them. Richmond is promoting a buddy system, so that if some students cannot make it home, they can join a pre-identified fellow student closer by.

Learning from Each Other, and Going It Alone
Along the way, IHEs are working together, sharing best practices and thorny questions. "There are a lot of wheels to be invented. It's great when you don't have to invent them all yourself," says DeBoer. A year ago, Minnesota hosted a web conference for its fellow Big Ten universities, in which a representative from each school shared the main points of its emergency plan so far.

Boston University and neighboring institutions Harvard and MIT exchange information regularly. After BU prepared its blueprint for a campuswide evacuation, it shared the results. When one of the other schools investigated the use of MRE rations (the self-heating "Meals Ready to Eat" used during military campaigns), it reported back with its findings.

Still, cautions Maryland's Osteen, "no one has a boiler-plate plan of what you can do. Quite frankly, we have been carving out our own plan and what makes the most sense for us."

Resources

American College Health Association resources page,
www.acha.org/info_resources/pandemic_flu.cfm
Centers for Disease Control and Prevention, www.cdc.gov/flu/avian
U.S. Department of Health and Human Services Checklist for Colleges and Universities,
www.pandemicflu.gov/plan/school/collegeschecklist.html
World Health Organization,
www.who.int/csr/disease/avian_influenza/pandemic/en
University of Minnesota Office of Emergency Response,
www.ahc.umn.edu/about/admin/oer/pandemic/home.html
The same goes for following guidelines from the World Health Organization, Centers for Disease Control, and her own American College Health Association, admits Barkin. "There's not a ready-made plan," she says. "There are models, resources, and checklists. But your plan really has to fit your demographics."

"If you can depend only so much on the emergency plans of others in the event of a pandemic, you can expect even less from federal, state, and local government," DeBoer warns. "The principle that an area in need gets help from other jurisdictions works very well with a localized disaster. But the neighbor-helping-neighbor model may not work in this case."

That message came through loud and clear in a statewide meeting of Virginia colleges hosted by the University of Richmond last fall. "We were told, 'You're going to have to ride this out without any assistance from government agencies,' " Sheffield reports.

"Folks may not be happy with the government's saying that local communities need to take care of themselves," says Barkin. "But that's better than making promises on which they can't deliver."


And in the cases of the University of Minnesota (with its Medical Reserve Corps) and Boston University (with its location in the heart of the city), emergency planners say that the local authorities may actually come to them for help in housing and treating hardship cases.

Catching Up
Not all schools are up to speed, or even in a forward gear, though. "As I travel around, I'm surprised by the number of schools who are just getting started or thinking of getting started," says Barkin. "What I'm hearing is that there are too many unknowns. It's a lot of work, and it's hard to find the time and resources with so many other responsibilities. It's also daunting, and people don't have a lot of experience planning on this kind of scale. I tell them, 'This process can look very overwhelming, and it is. But break it up into small parts and chip away at them.' "

Sheffield was surprised at how few Virginia schools attending that fall conference had started any preparations, and he offers his own advice: "When they say, 'This is like the Y2K scare (when it was predicted that computer systems around the world would shut down),' I tell them that their planning is not going to be in vain, and that their efforts can go along way towards other emergencies."

Ron Schachter is a Boston-based freelance writer who frequently covers education.

Stocking Up
One aspect of health crisis preparation is the need to increase stocks of food and bottled water-as well as flu medications-for use during an extended siege. "Right now we have a 'just-in-time' delivery system," says Peter Schneider of Boston University's Office of Environmental Health and Safety. "That won't work." Some advice for what may work:

Consider stockpiling medicines. Since most health experts agree that an avian flu vaccine would be at least six months in the making after an outbreak begins, the first line of defense would consist of the antiviral drug Tamiflu. "Whether the human-to-human form of the virus would be susceptible to Tamiflu is anyone's guess," notes Anita Barkin, director of Student Health Services at Carnegie Mellon (Pa.). It's a pricey proposition, she points out, since each dose costs $96 and has a relatively short shelf life.

Don't forget about supplies. Institutions are already stocking up on surgical masks and higher-grade N-95 masks.

Investigate off-campus storage options. "If we're looking at six to 10 weeks, we do not have sufficient space to store that type of food," adds John Sheffield, who directs safety and risk management efforts at the University of Richmond. He is considering off-campus storage, with an emphasis on foods that will not go to waste in the absence of a pandemic.


University of Minnesota's Priority List
A committee at the University of Minnesota, Twin Cities built a plan for an avian flu strike covering these areas of concern:
1. International Travel
2. Targeted Vaccine Distribution
3. Essential Personnel, Operations, and Services
4. Surveillance and Case Investigation
5. Health Care Needs
6. Student Housing Needs
7. Communications
8. Internal Coordination
9. External Coordination
10. Providing Service to the Broader Community

    Home > Food and Health News > Deadly Avian Flu Found in UK as US Offers Pandemic Guidelines


Deadly Avian Flu Found in UK as US Offers Pandemic Guidelines
Published on: February 5, 2007


An outbreak of the deadly A(H5N1) strain of bird flu has been discovered on a turkey farm in eastern England, and the timing is ironic considering that the US government has just issued guidelines to states and communities in the US about how to deal with a severe pandemic.

"The disease has killed 2,500 turkeys near Lowestoft since Thursday, making it the biggest outbreak of the strain reported in Britain since concern about its global spread began to take root in 2003," according to a story in the New York Times. "An additional 160,000 birds will now be culled in an effort to contain the outbreak, government officials said." A six-mile radius around the farm where the disease was found has now been restricted, and the British government says it has not yet identified the cause of the outbreak.

Fred Landeg, a senior government veterinarian, tells the Times that there is no public health concern. "Avian influenza is a disease of birds and whilst it can pass very rarely and with difficulty to humans, this requires extremely close contact with infected birds, particularly feces." However, the Times also notes that "since 2003, 164 people, most of them in Asia, have died of the A(H5N1) strain, and authorities worry that the virus could easily become transmissible among humans to create a global pandemic."

The scenario in Great Britain is reminiscent of when foot-and-mouth disease was found in the UK in 2001, resulting in the mass slaughter of almost four million animals.

Ironically, the discovery in the UK comes in as the US Centers for Disease Control And Prevention (CDC) issued new flu guidelines designed to help communities deal with the possibility of any sort of severe flu pandemic while waiting for enough vaccine to be produced.

For the first time, CDC has created a model that breaks pandemics into five categories, with a Category One outbreak assuming that 90,000 Americans would die of the flu, and the worst case, Category Five, assuming that 1.8 million people have died. In an average year, about 36,000 Americans die of flu-related causes.

"We have to be prepared for a Category 5 pandemic," said Dr. Martin S. Cetron, the CDC's director of global migration and quarantine. "It's not easy. The only thing that's harder is facing the consequences. That will be intolerable."

Among the other steps that the CDC urges communities to think about is the closing of schools, the cancellation of sporting events and entertainments like movies, and, where possible, discouraging the use of public transportation, the changing of working hours so that fewer people are interacting and more people can work from home.

      Thursday, February 8, 2007





   
Avian Bird Flu Preparation
Posted on February 8, 2007

by Jan Dunlop






What you need to know to survive an avian bird flu pandemic
Avian Bird Flu has the potential to cause a major pandemic around the world, estimates are that up to 150 million people would die. The Spanish flu of 1918 killed 50 million. Most scientists now say that the question is not if but when this will occur. If Avian Bird Flu mutates so that it can be transmitted from human to human, it will probably spread rapidly. This will trigger a massive rush to secure flu vaccines, protective masks and other essential supplies.

Now is the time to act. If you get prepared ahead of time you can avoid most of the panic that will occur. Here are some simple steps you can take to ensure you are prepared:

Stock up on Flu Antiviral Drugs

According to the Center for Disease Control CDC, there are four different influenza antiviral drugs that are approved by the U.S. Food and Drug Administration (FDA) for the treatment of influenza: Oseltamivir (Tamiflu), Zanamivir (Relenza), Amantadine and Rimantadine. All four have activity against influenza A viruses. However, sometimes influenza strains can become resistant to these drugs, and therefore the drugs may not always be effective. For example, analyses of some of the 2004 H5N1 viruses isolated from poultry and humans in Asia have shown that the viruses are resistant to two of the medications (Amantadine and Rimantadine).

Purchase N95 Masks

Masks serve two purposes. First, they reduce the risk of infection from an infected person and two, they also stop the spread of infection from someone who is infected.

N95 masks are used to protect against highly transmissible respiratory infections. “N” stands for NIOSH – The National Institute for Occupational Safety and Health of the USA, and “95” reflects the filter efficiency of the mask. So “N95” indicates the mask is 95% efficient at filtering out particles of a size of approximately 0.3 microns and above. A N100 mask has a 99.7% efficiency of filtering out these small particles. Other paper or surgical masks are not suitable.

Get your Emergency Supplies in Order

Planning ahead of time will allow you to reduce your risk of exposure to the bird flu and to take better measures at protecting yourself and your family.

        RAF Lakenheath medical facilities called prepared for possible bird flu outbreak


By Sean Kimmons, Stars and Stripes
European edition, Friday, February 9, 2007



RAF LAKENHEATH, England — A top medical official at Lakenheath said Tuesday that its facilities are prepared for a pandemic influenza outbreak following the recent discovery of the potentially deadly H5N1 avian influenza — better known as bird flu — at a nearby poultry farm.

Lakenheath officials developed an installation response plan last June to assist military personnel by providing medical care, controlling chaos and preventing the spread of an outbreak. The base has the largest U.S. military hospital in the United Kingdom and regularly treats patients from other bases.

Thousands of turkeys died last week from the virus at the farm in Holton, about 55 miles east of Lakenheath. About 160,000 other turkeys have been culled and disposed of since then, according to the British Department for Environment, Food and Rural Affairs.

A 1.8-mile protection zone and a six-mile surveillance zone were emplaced around the infected farm that restricts the movement of poultry, and requires them and other captive birds to be isolated from wild birds, the agency said.

As part of Lakenheath’s response plan, various units from the base would come together to manage the outbreak, said Lt. Col. Steven Hinten, the base public health flight commander.

“There would be different avenues of approach in limiting the exposure of influenza,” he said.

Depending on the situation, the base could institute so-called social distancing, such as canceling school and other public activities, managing personnel flow in and out of the base, and advertising symptoms and prevention tips to base personnel.

On the medical side, the main thing would be tackling the patient flow, Hinten said. The hospital could set up an influenza illness clinic to separate infected personnel from other patients. The clinic would serve as a triage area to determine who is worse off than others, he said.

Last year, ABC News and The New York Times reported that if there were a worldwide avian influenza outbreak among humans, hospitals could exceed their supply of ventilators, which are used to assist the breathing of those with respiratory illnesses, such as influenza.

Hinten agreed, and said that was one of the issues discussed at Lakenheath.

“Various options have been looked at, to include possible outside support from within [Department of Defense], if available, and/or maybe even from the local civilian community,” Hinten said.

He added that there is also a possibility that ventilators in this kind of incident wouldn’t be needed.

Other Air Force bases in the U.K. have devised similar response plans after U.S. Air Forces in Europe issued a template for handling a pandemic influenza outbreak in June.

Hinten stressed that Lakenheath’s plan does not cover other bases in the U.K.; however, some outside infected personnel could seek medical care at the base if need be, he said.

“They put together their own plans as well so as to appropriately address the issues that are unique to their area,” he said. “That is something we have discussed and will adjust to if the situation presents itself.”

Hinten said he hasn’t really noticed any concerns in the base community regarding the recent bird flu findings. He believes this may be due to last year’s on-base advertising campaign.

“We provided information on bird flu through base publications, commander’s access channel and pamphlets,” he said.

He said that the pamphlets are still available inside base medical facilities.

The H5N1 virus is a highly pathogenic strand of bird flu that has been responsible for killing 165 people worldwide, in addition to countless numbers of birds. In May, cases of a low-pathogenic strand of bird flu were reported from chicken farms in Dereham, about 35 miles northeast of Lakenheath, according to news reports.

There have been no reports of humans becoming ill in this latest outbreak, but England’s Secretary of State for Environment, Food and Rural Affairs still advised bird owners to be watchful and contact authorities if they suspect disease.

Anyone who finds dead wild gulls, waders, ducks, geese or swans, as well as groups of dead birds, can report it to the DEFRA helpline on 08459 33 55 77.

For more information on avian influenza and the latest outbreak, go to www.defra.gov.uk/animalh/diseases/notifiable/disease/ai.

    Friday, Feb. 9, 2007
Businesses, agencies brace for potential flu pandemic
Giant Food among those sharing their plans at a conference on outbreak preparedness
by Kevin J. Shay | Staff Writer



In the event of a bird flu pandemic, Giant Food is ready.

The grocer, part of Dutch food giant Royal Ahold NV with regional headquarters in Landover, has spent more than a year developing a 23-page report on what the company will do if a pandemic outbreak occurs, spokesman Barry Scher said.
Among the plans: limiting store hours, closing stores, distributing masks and gloves to employees and setting up a ‘‘rumor control department,” he said.

‘‘There will be a tremendous amount of rumors if this occurs,” Scher said. ‘‘We need to think far ahead through every facet of our business.”

Scher was one of several speakers at a first-time conference on pandemic flu preparedness organized by three Montgomery County departments Wednesday. About 200 business, health and emergency preparedness officials attended the seminar at the Universities at Shady Grove in Rockville.

The Centers for Disease Control and Prevention recently issued a five-level ‘‘pandemic severity index” to help people better understand the situation.

‘‘It became clear about a year ago that we’re probably not going to be adequately prepared when the first wave of a pandemic hits,” said Dr. Michael Sauri, founder and medical director of Occupational Health Consultants, a Rockville consulting firm. ‘‘But if we harden our business and communities to the effects of pandemic flu, then we can minimize the economic impacts and social disruption.”

A pandemic flu could last months and have several cycles, according to the Maryland Department of Health and Mental Hygiene. When a pandemic begins, a vaccine will likely not be available, officials said, so business officials and others should prepare for many employees to be out sick.

Based on the CDC index, the Spanish Flu of 1918, which killed more than 500,000 Americans and 20 million people worldwide, would be considered a Category 5 flu. The 1957 and 1968 influenza pandemics would fall under Category 2, with the average seasonal flu a Category 1.

If avian influenza outbreak turns into a pandemic, the costs to businesses would be enormous, according to the World Bank Group. The Washington, D.C., organization estimates that losses to the U.S. economy in production and related costs would total from $100 billion to $200 billion. Estimates on the impact to the global economy are much higher, at some $800 billion.

The flu strain in question — the H5N1 avian influenza virus — has jumped from birds to humans since first discovered in 1997, but primarily among people who directly handle birds. The flu strain has killed at least 100 people in Asia, according to reports.

At the Rockville conference, Regina Phelps, founder of San Francisco consulting company Emergency Management and Safety Solutions, urged business executives to take steps now to prepare.

‘‘That makes good business sense,” Phelps said. ‘‘Think about what you will do if many employees are out for two weeks or more.”

At Chevy Chase insurance giant Geico, individual departments do their own planning for a possible pandemic, said Steve Martz, assistant vice president of real estate and facilities. ‘‘Some departments have begun planning, while others have not started their planning,” he said.

Geico has had a crisis team in place for decades in case of catastrophes such as Hurricane Katrina, Martz said.

‘‘A lot of our employees can work from home,” he said. ‘‘A lot of business is done over the Internet and phone, so we can keep continuity with customers as long as those systems are operating.”

While many small companies might not have the resources to spend a lot of time on such planning, they can always find help from trade associations, Scher suggested. Chambers of commerce, several of which co-sponsored the Rockville conference, are another source, Martz said. And partnering with local public health departments is essential, Phelps said.

Dealing with child care is another issue to consider, said Penny Turnbull, senior director of continuity planning and chairwoman of Bethesda hotel giant Marriott International’s pandemic preparedness task force. ‘‘A lot of employees might need to stay home if they can’t put their children in child care,” she said.

When Giant was forming its pandemic task force in 2005, some employees questioned whether it was a fruitless exercise, Scher said.

‘‘They had the Y2K syndrome,” he said, referring to the multibillion-dollar effort to prepare for a feared major computer glitch in 2000.

But everyone should take the pandemic preparations seriously, Phelps said.

Officials said they were pleased with the turnout and will review whether more pandemic conferences will be held, or another method will be used to raise awareness, said Marilyn Piety, a program manager with the Montgomery County Department of Health and Human Services.

While the topic may seem ominous, not every comment at the conference was full of doom and gloom.

‘‘It takes a lot of cavemen to come up with a plan,” Martz said, jokingly referring to some Geico television ads.

Patricia M. Murret of Capital News Service contributed to this report.

Pandemic Preparedness

U.S. Department of Health and Human Services checklist for businesses on how to prepare for a potential bird flu pandemic: pandemicflu.gov⁄plan⁄business⁄businesschecklist.html.

Montgomery County Homeland Security Department’s alert system to relay emergencies: alert.montgomerycountymd.gov.

More resources: www.montgomerycountymd.gov⁄apc,www.ems-solutionsinc.com⁄emr_pandemic.html.

    

    History teaches pandemic motto: Be prepared like a hurricane

Prepare for flu pandemic like a hurricane

Be prepared. Be knowledgeable. Do not be frightened.


Such advice is nothing new to us in Hurricane Country, but this has nothing to do with storms of the weather variety. This is about a stormy pandemic.

I refuse to be an alarmist, but I do advise that each of us be as prepared as we can be for the unknown potential enemy. If, like me, you'd sat at a newspaper microfilm machine, bleary-eyed hours on end, to research the Mississippi Coast during the Spanish influenza pandemic of 1918-19, you'd understand my advice. We shouldn't sweep an iffy modern pandemic under the rug until it rears its infectious head.

A big difference between now and 88 years ago is that communication is better and the world is getting better prepared for the eventuality that bird flu or something worse or less might rear up.

England's quick reaction to the turkey farm incident in the past week in Suffolk proves that. Now it's a wait-and-see on the effectiveness of destroying a large, infected poultry farm and treating some workers with anti-viral drugs.

The world is still on a learning curve, despite three pandemics in the 20th century in 1918, 1957 and 1968. Our own Centers for Disease Control and Prevention and the Department of Health and Human Services are taking steps to train states and first responders on what to do in a pandemic.

At the beginning of this month, a new way of reporting influenza was announced by CDC, a system much like forecasting hurricane severity with Category 1 being the least severe and Category 5 more on the line of the deadly 1918 pandemic.

Scientists and health officials around the world are watching the H5N1, the so-called "bird flu." While the disease moving from poultry to humans is rare, the World Health Organization says more than 270 people have been infected and 165 have died since 2003, mainly in Asia. No cases of human infection have been reported in Europe or the United States.

To better understand bird flu deaths, about as many Americans died of insect bites in that same time frame, and in the worldwide picture, about 4.8 million died of traffic accidents. But this is like comparing apples to oranges because a pandemic has so many unknowns.

Where will it start? What strain of influenza will it be? How long will it take from the start of the pandemic to have an effective vaccine? What are the best public measures to stop the spread?

Researchers still argue about how many lives the 1918 pandemic claimed; in fact, they still argue about where it started although most agree "Spanish flu" is a misnomer. For sure, World War I and all the American and European soldiers who moved from country to country were part of the spreading problem.

The 1918 pandemic killed at least 50 million, with at least 675,000 of those in the United States and 9,234 in Mississippi.

I had hoped my research would shed light on how many died on the Coast, but it didn't. Information was not well reported in that era, and statistics were kept close to the vest by some health officials.

On Nov. 1, 1918, The Daily Herald, forerunner to this newspaper, said:

"Official information as to the number of cases of influenza occurring in the Mississippi Coastal District has been withheld heretofore, because of fear that a certain portion of the population might be tempted to become careless if on a certain day the number of cases reported by physicians should happen to be low."

One hint at the impact appears in an October 1918 Herald, when Gulfport's daily flu counts do appear. The highest was Oct. 14 with 50 new cases and the lowest was Oct. 21 with eight. Keep in mind that was just one of 11 Coast towns.

The microfilm documents this time up close and personal, unlike history books. In the death columns, I spotted family names I recognized, among them Lopez, Stanovich and Brodie.

In 1918, Coast schools and colleges closed for six weeks, sometimes longer. Church choirs fell quiet. Many shops and businesses closed. Phones went silent when operators got sick and streetcars fell behind schedule. Many but not all public gatherings in Mississippi were canceled.

Signs warning "Influenza. Visiting forbidden to and from this house" hung on houses. A shortage of masks, which the Red Cross advised, was obvious.

The old microfilm articles hint at basic steps we might take today. In your flu preparedness kit, which could simply be more items added to your hurricane kit (nonperishable food, batteries, radio, etc.), you might add nose-mouth masks and not expect the government or stores to have enough.

At least on one front, we should be a few steps ahead of other regions. Our experiences with Katrina taught us firsthand the importance of survival kits.


--------------------------------------------------------------------------------
Kat Bergeron can be reached at 896-2309 or at kbergeron@sunherald.com.

read in full here....   http://www.influenzareport.com/ir/overview.htm   Pandemic Prophylaxis The problem with a new pandemic influenza strain is that there is no hiding place on earth. Virtually any single human being will eventually become infected with the new virus, be it the beggar from Paris or the President of a wealthy western country. If you don't get the virus during the first wave of the pandemic, you'll probably get it during the second. And if you don't get it during the second wave, you will get it during one of the future epidemics. If a novel pandemic influenza strain takes over as the driver of influenza disease in humans, everyone needs to mount a protective antibody response against the virus - simply because the virus is bound to stay with us for many years. Antibodies will provide some protection against the new influenza strain, but to develop antibodies you have to either be infected or vaccinated. For the vast majority of the 6.5 billion living human beings, there will be no vaccine available any time soon after the arrival of a new pandemic influenza virus. Once a new virus has been shown to be effectively transmitted among humans, it will take approximately 6 months to start the production of the corresponding vaccine. Thereafter, vaccine supplies will be exquisitely inadequate, and years will be needed to produce enough vaccine for 6.5 billion people. In addition, production capacities are concentrated in Australia, Canada, France, Germany, Italy, Japan, the Netherlands, the United Kingdom, and the United States, and vaccine distribution can be expected to be controlled by the producing nations (Fedson 2005). We can all imagine who will be served first. It is therefore reasonable to assume that the vast majority of people living today will have no access to either vaccine or antiviral drugs for many, many months. With no vaccine available or vaccine arriving too late, individuals might wish to work out strategies to deal with a pandemic situation. To confront or to avoid - that will be the question many people will ask themselves. Simply confronting a new pandemic virus and hoping for a happy outcome, leaves the problem of timing. Indeed, there is conflicting evidence about the most adequate moment for getting infected: In the 1918 epidemic, the first wave which occurred during the spring months, was less deadly than the second, autumn wave (Barry 2004). It is reasonable to believe that people infected during the first wave had some protection during the second wave. That would speak in favour of confronting a new influenza strain as fast as possible. However, more detailed data from the second wave in 1918 suggest the contrary: the later someone got sick in the course of the second wave, the less likely he or she was to die, and the milder the illness tended to be (Barry 2004). Cities struck later generally suffered less, and individuals in a given city struck later also tended to suffer less. Thus, the West Coast American cities, hit later, had lower death rates than the East Coast cities; and Australia, which was not hit by the second wave until 1919, had the lowest death rate of any developed country (Barry 2004). A commonly observed phenomenon in infectious diseases is that pathogens become less virulent as they evolve in a human population. This would favour the second option, i.e., of avoiding a new influenza virus for as long as possible. An additional advantage of this choice is that several months after the start of the pandemic, the initial chaos the health systems will inevitably face during a major outbreak, will have at least partially resolved. The most extreme option of avoiding influenza would be to flee to remote areas of the globe - a mountain village in Corsica, the Libyan Desert, or American Samoa (Barry 2004). That might work but it might not. If the direct and unprotected confrontation with the new virus becomes inevitable, some protection is still possible: face masks (but: will masks be available everywhere? and for how long?) and social distancing (don't go to meetings, stay at home as much as possible) - but what if you are working as a cashier in a crowded Paris supermarket; as a metro driver in London's tube; as a clerk in Berlin's central post office?. Where will you get money from if you don't go to work for several months? Can you retire from the world? Can you retire from life? Pandemic Treatment We don't know whether the next pandemic influenza strain will be susceptible to the currently available antiviral drugs. If it is caused by a H5N1 virus, the neuraminidase inhibitors oseltamivir and zanamivir may be critical in the planning for a pandemic (Moscona 2005). Again, most people on earth will not have access to these drugs. They are in short supply and production capacities cannot easily be built up. Even in countries which have stockpiled oseltamivir, distribution of a drug that is in short supply will pose considerable ethical problems for treatment. In some countries with pronounced wealth disparities (i.e., some African and Latin American countries; the U.S.), social unrest can be anticipated. Experience in treating H5N1 disease in humans is limited and the clinical reports published to date include only a few patients (Yuen 1998, Chan 2002, Hien 2004, Chotpitayasunondh 2005, WHO 2005, de Jong 2005). In particular, the optimal dose and duration of oseltamivir treatment is uncertain in H5N1 disease, and the following preliminary recommendations have been proposed (WHO 2005): Start treatment with oseltamivir as soon as possible. As H5N1 infections continue to have a high mortality rate, consider treatment even as late as 8 days after onset of symptoms, if there is evidence of ongoing viral replication (WHO 2005, de Jong 2005) Consider increasing the dose of oseltamivir in severe disease (150 mg twice daily in adults) and continue treatment for longer periods (7-10 days or longer) (WHO 2006d) Although oseltamivir is generally well tolerated, gastrointestinal side effects in particular may increase with higher doses, particularly above 300 mg/day (WHO 2006d). For more details, check Hoffmann 2006b.   Global Management The management of an influenza outbreak is well-defined for epidemics, and less well-defined for pandemics. Epidemic Management The cornerstone of medical intervention in interpandemic years is vaccination (see summary at CDC 2005). As influenza viruses mutate constantly, vaccine formulations need to be re-examined annually. Vaccine production is a well-established procedure: throughout the year, influenza surveillance centres in 82 countries around the world watch circulating strains of influenza and observe the trends. The WHO then determines the strains that are most likely to resemble the strains in circulation during the next year's winter seasons, and vaccine producers start vaccine production. The decision on the composition of the next "cocktail" is made each year in February for the following northern hemisphere winter (WHO 2006b) and in September for the following southern hemisphere winter (for more details, see Korsman 2006 and the figure at http://influenzareport.com/link.php?id=15). Predicting the evolutionary changes of the viral haemaglutinin is not easy and not always successful. In years when the anticipated strain does not match the real world strain, protection from influenza vaccine may be as low as 30 %. Pandemic Management - See also Reyes-Terán 2006 and WHO 2006c - Serious influenza pandemics are rare and unpredictable events. Managing unedited situations requires some appreciation of the magnitude of the problems that lie ahead. The impact on human health may be highly variable and is expressed in the number of infected individuals clinically ill individuals hospitalised patients deaths. It is generally assumed that during the first year of the next pandemic 2 billion people will become infected with the new virus and that half of them will have symptoms. Less accurate are the estimates of the number of people that will require hospitalisation and the death toll. During the 1957 and 1968 pandemics, the excess mortality has been estimated at around one million deaths each. In contrast, 50 million individuals are thought to have died from the 1918 influenza pandemic. Excess mortality during the last influenza pandemics varied from 26 to 2,777 per 100,000 population (Table 2). Adjusted for today's world population, these figures would translate into 1.7 million to 180 million deaths. Table 2: Death toll in 20th century pandemics and projections for the next pandemic *   Population Death Toll per 100,000 people 1918 1.8 billion 50 million 2,777 1957 3.8 billion 1 million 26 1968 4.5 billion 1 million 27 Next 6.5 billion 1.7 million 26 Next 6.5 billion 180 million 2,777 According to data from http://www.census.gov/ipc/www/world.html + http://Influenzareport.com/link.php?id=20 In countries such as France, Spain and Germany, the yearly mortality from all causes is around 900 deaths per 100,000 population. A devastating pandemic might therefore, in the course of only a few months, cause three times as many deaths as would normally occur in an entire year. Indeed, social and economic disruption would occur in all countries to varying extents. In a world of extensive mass media coverage of catastrophic events, the resulting atmosphere would probably come close to war-time scenarios. In contrast, a mild pandemic similar to the 1968 episode would go nearly unnoticed and without considerable impact on national healthcare systems and on the global economy. The concern that the world might be in for a revival of the 1918 scenario is based on the observation that the currently spreading H5N1 virus shares disturbing characteristics with the virus of the 1918 pandemic (Taubenberger 2005). However, if H5N1 is to be the candidate virus for the next devastating influenza pandemic, why has it not yet acquired the ability to spread easily between humans? Over the past years, H5N1 has had both the time and opportunities to mutate into a pandemic strain. Why hasn't it? And if it hasn't in nearly 10 years, why should it do so in the future? It is true that of the 16 influenza H subtypes, only three (H1, H2 and H3) are known to have caused human pandemics (1918, 1957, 1968, and probably 1889 [Dowdle 2006]), and it has even been hypothesised that H5 viruses are inherently incapable of transmitting efficiently from human to human. Shall we one day discover that H5 viruses are not good for human pandemics, because not all possible subtypes can reassort to form functional human pandemic strains? We don't know. Apart from stepwise mutations that transform an avian influenza virus into a human influenza virus, reassortment is the second way in which new pandemic viruses are generated. The two pandemics that were triggered by this phenomenon occurred in 1957 and in 1968. Both were relatively mild and fundamentally different from what happened in 1918. There is some preliminary experimental evidence that reassortants of the 1918 virus might be less virulent than the co-ordinated expression of all eight 1918 virus genes (Tumpey 2005). Does that mean that pandemics resulting from reassortment events of a human and an avian virus are milder than pandemics caused by a virus which slowly accumulates mutations in order to "migrate" from water fowl hosts to human hosts? We don't know. The revival of the 1918 catastrophe might also never happen. But the 1918 influenza pandemic did occur, and good planning means being prepared for the worst. As it is impossible to predict whether the next pandemic will result in ~20 or ~2,000 deaths per 100,000 people, the international community should prepare for the 2,000 figure. The three defence lines are containment, drugs, and vaccines. Containment Containment and elimination of an emergent pandemic influenza strain at the point of origin has been estimated to be possible by a combination of antiviral prophylaxis and social distance measures (Ferguson 2005, Longini 2005). To this purpose, the WHO has recently started creating an international stockpile of 3 million courses of antiviral drugs to be dispatched to the area of an emerging influenza pandemic (WHO 20000824). If the pandemic cannot be contained early on during an outbreak, rapid intervention might at least delay international spread and gain precious time. Key criteria for the success of this strategy have been developed (Ferguson 2005). However, the optimal strategy for the use of stockpiled antiviral drugs is not known, because stopping a nascent influenza pandemic at its source has never before been attempted. Drugs Once a pandemic is under way - and vaccines have not yet become available - national responses depend on the availability of antiviral drugs. As demand for the drug will exceed supply, stockpiling of antiviral drugs, either in the form of capsules or the bulk active pharmaceutical ingredient, has been considered a viable option by some governments. The debate over which drugs should be stockpiled is not over. Until now, mainly oseltamivir has been used to constitute stockpiles of neuraminidase inhibitors. After the recent isolation of oseltamivir-resistant isolates in serious H5N1 infection, other antiviral agents to which oseltamivir-resistant influenza viruses remain susceptible, should be included in treatment arsenals for influenza A (H5N1) virus infections (de Jong 2005) - in other words: zanamivir. The value of adamantanes for stockpiling is less clear. H5N1 isolates obtained from patients in China in 2003 and in one lineage of avian and human H5N1 viruses in Thailand, Vietnam, and Cambodia were resistant to adamantanes (Hayden 2006). However, isolates tested from strains circulating recently in Indonesia, China, Mongolia, Russia, and Turkey appear to be sensitive to amantadine (Hayden 2005). With regard to the economical impact, there is some evidence that even stockpiling of the costly neuraminidase inhibitors might be cost-beneficial for treatment of patients and, if backed by adequate stocks, for short-term postexposure prophylaxis of close contacts (Balicer 2005). When comparing strategies for stockpiling these drugs to treat and prevent influenza in Singapore, the treatment-only strategy had optimal economic benefits: stockpiles of antiviral agents for 40 % of the population would save an estimated 418 lives and $414 million, at a cost of $52.6 million per shelf-life cycle of the stockpile. Prophylaxis was economically beneficial in high-risk subpopulations, which account for 78 % of deaths, and in pandemics in which the death rate was > 0.6 %. Prophylaxis for pandemics with a 5 % case-fatality rate would save 50,000 lives and $81 billion (Lee 2006). Once a pandemic starts, countries without stockpiles of antiviral drugs will probably be unable to buy new stocks. In this context it has been suggested that governments provide compulsory licensing provisions, permitting generic manufacturers to start producing antivirals locally under domestic patent laws or to import them from generic producers at affordable prices (Lokuge 2006). In Europe, some governments are trying to build up stocks of the neuraminidase inhibitor oseltamivir for 25 % of the population. The number of treatment doses required to achieve this degree of "coverage" are based on the daily standard treatment course of 75 mg bid for 5 days. However, if doses twice as high, prescribed over a period twice as long (WHO 2005, WHO 2006d) should turn out to be required in a substantial number of patients, a stockpile planned for 25 % of a population might melt away more rapidly than expected. For detailed information about drug treatment of influenza, see Hoffmann 2006b. Vaccines In an ideal world, we would have 6.5 billion vaccine doses the day after the pandemic starts; in addition, we would have 6.5 billion syringes to inject the vaccine; and finally, we would have an unlimited number of health personnel to administer the vaccine. We don't live in an ideal world. At present, the world has a production capacity of about 300 million trivalent influenza vaccines per year, most of which is produced in nine countries (Fedson 2005). 300 million trivalent influenza doses translate into 900 million univalent doses, enough to vaccinate 450 million people with an initial vaccination and a booster dose - if the H5N1 vaccine is sufficiently immunogenic... Influenza vaccines are currently prepared in fertilised chicken eggs, a process which was developed over 50 years ago (Osterholm 2005). New technologies may one day be able to develop vaccines more (Palese 2006). A dream vaccine would provide broad-spectrum protection against all influenza A subtypes (Neirynck 1999, Fiers 2004, De Filette 2006), but these vaccines are experimental and years away from industrial production. Distribution When drug and vaccine supplies are limited, healthcare authorities have to decide who gains access to the drugs and vaccines. Who should receive short-supply vaccines and antivirals first: young people or the elderly (Simonsen 2004)? If the standard used to measure effectiveness of medical intervention was "numbers of deaths prevented," then perhaps the elderly should be given priority - assuming they can produce an adequate antibody response to the pandemic vaccine. But if the concern is to minimise the years-of-life-lost, then the vaccine may be better used in young and middle-aged adults (Simonsen 2004). The Australian Government has acknowledged that, in the event of a pandemic, its own stockpile of antivirals will be limited and reserved for those on a confidential rationing list (Lokuge 2006). Who are they? Physicians, fire fighters, police forces - or politicians and other VIPs? Experts urge that a framework for determining priority groups be developed prior to the start of a pandemic and that such a scheme should be agreed on beforehand and be flexible enough to adapt to the likely level of disaster at hand (Simonson 2004). Conclusion The good news from epidemiological research is that past pandemics gave warning signs. In the spring of 1918, a pandemic wave occurred 6 months before the second deadly autumn wave (Olson 2005). The Asian H2N2 influenza virus was characterised by early summer, 1957, but significant mortality in the United States did not occur until October - and in 1968, the pandemic wave of mortality in Europe peaked a full year after the pandemic strain first arrived (Simonson 2004). Epidemiological studies of the 20th century pandemics offer some insight into what can be expected when the next influenza pandemic occurs (Simonson 2004): Mortality impact is difficult to predict, but a shift to younger ages is highly likely and people under 65 years of age will account for a high proportion of these deaths. Pandemic influenza is not always like a sudden storm, followed by a return to clear skies. Instead, mortality rates can remain elevated for several years - during which time an effective vaccine would be in high demand. In all three pandemics in the twentieth century, the majority of associated deaths occurred 6 months to a year after the pandemic virus first emerged, suggesting that intense and timely surveillance of both age-specific mortality and new influenza viruses could provide sufficient time for production and distribution of vaccines and antivirals to prevent much, if not most, of the mortality impact. The next pandemic will come, but we do not know when. We do not know how severe it will be. Will it be mild like the last two pandemics of 1968 and 1957, when the new pandemic strain resulted from the reassortment of the pre-existing human strains and an avian influenza strain? Or will it be as catastrophic as the 1918 pandemic? Only the future will tell. Let's be prepared!

Golden Links Influenza. Special Issue of the Journal of Emerging Infectious Diseases, 2006. http://www.cdc.gov/ncidod/EID/vol12no01/contents_v12n01.htm Pandemic Influenza: Confronting a Re-emergent Threat. Special Issue of the Journal of Infectious Diseases, 1997. http://www.journals.uchicago.edu/JID/journal/contents/v176nS1.html   Interviews Interview with Dr. Jeffrey Taubenberger. Spanish and avian flu pandemics. Nature Podcast, 6 October 2006 - http://www.nature.com/nature/podcast/v437/n7060/nature-2005-10-06.mp3 Interview with Dr. Frederick Hayden on antiviral resistance in influenza viruses. 23 February 2006 - http://content.nejm.org/cgi/content/full/354/8/785/DC1 Interview with Dr. Anne Moscona on the clinical implications of oseltamivir resistance. 22 December 2005 - http://content.nejm.org/cgi/content/full/353/25/2633/DC1 Interview with Dr. Michael Osterholm on preparing for an influenza pandemic. 5 May 2005 - http://content.nejm.org/cgi/content/full/352/18/1839/DC1   References

    'All schools may have to close if outbreak'
By Charles Clover, Environment Editor
Last Updated: 1:56am GMT 13/02/2007



Every school might have to close within three weeks of a human-to-human outbreak of bird flu anywhere in the world, one of the country's leading experts on epidemics warned yesterday.

Prof Sir Roy Anderson, who advised Tony Blair throughout the foot and mouth epidemic, said Britain would have very little time to take the decisions that could save the lives of millions in the case of a global pandemic.

He said that key strategic issues, including considering the closure of schools and work places, would have to be taken in the first three weeks. Even the shaking of hands would have to be looked at.

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But Sir Roy, from the faculty of medicine, Imperial College London, questioned whether a call to close schools would be universally accepted.

"We would have to look at the economic implications of that," he said. "If we close schools and children stay at home, are we going to bring the country to its knees? We have to look at various aspects of society.

"My view is that we would have to consider it if the virus is very, very pathogenic."

But restricting air travel to this country would be "a waste of time" and hugely costly, Sir Roy told a conference at the Royal Society of Medicine in London.

He said: "You would have to close borders instantly. The effort of spending money on that is questionable."

Scientists at Imperial College have discovered that the most effective control measures are restricting social and work activities, simple sanitary procedures — including washing hands, not shaking hands and wearing masks — and the isolation and rapid treatment of families who get the virus.

Sir Roy said models showed that rapid isolation and the treatment of individuals who get the virus and their families "may be able to contain" the spread of the virus.

He said this would slow down the spread of an epidemic and buy time for a vaccine to be isolated and developed.

The conference heard that the disease is still one or two stages away from becoming a disease that passes readily from human to human.

Some scientists believe that it may never do so. But Sir Roy said it would be folly to take the risk.

If Britain got a human-to-human influenza virus of the kind that devastated the world in 1918, "actions must be uniform" around the country.

"Logistics will be everything," Sir Roy said. "I do not think people have got to grips with the magnitude of this problem."

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/02/13/nbflu113.xml

we are good... several on here mentioned how fast we need to act.

    Prepare for pandemics or perish
Plan needed in event of major disease outbreak, local businesses warned
By BRUCE ERSKINE Business Reporter
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Businesses that don’t prepare for pandemics could be wiped out, says Julie McCashin, vice-president of health services with International SOS Assistance Inc.

"It could mean going out of business; it’s that simple," Ms. McCashin said in an interview in Halifax on Tuesday after giving a presentation at the Halifax Club on the threat of pandemics and how businesses can cope with them.

"If your job is to deliver a service or a product and you can’t do that in the course of the pandemic, you’ll lose contracts, you’ll lose revenue and you would expect a number of businesses would go out of business."

Pandemics are defined as diseases affecting whole countries or the entire world. The last global pandemic was the Spanish influenza of 1918, which killed millions.

While there hasn’t since been a pandemic on that scale, recent outbreaks of avian flu in Europe have raised alarms about the possibility of a new pandemic that could affect whole populations and the businesses they support.

"The best way to try to avoid that is to try to come up with a system to meet your contractual obligations," said Ms. McCashin, whose firm provides medical and security services to businesses in 68 countries and employs about 4,500 people.

Ms. McCashin, who is based in Houston, has helped develop pandemic contingency plans for banks and oil companies. She said companies need to prepare for high levels of absenteeism during a pandemic.

"Some models predict up to 50 per cent of employees won’t come to work either because they’re ill themselves, caring for an ill family member, afraid to leave home," she said, adding that parents might have to stay home with their children if schools are closed.

"They have to come up with mechanisms for coping and continuing to operate critical functions with that level of absenteeism."

Businesses can do that, she said, by identifying those critical functions; by training employees to fill in for absent co-workers; by looking at ways to shift activities to less-affected business areas; and by trying to reduce the number of ill employees by giving them respiratory hygiene training or letting them work from home.

Ms. McCashin said businesses have become more aware of the need to *********s, largely because of the impact of the Sept. 11, 2001, terrorist attacks in the United States.

"I’ve worked a lot with the banking sector," she said, noting that International SOS, which according to the company’s website was co-founded by a French doctor in 1985, has helped more than 100 companies draft pandemic plans.

"They got caught off guard by 9-11. They lost a lot of data, they lost personnel, they lost history and if a pandemic hits, they don’t want to be in the same position," she said.

"They know that by planning, they will be in a better position to manage and keep the company alive."

Dana Mills, the firm’s Halifax-based Atlantic regional sales director, said dealing with a pandemic is a long-term process that can only benefit from advanced planning.

"This is something that will be experienced over the span of 18 months or longer," she said, adding that the firm has no regional clients to date. "You can’t decide who is going to be sick and who isn’t."

( berskine@herald.ca)

’If your job is to deliver a service or a product and you can’t do that in the course of the pandemic, you’ll lose contracts, you’ll lose revenue and you would expect a number of businesses would go out of business.’

http://www.thechronicleherald.ca/Business/559001.html