MedPrep Influenza Updates

Japan update and packages

2011-03-17T14:31:00.002-04:00

Japan update and Japanese packages

Dr. Stuart B. Weiss

Information UPDATE

March 17, 2011

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Quick update and an interesting question about packages from Tokyo

I received an interesting question today about concerns employees in the US have when receiving packages from Tokyo. So I reached out to a reliable nuclear expert to find out if people should be concerned.

Current Situation summary:

Problems continue at the Fukushima Daiichi facility. Restoration of electrical power to the site is still being worked on. Off-site electrical power has not been available at the site since the earthquake and Tsunami on March 11. Restoring electrical power to the water pumps would significantly help cool things down. Helicopters are being used to drop water onto the reactors and spent rod pools.
One interesting item mentioned by the nuclear expert is that the explosions seen on television are not close to the pumps and valves and besides blowing the tin roof off the building might not have done much other damage. So if they can get the water flowing, things will improve.
Here is additional information from the Nuclear Energy Institute for this morning:

Reactor 1's primary containment is believed to be intact and the reactor is in a stable condition. Seawater injection into the reactor is continuing.

Reactor 2 is in stable condition with seawater injection continuing. The reactor's primary containment may not have been breached, Tokyo Electric Power Co. and World Association of Nuclear Operators officials said on Thursday.

Access problems at the site have delayed connection of a temporary cable to restore off-site electricity. The connection will provide power to the control rod drive pump, instrumentation, batteries and the control room. Power has not been available at the site since the earthquake on March 11.

Reactor 3 is in stable condition with seawater injection continuing. The primary containment is believed to be intact. Pressure in the containment has fluctuated due to venting of the reactor containment structure.

TEPCO officials say that although one side of the concrete wall of the fuel pool structure has collapsed, the steel liner of the pool remains intact, based on aerial photos of the reactor taken on March 17. The pool still has water providing some cooling for the fuel; however, helicopters dropped water on the reactor four times during the morning (Japan time) on March 17. Water also was sprayed at reactor 4 using high-pressure water cannons. [Reactor 4 was already shut down for maintenance prior to the earthquake]
Reactors 5 and 6 were both shut down before the quake occurred. Primary and secondary containments are intact at both reactors. Temperature instruments in the spent fuel pools at reactors 5 and 6 are operational, and temperatures are being maintained at about 62 degrees Celsius. TEPCO is continuing efforts to restore power at reactor 5.

ANALYSIS:

According to the expert I spoke with today, the cause of the increase in background radiation in Tokyo is thought to be from radioactive gases not particulate matter. Whatever particles have been released from the Fukushima plant would settle out on the ground long before reaching Tokyo. So there is no risk of being exposed to significant radiation from boxes or packages coming from Tokyo. Of course, if you are receiving packages from places closer to Fukushima, there is more risk of actual particles being in the box.

ADVICE:

So here is my advice to you at this point:

Make sure that someone keeps watching this situation.
Assure employees that packages from Tokyo are safe at this time. Packages from areas closer to Fukushima are more significant. I have reached out to experts about these types of packages and what, if any, monitoring can be done to ensure safety. I'll send an update when/if I hear any definitive.

MedPrep Consulting Group is internationally recognized as a leader in pandemic, disaster and business continuity planning, training and exercising.

Stuart Weiss, MD, CBCP is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, FACEP, CBCP
MedPrep Consulting Group LLC

212-875-8888

sweiss@MedPrepGroup.com

Japan and Potassium Iodide

2011-03-16T15:41:00.001-04:00

Radiation and Potassium Iodide

Dr. Stuart B. Weiss

Information UPDATE

March 16, 2011

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People on the west coast of the US and Canada are snapping up Potassium Iodide pills and solutions, should you?

We haven't sent out a general mailing to this list in over a year but I thought now might be a good time due to the ongoing events in Japan and the fear it is causing in the US and Canada.

Current Situation summary:

All four reactors at the Fukushima Daiini facility are shut down safely and cooling operations are being maintained.
The problems are at the Fukushima Daiichi facility. Restoration of electrical power to the site was under way as of 6:00 a.m. EDT today. Off-site electrical power has not been available at the site since the earthquake on March 11. Reactors 1, 2 and 3 at the plant are being cooled with seawater mixed with Boron. There is some level of uranium fuel damage at all three units, and containment structure damage is suspected at reactor 2. Before the earthquake, reactor 4 had been in maintenance mode and was completely defueled. Attempts to provide cooling water to the used fuel pool at reactor 4 by helicopter were not successful. Preparations are being made to inject water into the fuel storage pool using a high-capacity spray pump. There have been two fires inside the reactor containment building at reactor 4, but they have been extinguished. Although the reactor containment building at Unit 4 was damaged, the primary containment vessel remains intact.
According to Reuters, the United States is urging its citizens within 80 kilometers (50 miles) of Japan's Fukushima nuclear power plants to evacuate or remain indoors. The U.S. Embassy in Tokyo had previously recommended U.S. citizens to take similar action if they were within 50 kilometers of the facilities. The United Kingdom is also urging its nationals in Tokyo and north of Tokyo to leave the area.
Radiation levels in Tokyo, 150 miles to the south, are elevated but still below levels considered dangerous to human health.
The situation is still unstable and evolving in the Fukushima Daiichi facility.
There has been a spike in purchases of Potassium Iodide (KI) pills and solution (SSKI) in communities in the West Coast of the US and Canada as reported in multiple media sources.

ANALYSIS:

The situation in Japan continues to evolve and our thoughts and prayers go out to the people of Japan as they go through this difficult crisis.

I want to focus on the issue of the radiation risk to people in the US and the use of Potassium Iodide. With 5000 miles of ocean separating the US and Japan, the risk of ANY significant amount of radiation coming to the US from Japan is almost zero. Something extremely bad (i.e. a huge prolonged radioactive material release) would have to occur and even then, the risk is still low. We are exposed to radiation everyday in our normal lives from our environment, it is a part of living on Earth and our bodies cope with this low level of radiation. So while it is understandable that people would be apprehensive about something like radiation which you cant see, smell or taste, the fear that people in the US would be affected is unfounded right now.

So what does Potassium Iodide have to do with this? One of the early materials that is released from a reactor accident is radioactive Iodine. This material gets into the air, food or water and can be absorbed by our body. Once inside our body, the Iodine is absorbed by the thyroid gland and sits there causing thyroid damage and thyroid cancer. Our thyroid gland absorbs Iodine all the time to make thyroid hormone and it can't tell the difference between normal Iodine and radioactive Iodine. So the idea of Potassium Iodide is to "fill up" the thyroid with normal Iodine so it doesn't want to absorb any more Iodine that comes into our body (radioactive or normal). You have to fill it up quickly which is why people have to take Potassium Iodide within several hours of a reactor accident.

Potassium Iodide only protects the thyroid gland and nothing else so if you are exposed to huge doses of radiation, you would still get sick.

Potassium Iodide has side effects like any other medication. In a nuclear emergency, the benefits of taking it outweigh the risk of any possible side effects. In the US right now, there is NO RADIATION RISK from Japan so the benefits of taking it are zero and risks of side effects are still there. Side effects range from mild stomach upset to life threatening allergic reactions. You are also susceptible to thyroid problems. That is why people in the US should not be taking Potassium Iodide unless prescribed by a doctor for another problem.

So the bottom line is if you want to buy Potassium Iodide to keep in your home, go ahead. It is an over-the-counter medication in the US. But don't take it unless advised to by public health and keep it and all medications away from young children. Don't spend hundreds of dollars on buying it either, there is no crisis in the US (some media are reporting price gouging for Potassium Iodide, it is a cheap medication).

Lastly, this does not apply to any employees or families in Japan. Depending on where they live and how old they are, recommendations are different and they should be following the local public health guidance.

ADVICE:

So here is my advice to you at this point:

Make sure that someone keeps watching this situation.
Discourage your employees from buying and taking Potassium Iodide at this time.
Consider publishing some information for your employees. The CDC has good information on Potassium Iodide.

MedPrep Consulting Group is internationally recognized as a leader in pandemic, disaster and business continuity planning, training and exercising.

Stuart Weiss, MD, CBCP is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update - January 28

2010-01-28T18:16:00.000-05:00

Pandemic H1N1 Update
Dr. Stuart B. Weiss

INFLUENZA UPDATE

Jan 28, 2010

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We seem to have dodged the pandemic bullet for now so what should you be doing?

Pandemic H1N1 activity in the U.S. and around most of the world continues to decline. There are still areas with widespread influenza activity (North Africa and South Asia) but activity in the U.S. is LESS than a normal seasonal year.

Current Situation:

In the CDC briefing last week, it was reported that most signs of flu activity in the U.S. are declining with no states reporting widespread activity and only 7 reporting regional flu activity. Current rates of outpatient visits for flu are at 1.8%. There were nine pediatric influenza deaths that week and seven the week before.
The WHO reports that influenza activity is decreasing in much of the world with intense activity remaining in South Asia and North Africa.
The inevitable finger pointing has begun with various groups accusing the WHO of being influenced by vaccine manufacturers and for instigating a "fake" pandemic. The WHO has vigorously denied any wrongdoing (see below for comments).

Vaccine: Several countries are either reducing their vaccine orders or trying to get out of existing vaccine purchase contracts as unused amounts of vaccine pile up. Governments around the world are trying to encourage people to get vaccinated. In Mexico City, they began to offer vaccination in the 26 busiest subway stations. College and Universities in the U.S. have vaccine but its been an uphill battle getting students to come in to be vaccinated.
A study published last week in the British medical journal Lancet found that 10 times more young people had been infected with the H1N1 pandemic virus during the first wave than had been picked up by traditional surveillance. The researchers also found the many more older people had pre-existing antibodies. The may explain the mild pandemic experience we are having.
The CDC warned people not to be fooled like they were in the 1957 pandemic when it was declared over in Dec-Jan 1957 only to return a few months later with increased numbers of deaths.

ANALYSIS:

Its been an interesting few weeks. It seems that we are not only having mild pandemic flu season but actually this flu season is turning out to be more mild than even a normal flu season. The CDC reported the usual outpatient visits to a doctor for ILI (Influenza-like Illness) during a flu season is 2.3% and we are experiencing only 1.8%. Who could have predicted that. Its no wonder that we don't hear about H1N1 anymore and that the finger pointing has begun. I have to say that the accusations of a "false" or "fake" pandemic are completely incorrect. This was and is a pandemic and we have luckily dodged the pandemic bullet probably having to do with what the British study found. Looking back at the WHO's behavior, I have to say that if anything, they delayed announcing a pandemic in order to be absolutely certain. If you think back to my Pandemic Alerts from the spring, I was saying the new disease had reached pandemic status weeks before the official WHO announcement. Its also important to remember that there are significant lead times on vaccine development and actions governments can take so public health officials are constantly looking to be proactive. I am not sure where all this finger pointing will go but it seems completely unjustified.

The British study is interesting and may be the reason that we are seeing such a mild January. When they looked at the number of people who had antibodies to H1N1 (2009) they found ten times as many as were reported by surveillance. Surveillance only picks up people who seek medical care so there must have been a huge population of people who had mild or minimal symptoms and never sought medical care. This huge population of people is now immune. In addition, they found that more older people than previously thought had pre-existing antibodies. Since the virus has not mutated significantly, the combination of the two factors has led to a large number of people who can not catch this disease and has caused it to wane.

The bottom line here is that we have been lucky so far. Influenza viruses are notorious for mutating and this one has not. Influenza viruses don't usually cause large numbers of people to have minimal or no symptoms of infection, this one apparently has. But, the winter flu season is not over. Folks in 1957 were fooled by a mild December-January and the virus came back with an increased mortality.

Many of our clients are taking this opportunity to ask us to help them review their infectious disease plans to incorporate lessons learned and look for gaps. They realize that although we may have dodged the bullet this time, something else will pop-up. We also continue to help clients develop new and more useful triggers for their corporate response. On the other hand, a few of our clients have disbanded their pandemic teams and have taken their eye completely off this ball. That is a mistake that I hope you will not make.

ADVICE:

So here is my advice to you at this point:

Make sure that someone keeps watching this situation. It is too soon to declare this over.
De-escalate your response for the moment. You may want to decrease the frequency of conference calls or meetings but do not disband your pandemic team. Keep them in the loop until the Spring when we can say with certainty that flu is over for the time being.
Use this opportunity to learn from what you have done and augment your current infectious disease plans and update your triggers, if need be,
Develop an after action report reviewing actions taken since last April to help you with future infectious disease outbreaks.
Keep your eye on H5N1 as it continue to be a problem in parts of the world.

TOOLS:

We are infectious disease planning experts and can assist you with your infectious disease / pandemic flu plan development and analysis. We are one of the few physician led firms that bridge the gap between business continuity and disaster medicine. I am proud to have both an MD and CBCP after my name. So send me an email or call if you think we can assist you. My team would be happy to develop a very reasonable proposal for a plan review and after action report. I can be reached at sweiss@MedPrepGroup.com or call us at 212-875-8888.

MedPrep Consulting Group is internationally recognized as a leader in pandemic, disaster and business continuity planning, training and exercising. We have resources and expertise that you can count on. Ask us about our Virtual Medical Director Program for companies without in-house medical direction.

Stuart Weiss, MD, CBCP is the CEO of MedPrep Consulting Group. For more information, visit http://rs6.net/tn.jsp?t=6oilehdab.0.k8wpj8cab.ksb4ircab.0&ts=S0452&p=http%3A%2F%2Fwww.medprepgroup.com%2F

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update - December 21

2009-12-21T21:56:00.000-05:00

Pandemic H1N1 Update

Dr. Stuart B. Weiss

INFLUENZA UPDATE

Dec 21, 2009

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Influenza activity contines to fade down to seasonal levels in the U.S.

Pandemic H1N1 activity in the U.S. and around most of the world continues to decline with some notable exceptions, namely India and parts of the Russian Federation.

Current Situation:

The CDC confirmed that the number of states reporting widespread influenza activity continues to decrease, from 14 states down to 11. The number of people visiting physicians in the US for influenza-like illness has decreased again this week. The number of pediatric deaths has decreased as well.

The WHO reports that influenza activity has decreased or plateaued in much of the world with some exceptions:
- Europe: Activity is declining across Europe except in parts of southeast Europe and the Russian Federation.
- Asia: East - transmission remains active but declining. West & Central Asia - Increasing activity in Kazakhstan and Kyrgyzstan. Activity in the Middle East have peaked.
- Southeast Asia: India, Nepal, Sri Lanka and the Maldives continue to show increasing flu intensity.
- Africa: Limited data shows continued activity across the continent (except in South Africa where it is summer)
- Southern Hemisphere: Little to no activity.
Vaccine Update:
- The CDC reported that almost 100 millions doses of vaccine have been released. Approximately half of the states across the U.S. are relaxing their vaccination guidelines to include anyone who wishes to be vaccinated.
- Several scientists wrote that the U.S. should honor its commitment to donate 10% of its vaccine supply to poor third world countries. Secretary Sebelius said that the U.S. will honor its commitment.
- The WHO reports that it will donate vaccine to its first three recipients, Afghanistan, Azerbaijan and Mongolia.
China's death toll leapt by more than 30% in recent days which is raising alarm with the approaching Lunar New Year or Spring holiday. This is the biggest and most important holiday and millions of people crowd the roadways, trains and airports to return home.

HOUSEKEEPING ITEM:

If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to me at sbw1@MedPrepGroup.com

ANALYSIS:

Officials in the government continue to encourage everyone to get vaccinated as do I. As I wrote about a few weeks back, activity continues to be a problem in India so if you have business processes outsourced to India, make sure your contingency plans have been updated. We have much experience auditing these types of plans so if you need assistance, give us a call.

ADVICE:

Get vaccinated. It is a safe vaccine.
Keep one eye on the virus looking out for a third wave. It is too early to tell if one will occur.
Review your plans for offices in areas with intense or increasing influenza activity.

TOOLS:

Pandemic and Infectious Disease Plan Audits - Having outside experts review your pandemic plans may bring you new insight into planning areas that need work. Take this opportunity to review your pandemic and other infectious disease plans. Think about inviting us in to bring a new set of expert eyes to take a look at your plans.

Corporate Exercises - Validating your plans through the use of well planned exercises remains an important tool in the business continuity toolkit. We are experts in developing and facilitating exercises customized to the needs of our clients.

Virtual Medical Director - If you don't have a corporate medical director, our Virtual Medical Director program may be a good solution for you. Our Virtual Medical Director service provides you with 24 hour access to physicians and experts trained in emergency medicine, disaster medicine, business continuity, occupational health and mental health crisis management to give you situation updates, analysis and advice. We have affordable decision support plans that you can enroll in.

Pandemic Planning Assistance - We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jump start your planning or take a look at your current plans with a fresh set of eyes.

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Vaccine Recall - December 15

2009-12-15T19:40:00.000-05:00

Pandemic H1N1 Update

Dr. Stuart B. Weiss

INFLUENZA VACCINE UPDATE

Dec 15, 2009

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Non-safety Recall of Pediatric H1N1 (2009) Vaccine

Today, the CDC announced a recall of some lots of Sanofi Pasteur H1N1 Pediatric (.025ml for 6-35 month olds) vaccine in pre-filled syringes.

Current Situation:

The CDC reports that routine testing of the potency (strength) of vaccine in three lots of pre-filled pediatric vaccine fell slightly below the required strength and was being recalled. Vaccine manufacturers routinely test vaccine lots after they are released to make sure that they maintain their potency.
According to the CDC, the potency is only slightly below the required potency.
This only affects certain lots of pediatric vaccine in pre-filled syringes intended for 6-36 month olds.

HOUSEKEEPING ITEM:

If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to me at sbw1@MedPrepGroup.com

ANALYSIS:

There is basically nothing to do about this. If your young child received the recommended two doses of vaccine, the CDC says that they are protected since the potency was only slightly below the required level.

Since there is no safety issue, there is nothing to worry about.

For further information, here is the link to the CDC site:

http://www.cdc.gov/h1n1flu/vaccination/syringes_qa.htm

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update - December 14

2009-12-14T23:51:00.000-05:00

Pandemic H1N1 Update

Dr. Stuart B. Weiss

INFLUENZA UPDATE

Dec 14, 2009

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Give yourself an early holiday gift, get vaccinated.

As influenza activity in the U.S. and much of Europe continues to wane and vaccine stockpiles continue to increase, now is the time to get vaccinated for H1N1 (2009) before the winter wave arrives.

Current Situation:

The CDC confirmed that the number of states reporting widespread influenza activity has decreased again, from 25 states down to 14. The number of people visiting physicians in the US for influenza-like illness has decreased again this week.
the CDC released new projections indicating that approximately 50 million American have gotten pandemic H1N1 or about 15% of the U.S. population. The flu has resulted in about 200,000 hospitalizations so far, a number that equals a usual entire flu season (and we are only in December), and approximately 9820 deaths with 1,090 children, 7450 adults 18-64 and only 1280 people over 65. This is markedly different from the usual flu pattern.
The number of new influenza cases on college campuses increased after the Thanksgiving break. It had been dropping for the past several weeks.
The WHO reports that while there is slowing of influenza activity in North America and most of Europe, activity continues across the northern hemisphere:

Europe: Activity has peaked or is peaking across Europe except in France where activity is still rising.
East Asia: Increasing influenza-like illness in Japan and northern China. Hong Kong and Chinese Taipei are showing increasing activity after a previous peak.
South and Southeast Asia: India and Sri Lanka continue to show increasing flu intensity.
Africa: Limited data shows continued activity across the continent (except in South Africa where it is summer)
Southern Hemisphere: Little to no activity.

Vaccine Update:
- The CDC reported that 73 millions doses of vaccine has been released. Many states across the U.S. are relaxing their vaccination guidelines to include anyone who wishes to be vaccinated.

CDC reported 16 additional pediatric deaths this week due to flu related complications.
Two studies came out showing a disparity in death rates among ethic minorities. A study in Illinois showed the death rate in Blacks and Hispanics to be twice the rate of Caucasians. A second study in New Mexico showed a higher death rate in Native Americans. There are many factors that may have contributed to this and it will take more time to sort this out.
A new study looked at the death rates for this pandemic. The death range, depending on how it is calculated, ranges from slightly above a typical flu season to markedly less than a typical flu season. More time will be required to come to more definitive numbers. Another study looked at immunity and suggested that many people many have some partial immunity which explains that large number of cases but the low death rate.
There was a report in the British Medical Journal and investigated by a British Television station looking into the usefulness of Tamiflu to prevent serious complications of seasonal flu. After reading the articles and the rebuttals, it seems there is much more being written about access to data than about the usefulness of Tamiflu. this report focused on seasonal flu and did not discuss pandemic flu. the bottom line is that more transparency in study data is necessary in the future.
The USDA licensed the first pig H1N1 (2009) vaccine that can be used by pork producers. It is produced by Pfizer Animal Health division.

HOUSEKEEPING ITEM:

If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to me at sbw1@MedPrepGroup.com

ANALYSIS:

I had the opportunity to speak to a large group of legislators this past weekend about H1N1 (2009). One of their main questions was whether we are done with the flu or will there be a third wave. While it is impossible to know for certain, there are several factors which makes me think we may not be through with this flu. First, if you look back at the 1957 flu, there was a great big peak in early winter which died down nicely and then renewed its attack rate in February/March 1958. Second, if we look at the illness rate on college campuses after Thanksgiving break, when students returned from home, we saw a bump in the number of cases and Christmas break is rapidly approaching. Third, only 15% of American have gotten the illness and have immunity. Even if you add in the immunity that some older American have, and the folks getting vaccinated, we still have a large number of people who are susceptible in this country (probably more than half our population). Taken together, it seems like it is likely that we will have another wave. So although I don't have a crystal ball, I continue to advise clients to keep their eye on this problem and keep their pandemic planning efforts up to date. This is what I told the legislators as well.

I also reminded them that influenza viruses are notorious for mutating. This virus has remained stable so far but that is another unknown in the equation and another reason to keep your planning efforts on track at some level.

Lastly, if you think this is a mild flu, just look at the pediatric death rate. We have almost 1100 kids that have died already from H1N1 (2009) complications. That is many times the normal number of children that died of flu. So although most people recover uneventfully, this is taking a hard toll on our children.

ADVICE:

Get vaccinated. It is a safe vaccine and now that there is enough, it should be not problem to get you and your family and co-workers vaccinated. Speak to your doctor or visit a local health clinic. Do it now.
Take this opportunity to compile lessons learned over the past 8 months. Look at what worked and what didn't work and revise your plans. This breather we are having is a gift you should take advantage of. If I am correct and we have a third wave, if you have updated your plans, you will be ready.

TOOLS:

Pandemic QuickStart - If you need to quickly bring your company up to speed with its pandemic planing efforts, we can help with our quickstart resources.

Pandemic Planning Assistance - We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jumpstart your planning or take a look at your current plans with a fresh set of eyes.

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update - December 8

2009-12-08T10:21:00.000-05:00

Pandemic H1N1 Update

Dr. Stuart B. Weiss

INFLUENZA UPDATE

Dec 8, 2009

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Will pandemic H1N1 continue its downward trend or will it follow the pattern of 1957. Only time will tell.

As influenza activity continues to wane and vaccine stockpiles continue to increase, now is the time to encourage people to protect themselves by getting vaccinated.

Current Situation:

The CDC confirmed that the number of states reporting widespread influenza activity has decreased again, from 32 states down to 25. The number of people visiting physicians in the US for influenza-like illness has decreased for the fifth straight week although the overall number is still high for this time of year. The number of deaths due to flu is still above the epidemic threshold for the United States. 99% of all sub-typed virus in the U.S. is still pandemic H1N1.
The number of new influenza cases on college campuses dropped again this week.
The WHO reports that while there is slowing of influenza activity in several parts of the world, activity continues across the northern hemisphere:
- Western and Northern Europe: Activity has peaked or is peaking. Numbers of new cases has plateaued in many parts.
- Central Europe (from Baltic to Balkan countries, from Germany to Romania): Influenza activity continues to increase
- Eastern Europe: Activity seems to be peaking and leveling off in most of eastern Europe. In the Russian Federation, activity remains high with an increasing trend.
- East Asia: Increasing influenza-like illness in Japan and southern China. Decreasing activity in northern China.
- South and Southeast Asia: India, Nepal and Sri Lanka continue to show increasing flu intensity.
- Africa: Influenza activity continues across the continent with co-circulation of seasonal H3N2 and pandemic H1N1
- Southern Hemisphere: Countries in temperate zones continue to show little to no activity, most countries in tropical zones have decreasing activity.
Vaccine Update:

The CDC reported that 73 millions doses of vaccine has been released with 10 million more expected this week.
Some states are reporting a surplus of vaccine and are relaxing their vaccine criteria to include all citizens.

Liquid Tamiflu shortage is easing as Roche reported that more Tamiflu suspension is being shipped.
CDC reported 17 additional pediatric deaths this week due to flu related complications.
Vietnam reported another H5N1 (Bird flu) case in a 33 year old male who eat duck blood pudding. From Pro-Med: "raw blood soup (tiet canh in Vietnamese) is a dish made with raw blood of ducks or geese (sometimes pigs), with peanuts and herbs on top. This is the typical protein-rich breakfast of the country people in Northern Vietnam, but is dangerous because of the H5N1 bird flu virus. It is made by taking fresh blood and sticking it in the refrigerator to gently congeal. Raw blood soup is a Vietnamese dish that makes very little effort to appeal to the taste buds of the non-Vietnamese diner. Usually you will find a few chopped peanuts scattered on top of your blood dish but that's as far as it goes for fanciness. Blood soup has the oddest texture and tastes strangely metallic."

For the curious (& unsqueamish) an image of plates of duck soup is available at www.loupiote.com/photos/87750125.shtml .

HOUSEKEEPING ITEM:

If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to me at sbw1@MedPrepGroup.com

ANALYSIS:

The number of flu cases continues to trend downward in the U.S. and Canada as well as western and northern Europe. The question is whether this will continue through the remainder of the flu season or will we see a pattern similar to the 1957 pandemic where there was a surge at the beginning of the school year followed by a waning period which ended with a new surge in December. Or will we see seasonal flu begin to circulate as is occurring in parts of Africa. Its too early to know but it is important to keep your eye on this evolving situation.

The report of the first new case of H5N1 in Vietnam in the past 6 months reminds us that H5N1 is entrenched in the bird population in southeast Asia and although much of our attention has been on pandemic H1N1, you should not forget to keep some attention of that virus as well.

ADVICE:

If you live or work in a state that has relaxed its immunization criteria, encourage employees to be vaccinated. Pandemic H1N1 is still causing serious illness across the U.S. and Canada and the vaccine is proving to be extremely safe.
Take this opportunity to review your work from home program. There have been several reports released recently about the common pitfalls associated with work from home programs especially as it relates to the "last mile". Review potential problems with your IT staff. Also take a look at which outside critical vendors/contractors need access to your network and make sure that they will be able to get in.

TOOLS:

Pandemic QuickStart - If you need to quickly bring your company up to speed with its pandemic planing efforts, we can help with our quickstart resources.

Pandemic Planning Assistance - We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jumpstart your planning or take a look at your current plans with a fresh set of eyes.

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update - November 30

2009-11-30T23:10:00.000-05:00

Pandemic H1N1 Update

Dr. Stuart B. Weiss

INFLUENZA UPDATE

Nov 30, 2009

SUBSCRIBE: Click button at bottom or send email to: sbw1@MedPrepGroup.com

We've had a relatively quiet holiday week as pandemic flu activity continues to decrease across the U.S. but the kids keep taking a heavy hit.

While we sit back and relax a bit in the U.S., other countries are not so fortunate. This could be a nice break for us before seasonal flu arrives.

Current Situation:

The CDC confirmed that the number of states reporting widespread influenza activity has decreased again, from 43 states down to 32. The number of people visiting physicians in the US for influenza-like illness has decreased for the fourth straight week although the overall number is still very high. 99% of all sub-typed virus is still pandemic H1N1.
The number of new influenza cases on college campuses dropped again this week. The number of new cases was down 37% from last week.
The WHO reports that while there is slowing of new cases in North America, activity continues in other areas of the world:
- Europe: The pandemic death toll in Europe has nearly doubled every two weeks over the past 6 weeks. Three countries report very high flu intensity: Italy, Norway and Sweden. Nine countries report high flu intensity: Bulgaria, Denmark, Germany, Iceland, Ireland, Lithuania, Luxembourg, Poland and Portugal.
- East Asia: Japan's number of new cases is stable with a slight decrease in activity in urban areas. Mongolia continues to show intense flu activity although the number of new cases seems to have peaked.
- India, Nepal and Sri Lanka continue to show increasing flu intensity.
- Southern Hemisphere: Countries in temperate zones continue to show little to no activity, most countries in tropical zones have decreasing activity (except Ecuador and Venezuela).
Vaccine Update:
- Novartis unveiled its cell-based vaccine production facility last week. It is the first such facility in the U.S. and will be running by 2011 with full production capability in 2013. It is located in Holly Springs, N.C.
CDC reported 27 additional pediatric deaths this week due to flu related complications.
The CDC confirmed that a West Virginia physician was sick with pandemic H1N1 twice, once in April and once in October.
The CDC estimates that the current case fatality rate for the pandemic H1N1 virus is 0.018% which is about 100 times less lethal than the 1918 pandemic flu virus
China reported two confirmed cases of pandemic H1N1 in dogs adding that species to the list of susceptible species which includes Birds, Cats, Ferrets, Pigs and Humans.
Egypt reported another H5N1 (Bird flu) case in a 3 year old male.

HOUSEKEEPING ITEM:

If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to me at sbw1@MedPrepGroup.com

ANALYSIS:

Clearly we have decreasing pandemic activity in the U.S. although the increasing number of pediatric deaths is quite concerning. I still strongly recommend that eligible children receive the extremely safe pandemic flu vaccine.

For those of you that have outsourced business processes to India, I want to spend a moment discussing that. Many of our clients have partnered with Indian firms or have offices in Chennai, Bangalore, Hyderabad, Mumbai, etc. to perform important business functions. Based on the rising flu intensity in that region (India, Nepal, Sri Lanka) and the weak public health system throughout India, we would strongly suggest that you develop business continuity plans around losing some or all of those assets for a period of time. You must answer the question of how you will maintain those outsourced business processes should there be a prolonged and widespread disease outbreak.

Lastly, there was an interesting article published in Virology that speaks to the origin of the pandemic virus. The virologist who wrote the article analyzed the virus and claims that there is a suggestion that this wasn't a naturally occurring virus but was instead created in a lab. This same virologist made this assertion earlier but it was dismissed and he has made it again. This will be interesting to follow.

ADVICE:

If you have overseas offices or use overseas companies for important business processes, it is important to develop contingency plans for how you will take over critical outsourced functions if overseas offices are closed due to flu. We are seeing a decrease of flu cases in the U.S. but that is not true in other countries. This is especially important in India. We have experience in this area if you need assistance.
Take this opportunity to remind employees about proper hand hygiene. If you put up posters last April about hand hygiene, change them or move them. People do not pay attention to something that has been hanging on a wall for months.
Lastly, don't take your eye completely off H5N1 as Egypt reported yet another case this week.

TOOLS:

Pandemic QuickStart - If you need to quickly bring your company up to speed with its pandemic planing efforts, we can help with our quickstart resources.

Pandemic Planning Assistance - We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jumpstart your planning or take a look at your current plans with a fresh set of eyes.

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update - November 22

2009-11-23T09:07:00.001-05:00

Novel Influenza H1N1 Update

Dr. Stuart B. Weiss

INFLUENZA UPDATE

Nov 22, 2009

SUBSCRIBE: Click button at bottom or send email to: sweiss@MedPrepGroup.com

Okay, it seems official. The U.S. novel H1N1 has peaked for the moment but all the news is still not rosey.

While the situations seems to be improving in the U.S., the number of influenza cases is still way up and in other parts of the world, there is no sign of a peak yet.

Current Situation:

The CDC reports that 43 states now report widespread flu activity, this is down from 46 states last week. The number of people visiting physicians in the US for influenza-like illness has decreased for the third straight week although the overall number is still very high.
The WHO reports that while there is some slowing of new cases in the U.S., Canada continue to show intensifying disease. In other areas of the world:
- Europe: Transmission is widespread and increasing across Europe especially in north, east and southeast Europe with some dramatic recent spikes in eastern Europe. A peak seems to have occurred in some western Europe countries especially Iceland, Ireland, UK and Belgium.
- Central/Western Asia: Increased disease in Kazakhstan, Uzbekistan and parts of Afghanistan. this is affecting troops and Afghan security forces.
- East Asia: Japan's numbers of new cases is slightly decreased. Some experts suspect large numbers of cases in China. There is also seasonal H1N1 and H3N2 circulating in China
- Southern Hemisphere: Temperate zones showing little to no activity, tropical zones have variable activity
Vaccine Update:
- Supply shortages of H1N1 vaccine continue as 11 million doses of vaccine were released last week. This brings the total to 54.1 million doses.
CDC reported 21 additional pediatric deaths this week due to flu related complications. 2/3 of the children had underlying medical problems such as asthma, cerebral palsy or muscular dystrophy.
There were two clusters of patients in hospitals with Tamiflu resistant novel H1N1 viral infections. One cluster was in the UK and another was in the U.S..
At a news conference late last week, the CDC mentioned a mutation in the novel H1N1 virus was found in Norway. This mutation may make the virus live easier deep in lung tissue.
Researchers at the USDA found that the novel H1N1 virus has changed enough that it doesn't infect birds well or spread between them easily.
Egypt reported another H5N1 (Bird flu) case in a 21 year old male who was involved with slaughtering chickens.

HOUSEKEEPING ITEM:

If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to me at sweiss@MedPrepGroup.com

ANALYSIS:

Its now been three weeks in a row that the number of cases of people visiting their physicians for influenza like illness has decreased and in fact, several television network news stories last week interviewed hospital folks who reported less emergency department and clinic visits. It does indeed appear that we have peaked and are on the downswing of this wave. I say wave because there are some reports of a second wave starting in some countries already. As indicated by the virus mutation, the clusters of resistance and the virus's adaptation to humans, this is far from over. In fact, in many parts of the world, the numbers are still markedly increasing. This decrease in the U.S. gives us a chance to take a deep breath but I can't stress strongly enough that planning efforts should continue. It is not time to let down your guard as there is no evidence to support that position this early in the flu season. The highest travel time of the year is approaching and people from different parts of our country and the world will be coming together. We will have to watch to see if this changes the viral patterns.

I have done several webinars and talks this past week in different parts of the country and had many questions about the novel H1N1 vaccine. My advice remains the same. It is an extremely safe vaccine and I recommend it to everyone who is eligible. Use this lull in public attention to have eligible people vaccinated. Go on the Goggle flu site and find where vaccine is available.

ADVICE:

In the U.S. this past week, there were congressional hearings on making sick time mandatory as a way to fight H1N1. Don't wait for congress to act, review your H.R. plans and make some decisions on how you will handle employees who are out sick with the flu or those that stay home with sick family members. Review the American With Disabilities act and decide what screening questions you can ask.
It may be challenging to keep interest in this topic as your C-suite executives have seen the news stories about flu having peaked. Remind them that even though we have peaked, this is one of three expected waves and we still have markedly increase flu cases across the U.S. even thought the numbers of new cases seem to have peaked three weeks ago.
Lastly, don't take your eye completely off H5N1 as Egypt reported yet another case this week.

TOOLS:

Pandemic QuickStart - If you need to quickly bring your company up to speed with its pandemic planing efforts, we can help with our quickstart resources.

Pandemic Planning Assistance - We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jumpstart your planning or take a look at your current plans with a fresh set of eyes.

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update - November 15

2009-11-16T00:10:00.000-05:00

Novel Influenza H1N1 Update

Dr. Stuart B. Weiss

INFLUENZA UPDATE

Nov 15, 2009

SUBSCRIBE: Click button at bottom or send email to: sweiss@MedPrepGroup.com

Perhaps there is a small light at the end of the tunnel

Its way too early to say for sure but there are some early signs that flu activity may have peaked in the US and is slightly declining.

Current Situation:

The CDC reports that 46 states now report widespread flu activity, this is down from 48 states last week. The number of people visiting physicians in the US for influenza-like illness has decreased for the second straight week although the overall number is still very high.
The WHO reports that while there is some slowing of new cases in the US, Canada has reported sharp increases over the past three weeks and there is increasing activity in several European countries as well as some regions in eastern Asia. The huge outbreak in the Ukraine continues to be a big problem for that country. They are estimating that there have been over 1 million cases there (the country only has 48 million people). There have been sharp increases in flu activity in some Middle Eastern counties including Israel and Afghanistan as well as increases in eastern Asia including China and Japan. See the WHO update at: http://www.who.int/csr/don/2009_11_13/en/index.html for more details.
Vaccine Update:
- Supply of H1N1 vaccine continues to be a problem in the US. As we wrote about earlier, there are significant delays in shipment of vaccine from manufacturers. Several manufacturers this week stated that they will be shipping much more vaccine shortly and will meet their US government commitments.
- Although the US Government had originally predicted that we would have 60-80 million doses by this point, only 41.6 million have been shipped.
- Around the world, millions of people have received the vaccine and it continues to be a very safe vaccine.
CDC changed the way it tracks and counts pandemic H1N1 cases increasing the numbers included in the case counts. The new, more inclusive counts are:
- There have probably been around 22 million cases of pandemic H1N1 illness in the US
- Approximately 98,000 people have been hospitalized for flu related illnesses
- There have been 3900 deaths with 540 pediatric deaths
- The breakdowns are as follows:
  - Cases: 0-17 = 8 million cases, 18-64 = 12 million, 65+ = 2 million
  - Hospitalizations: 0-17 = 36,000, 18-64 = 53,000, 65+ = 9000
  - Deaths: 0-17 = 540, 18-64 = 2920, 65+ = 440
The new CDC counts do not indicate any change in the disease, just a more accurate counting of the cases.

HOUSEKEEPING ITEM:

If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to me at sweiss@MedPrepGroup.com

ANALYSIS:

Although it is way to early to make any predictions, the fact that visits to physicians for influenza-like illness has dropped for the second week in a row and the number of states with widespread flu illness has dropped by two may be pointing to the US having peaked a few weeks ago with this wave of the influenza pandemic. Remember that cases are still markedly rising in some parts of the world and we may still see significant supply chain interruptions around the world. But before you start thinking that the worst has passed us, it is important to understand that it is way too early to decide that. We will need to continue to watch this disease carefully as it unfolds in the coming weeks to know if we have peaked in the US.

As you continue your pandemic planning efforts, you should take a look at a good document that the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP) put out last week. Based in large part on the September summit, CIDRAP, in collaboration with the Society for Human Resource Management (SHRM) released a new toolkit: Doing Business During an Influenza Pandemic: Human Resource Policies, Protocols, Templates, Tools, & Tips. It is definitely worth a read. The toolkit is available free of charge as a PDF document: http://www.cidrapsource.com/hrtoolkit

ADVICE (we continue to recommend the following):

Keep yourself informed on what is going on. We will help you do that through our Business Alerts but you may want to also subscribe to ProMed and look at the CIDRAP site frequently. This virus is spreading and adapting and you need to anticipate problems.
If you have finished writing plans and policies, think about validating those plans or policies with an external audit or small drills and exercises.
Watch out for pandemic fatigue. With all the information flowing out there and the blogs and webinars and seminars and notices its easy to get overloaded and tired. Pick a few trusted sources and stick with them.

TOOLS:

Pandemic QuickStart - If you need to quickly bring your company up to speed with its pandemic planing efforts, we can help with our quickstart resources.

Pandemic Planning Assistance - We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jumpstart your planning or take a look at your current plans with a fresh set of eyes.

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update - November 8

2009-11-08T21:31:00.001-05:00

Novel Influenza H1N1 Update

Dr. Stuart B. Weiss

INFLUENZA UPDATE

Nov 8, 2009

SUBSCRIBE: Click button at bottom or send email to: sweiss@MedPrepGroup.com

After a few weeks we are back, and boy has alot happened during that time!

I want to apologize to our loyal readers for no newsletter over the past few weeks. So let's review what has been happening and make sure you are up to date.

Current Situation:

Outbreaks on college and university campuses across the country have surged again after declining. Most cases continue to be mild, according to the American College Health Association. The number of school closings across the country continues to rise, as reported by the US Department of Education.
The CDC reports that 48 states now report widespread flu activity. Although we haven't reached the peak yet, flu activity has already exceeded what we have seen in some of the worst flu seasons. Pneumonia and influenza rates continue to rise.
The WHO reports that there is widespread disease across the northern hemisphere. Mexico is seeing more flu cases now than they saw in the initial outbreak in April/May. Europe is experiencing an unusually early flu season with wide spread cases. A huge outbreak in the Ukraine is causing a big problem for that country. They are estimating that there have been 500,000 cases since mid-October with 24,000 people hospitalized (the country only has 48 million people).
Vaccine Update:
- Supply of H1N1 vaccine continue to be a problem in the US. As we wrote about earlier, there are significant delays in shipment of vaccine from manufacturers. This is due to the difficulties in growing the virus in eggs, which is part of the manufacturing process.
- Although the US Government had originally predicted that we would have 60-80 million doses by this point, only 38 million have been shipped.
- Vaccine delay has impacted vaccination programs in states across the US and has eroded the confidence in public health initiatives, according to several state health representatives. The Alabama Health Department testified to congress that they don't expect to receive adequate vaccine to immunize their high priority groups until the end of December or January.
- Around the world, millions of people have received the vaccine and it is proving to be a very safe vaccine.
- Since vaccine campaigns started in October, only 1/3 of parents who tried to get their children vaccinated have been successful.
Disease Update:
- 99 % of the subtyped flu that is tested is the new novel H1N1. Those areas that had seen some early seasonal flu strains circulating, have seen that drop off significantly.
More Mask controversy
- In the continuing discussion of masks, the original study done in China and reported here last month showing that N-95 masks were much more protective than surgical masks has been "re-analyzed" and now is much less conclusive. Due to some changes in the statistical analysis done, N-95's still show some benefit but the study numbers make the difference not statistically significant.
President Obama declares a National Emergency (on October 26th)
- This was not unexpected and it allows HHS Secretary Sebelius to waive or modify certain provisions in Medicare, Medicaid, Child Health Insurance Program (CHIP), EMTALA and HIPAA programs. It also allows hospitals to respond to this crisis easier.
Medications
- There has been a shortage of liquid Tamiflu and the government has released about 300,000 bottles of liquid Tamiflu from the National Strategic Stockpile. There are also directions for compounding liquid Tamiflu on the CDC website that pharmacists can use.
- The government issues emergency use authorization for IV Perimivir and Zanamivir for critically ill patients that don't respond to Tamiflu. A few cases were recently presented on a conference call and they had good results.
First cat to catch H1N1
- Iowa has reported that a house cat has been documented with the novel H1N1 infection after two of its three owners were sick with flu. This is the first time a cat has been documented to have the disease. Prior to this, infections were only documented in humans, pigs, birds and ferrets.
No more kissing in Turkey
- Last week, the health minister in Turkey advised all Turks to avoid kissing anyone for the next 5 months.

HOUSEKEEPING ITEM:

If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to me at sweiss@MedPrepGroup.com

ANALYSIS:

Since this is a long newsletter, I will keep the analysis short this week.

There continues to increasing numbers of cases across the US. We are seeing case numbers that are higher than some of the worst past flu seasons. Luckily, most cases are mild but we have not reached our peak yet. Young people are still being affected. There were 18 pediatric deaths reported last week and the vast majority of deaths are in people younger than 65 years old.

People have been asking me if they should get their children vaccinated. The answer is yes, if they are in the high risk group and they do not have anything that would prevent them from safely receiving the vaccine (speak to your pediatrician about this). I want to take a moment to stress the safety of the new pandemic H1N1 virus vaccine. Millions of people have already been vaccinated around the world and the vaccine is proving to be very safe. This vaccine is manufactured in the same way as every other influenza vaccine by the same companies.

Remember, all vaccine coming out now is going to the high priority groups. You and your employees will not get access to the vaccine until next year. In fact, one government official testified that the current flu outbreak may be over before adequate vaccine is available for the general population. That is why it is important to continue your pandemic planning and take appropriate employee protection steps.

The ongoing controversy about masks is unfortunate. Problems with the study methodology continue because it is hard to design a truly clear study because it would require some folks to not wear a mask around sick patients and that is contrary to CDC guidance. So we continue to recommend N-95 masks for emergency responders, security and people at high risk who cannot maintain good social distancing due to job requirements. Everyone else who requires a mask should use surgical masks. This may change as we learn more information.

ADVICE:

Keep yourself informed on what is going on. We will help you do that through our Business Alerts but you may want to also subscribe to ProMed and look at the CIDRAP site frequently. This virus is spreading and adapting and you need to anticipate problems.
If you have finished writing plans and policies, think about validating those plans or policies with an external audit or small drills and exercises.
Watch out for pandemic fatigue. With all the information flowing out there and the blogs and webinars and seminars and notices its easy to get overloaded and tired. Pick a few trusted sources and stick with them.

TOOLS:

Pandemic QuickStart - If you need to quickly bring your company up to speed with its pandemic planing efforts, we can help with our quickstart resources.

Pandemic Planning Assistance - We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jumpstart your planning or take a look at your current plans with a fresh set of eyes.

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update - October 8

2009-10-08T14:51:00.003-04:00

Novel Influenza H1N1 Update

Dr. Stuart B. Weiss

INFLUENZA UPDATE

Oct 8, 2009

SUBSCRIBE: Click button at bottom or send email to: sweiss@MedPrepGroup.com

The Official "Flu Season" started on October 4th but tell that to the H1N1 virus

Although the official flu season started 4 days ago, the CDC is reporting that there is widespread flu activity in 27 States. Here is what's happening...

Current Situation:

Outbreaks on college and university campuses across the country continue to be widespread but the number of new cases decreased this past week. Most cases continue to be mild, according to the American College Health Association.
ABC reported last night that approximately 400 schools have been closed so far related to widespread absenteeism form flu. A quick scan of our global surveillance system also shows schools scattered across the US closing for several days to slow the spread of illness.
The CDC reports that twenty-seven states now report widespread flu activity with some activity in all states. The CDC data is usually two weeks old so this reflects that week of September 20-26
The WHO reports that there is widespread disease across the northern hemisphere especially in the US and northwestern Mexico.
Vaccine Update:
- States have begun receiving pandemic flu vaccine. Most are prioritizing health care workers for this first round of doses but it varies State to State.
- The military will mandate vaccination of all active duty troops and expects to have 1.4 million people vaccinated with the new vaccine.
- Multiple global experts have weighed in on the Canadian study showing a supposed increased risk of catching pandemic flu if you have a seasonal flu shot. They all think the Canadian results are flawed and should not change vaccine strategies at all.
Disease Update:
- The CDC working with Emory University has designed a good algorithm for quickly sorting patients presenting with influenza-like illness. This could be useful for emergency departments, clinics and corporate health departments. You can find it at: www.cdc.gov/h1n1flu/clinicians/pdf/adultalgorithm.pdf
- Emory has also worked with Microsoft to launch a public flu screening tool for people to check if they should see a health care provider. It is interesting and can be found at: www.h1n1responsecenter.com
- A new syndrome called FLAARDS was published by Australian and New Zealand researchers. While FLAARDS sounds like a funny name it stands for Flu-A Associated Acute Respiratory Distress Syndrome. We may hear more about this as more data from the southern hemisphere is published. FLAARDS is associated with inflamed fluid filled lungs requiring ventilation or ECHO and may include multi-organ failure and death.
More Mask controversy
- In the continuing discussion of masks, a new study from Ontario looked at nurses wearing either N-95 masks or surgical masks and found no difference in the prevention of flu between the two. Experts reviewing the study were quick to point out the significant flaws in the study that may have caused erroneous results. These results are directly opposite of the study a few weeks ago from Australian researchers showing N-95 masks to be superior to surgical masks. So the debate continues.
EEOC guidance for corporations
- The EEOC put out some good guidance on the application of the Americans with Disabilities Act (ADA) to pandemic planning. While I am not a lawyer, it has clarifying examples and simple questions and answers. It is certainly worth looking at. you can find it at: http://www.eeoc.gov/facts/pandemic_flu.html You can also find a good CIDRAP article on this at: http://www.cidrap.umn.edu/cidrap/content/influenza/biz-plan/news/oct0709eeoc.html

HOUSEKEEPING ITEM:

If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to me at sweiss@MedPrepGroup.com

ANALYSIS:

There continues to increasing numbers of cases across the US. Thankfully, the cases remain mild, for the most part. Although the number of cases have diminished a little in college campuses, this should not lull you into thinking that the wave is over or has peaked. That is unlikely. We still expect that many more people will catch this virus and be out for 3-5 days. So far, we have seen reported that about 400 schools have been closed across the county. That is a small number but may rise as this continues.

I want to take a moment to stress the safety of the new pandemic H1N1 virus vaccine. This vaccine is manufactured in the same way as every other influenza vaccine by the same companies. In fact, if this virus had first emerged a few months earlier, this virus would have been included in the seasonal flu vaccine and we wouldn't be having this conversation. Please encourage your employees to get the vaccine when it is available. The question of when it will be available is a whole other story. Remember, almost all vaccine coming out now is going to the high priority groups. You and your employees will not get access to the vaccine until November or December. That is why it is important to continue your pandemic planning and take appropriate employee protection steps.

ADVICE - my advice this week is the same as last week:

Keep yourself informed on what is going on. We will help you do that through our Business Alerts but you may want to also subscribe to ProMed and look at the CIDRAP site frequently. This virus is spreading and adapting and you need to anticipate problems.
If you have finished writing plans and policies, think about validating those plans or policies with an external audit or small drills and exercises.
Watch out for pandemic fatigue. With all the information flowing out there and the blogs and webinars and seminars and notices its easy to get overloaded and tired. Pick a few trusted sources and stick with them.

TOOLS:

Pandemic QuickStart - If you need to quickly bring your company up to speed with its pandemic planing efforts, we can help with our quickstart resources.

DC3 Expert Trigger Assessment and Readiness Analysis tool will be available next week. This software replaces the old non-helpful WHO Pandemic phases and will analyze your current H1N1 situation from several key perspectives and give you intelligent Organizational Levels to link your trigger based action plan to. DC3 incorporates expert medical opinion that is updated regularly into the logic and will advise you on actions you should be taking and help you assess your readiness.

Global Disease Surveillance - MedPrep has teamed with a global surveillance company to provide geomapped specific surveillance for corporations who want site specific news and information. Through this system, we monitor over 30,000 information sources and provide you with intelligence and analysis on influenza and 259 other infectious diseases.

Pandemic Planning Assistance - We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jumpstart your planning or take a look at your current plans with a fresh set of eyes.

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update - October 1

2009-10-01T18:10:00.001-04:00

Novel Influenza H1N1 Update

Dr. Stuart B. Weiss

INFLUENZA UPDATE

WHO PANDEMIC ALERT LEVEL 6

Oct 1, 2009

SUBSCRIBE: Click button at bottom or send email to: sweiss@MedPrepGroup.com

The Influenza virus in on the march and its mutated, a little.

The Influenza virus and vaccine have been in the news alot this week for good reasons and bad. Here is what's happening...

Current Situation:

Outbreaks on college and university campuses across the country continue to be widespread. Most cases continue to be mild. The highest rates of activity are now in the Northeast and while there is still significant activity in the Southeast, things have calmed down a bit. According to the American College Health Association, the campus attack rate is 20.1 cases per 10,000 students for the week ending Sept 25th.
Twenty-six states now report widespread flu activity with some activity in all states.
Vaccine Update:
- Many vaccine manufacturers have begun shipping or will begin shipping vaccine soon. States are ramping up to begin widespread vaccination programs.
- Data from an unpublished study in Canada was reported in the press which reportedly points to an increased risk of catching pandemic H1N1 flu if you received a seasonal flu shot last year. This result has NOT been reproduced anywhere else in the world (see analysis for more discussion on this)
Tamiflu:
- The government warned of a shortage of pediatric Tamiflu suspension and the CDC issued new guidance to pharmacists on how to make suspension from pills.
H1N1 Virus mutation

Virologists in the Netherlands reported on two cases of H1N1 with a mutation in the PB2 protein which could help the virus better adapt to humans (see analysis section).
Influenza viruses are notorious for constantly mutating so changes are to be expected.

H5N1 Avian Flu

Egypt reported two more cases of H5N1 virus this past week.

HOUSEKEEPING ITEM:

If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to me at sweiss@MedPrepGroup.com

ANALYSIS:

There are two items that I want to discuss. First is the study from Canada having to do with increased risk of novel H1N1 if a person received seasonal flu vaccine last year. These were results from an unpublished study reported in the Canadian press. Because the study and journal article are undergoing peer review, the authors can't comment on anything or answer questions. The results reported in the press are that people who received the seasonal flu vaccine last year were twice as likely to catch novel H1N1. As a result of this, several provinces in Canada have postponed their seasonal flu vaccination programs. Let me be very clear about this, this is an unpublished study that has not been peer reviewed. It may have many design flaws in the research. This is especially true since the WHO, CDC, British and Australian investigators have failed to find similar results when those groups looked into this. This lack of independent confirmation is a BIG red flag for studies. We need to watch this and look at the peer review and the actual article when it is published. It may turn out to be true but it is too early to tell. So in my opinion, the Canadian actions are very premature. It is interesting that a week or two ago, I read that they were thinking about postponing their seasonal vaccine programs. Perhaps this provided an easy excuse. We will see.

The second item is about a virus mutation that hasn't received much press. Virologists in the Netherlands have reported finding two cases of virus that has a mutation in the Polymerase basic 2 or PB2 protein. Back on May 5th, I wrote about the PB1-F2 protein and how it seems to be important in how lethal the virus is. The PB2 protein change moves that particular protein from a form that is usually seen in non-human influenza viruses to one that is frequently seen in human viruses. This change is usually associated with increased efficiency of virus duplication in humans. While the two people with this changed virus had normal mild flu courses, the fact that the virus has adapted to make it better growing in humans is a bit concerning. This bears close watching and further reinforces that its way too early to declare that this is "just the flu".

Finally, Egypt announced two more cases of H5N1 avian flu this past week. That virus continues to slowly spread. While it is easy to focus on the current H1N1 pandemic, we must remember that we have another influenza virus out there infecting humans. This is why you should have a pandemic plan with two sets of assumptions or scenarios, one with the current relatively mild but widespread pattern, and one with a more lethal pattern.

Common Questions:

If I had the flu last spring, can I get it again?

If a Family member is sick, can that employee come to work?

Can I get the flu from the flu shot?

ADVICE:

Keep yourself informed on what is going on. We will help you do that through our Business Alerts but you may want to also subscribe to ProMed and look at the CIDRAP site frequently. This virus is spreading and adapting and you need to anticipate problems.
If you have finished writing plans and policies, think about validating those plans or policies with an external audit or small drills and exercises.
Watch out for pandemic fatigue. With all the information flowing out there and the blogs and webinars and seminars and notices its easy to get overloaded and tired. Pick a few trusted sources and stick with them.
Watch for sensational but unsubstantiated studies or results that are reported in various media outlets. Scientific studies should be peer reviewed and reproducible.

TOOLS:

Pandemic QuickStart - If you need to quickly bring your company up to speed with its pandemic planing efforts, we can help with our quickstart resources.

Pandemic Planning Assistance - We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jumpstart your planning or take a look at your current plans with a fresh set of eyes.

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update - Sept 23rd

2009-09-24T00:01:00.000-04:00

Novel Influenza H1N1 Update

Dr. Stuart B. Weiss

INFLUENZA UPDATE

WHO PANDEMIC ALERT LEVEL 6

Sept 23, 2009

SUBSCRIBE: Click button at bottom or send email to: sweiss@MedPrepGroup.com

Most cases of Flu are mild, but should you let your guard down? I don't think so and I'll tell you why.

CIDRAP Pandemic Conference Attendees: To those of you who I had the pleasure of meeting, thanks for coming up to me and introducing yourself.

A key point from the CIDRAP Pandemic conference is that influenza viruses are notoriously unpredictable. It is way too early to assume that the current mild trend that we have been seeing will continue.

Current Situation:

Outbreaks on college campuses and in schools across the country continue to be widespread. Most cases continue to be mild
Vaccine Update:
- New data points to good immune response to a single vaccination for children 10 years and older. Two shots will still be needed in children less than 10
- The U.S. government has increased its vaccine order to 250 million doses and expects the first shipments in a few weeks. The first vaccine to ship will be Medimmune's nasal spray vaccine. By the end of October, the government hopes to have 60-70 million doses shipped.
- The initial doses will be shipped from manufacturers to the Federal Government who will then distribute it to state health departments. The states will then organize vaccination of the high priority groups.
Masks:
- A new study done in China was presented at a microbiology conference last week. This study showed that N-95 type masks (respirators) provided up to 75% reduction in the risk of catching the flu in healthcare workers while the surgical mask showed no reduction in the risk of catching the flu. The study also found that fit testing did not make much of a difference in the effectiveness of N95 masks. The full study is not yet released so these are preliminary results and should not be used to make policy decisions until the full study is out. There have been some suggestions that there may be problems in the way the study was conducted but these results are interesting.
- The CDC expects to release updated mask guidance within the next week or two.
Health Care Systems
- Margaret Chan, the Secretary General of the WHO, stated her concern about ICU's being overwhelmed. A surge of patients requiring prolonged ICU care in the southern hemisphere during their flu season was a major problem for healthcare systems.
- Some hospital systems are already seeing a marked increase in children presenting with flu-like illness. Dell Children's Hospital in Austin, Texas has taken to setting up treatment tents outside to handle the surge of children into their pediatric ED.
- The CDC is expected to release guidance soon that amends the recommendation for healthcare workers to allow them to return to work once they are fever free for 24 hours without fever reducing medicine. This brings this recommendation in line with non-healthcare worker recommendations. The current recommendation for 7 days for healthcare workers remains in place at this time.
Tele-work Program and Corporate IT Security
- It turns out that the biggest risk to your corporate IT network security from a robust work-from-home program may be from your kids and not some criminal element in North Korea. At the Telework session at the CIDRAP conference, it was discussed that 80-90 percent of corporate IT intrusions are from insiders. Imagine what would happen if bored kids are left in a room with your laptop while you are cooking or shopping. How many would go exploring to see how far they could get inside your corporate network?

HOUSEKEEPING ITEM:

If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to me at sweiss@MedPrepGroup.com

ANALYSIS:

Its good that vaccine shipments will begin shortly. However, take a good look at the priority groups for the initial doses of vaccine. You will not see the majority of your employees on that list. Even optimistically when there are 60-70 million doses available at the end of October, the vast majority will go to high risk people and healthcare workers. And even if some of your employees do get the shot, it takes about 2 weeks to have a good immune response. So we are talking about mid-November before you will start seeing vaccine protection. Most of you will probably not see significant protection of employees until December. So, if you were depending on the vaccine to take care of your pandemic troubles, you need to reconsider.

I have received some questions about live vaccine vs. killed vaccine. While there are some important differences for people with immune problems and other medical conditions, most young healthy people can receive either type of vaccine without concern. You will need to ask your healthcare provider about this. The nasal flu vaccine spray uses a live markedly weakened virus while the usual shot in the arm vaccine uses a killed virus.

I also received some questions about boosting one's immune system and about Vitamin D. While there have been some folks discussing the role of Vitamin D in our immune system, there is no conclusive evidence that Vitamin D will protect you from the flu or make your illness less severe (I know I will receive email on this).

There was audience polling conducted at the CIDRAP conference that was not completely scientific but was interesting. Here are some highlights of the polling:

Front Door Screening: 28% plan to conduct it, 49% no, 17% considering it
Peak percentage of worker absenteeism being planned for during the upcoming flu season: 36% planning for a range of scenarios, 21% planning for 21-30% absenteeism, 13% for 11-20%, 12% for 31-40%, 5% for 0 - 10%, 13% didn't know
How many had customers call to ask about ability to provide goods/services during a pandemic: 22% said 0, 15% said 1-5, 1% said 6-10, 23% said 10 and 40% didn't know
Did they have defined trigger points for their pandemic plan: 62% yes, 32% no, 6% didn't know
What were trigger points based on: 12% said WHO, 9% said CDC pandemic severity scale, 9% said "government authority", 7% said company wide absenteeism, 17% said site specific absenteeism, 8% said security, 20% said other (some of these may have been DC3 - see below)

In the H.R. sessions, there was much discussion about pay policies, sending sick employees home, FMLA, HIPPA, EEOC, ADA, Fair Labor Standards Act, and a host of other regulations. I will discuss these in upcoming Business Alerts. One key point involved FMLA. The CDC has been asking employers to not require physician visits in order to return to work after an illness. However, for an illness to be covered under FMLA, it must be a serious health condition involving either hospitalization or ongoing care by a health care provider, thus requiring a physician visit. When the Department of Labor representative was questioned about this, she just acknowledged that this was an inconsistency but did not offer any solutions. Although the employer may waive the documentation under FMLA, they cannot waive the other requirements of FMLA. I am certainly not a lawyer and you need to check with your H.R. folks but this just points to the fact that you should spend some time reviewing your H.R. policies and how they would relate to people who are home sick, people who are home taking care of sick family member, people home watching children and people who stay home from work due to fear, etc.. Another important point was about so called "no fault" absence policies. Some employers have a policies that assigns points to workers if they are late or miss work (even if they are sick) and mandates automatic termination if a certain amount of points are accrued. The recommendation was to consider suspending the accrual of points for H1N1 short term illnesses. The impact on a business should be small and the upside of avoiding grievances and potential lawsuits is big.

ADVICE:

If you are depending on vaccine to answer all your pandemic concerns, rethink that strategy.
Review your H.R. Policies considering the different reasons people may miss work. Decide if you will pay people who miss work and what acceptable reasons are to miss work. Try to create a culture of worker health that enables workers to make good choices and stay home if they are sick
Educate your employees now on what they can do to reduce disease spread, on what to look for to make a choice to stay home from work and on high risk groups that need early protection.
Look at your triggers. If you are part of the 50% that base their triggers on government scales or "other" you should immediately rethink that part of your plan. Ask me for a demo of our DC3 software which provides you with informed intelligent triggers.
Stay informed. Find a good source of information and follow the course of this virus over the next few months.
If you find yourself desperately trying to catch up with pandemic planning for your company, call us. We can help bring you up to speed quickly. Look at our tools listed below.

TOOLS:

Pandemic Planning Assistance - We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jumpstart your planning or take a look at your current plans with a fresh set of eyes.

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update - Sept 15th

2009-09-15T12:15:00.002-04:00

Novel Influenza H1N1 Update

Dr. Stuart B. Weiss

INFLUENZA UPDATE

WHO PANDEMIC ALERT LEVEL 6

Sept 15, 2009

SUBSCRIBE: Click button at bottom or send email to: sweiss@MedPrepGroup.com

More good news about the new influenza vaccine but bad news from the small business sector

DRJ Attendees: I am giving a 1 hour H1N1 update tonight (Tuesday) at 6:00 in Marina-5 room

As we continue to monitor sources around the world, we continue to see rising flu cases. In some areas, the flu activity has already reached levels normally seen at the height of the flu season.

Current Situation:

Schools and Universities continue to report increasing numbers of cases. The American College Health Association reported that for the week ending Sept 4th, there was a large increase in the number of cases (105% increase from the week before) and 170 new institutions joined the list of locations with suspected or confirmed cases.
There is continued good news from vaccine manufacturers and government studies. The National Institutes of Health (NIH) vaccine studies as well as study results from Sanofi and Glaxo indicate that a single dose of vaccine produces good immune results in "non-elderly" adults. Studies are still underway in children and should be out in about two weeks. There is still a chance that children will require two doses of vaccine. Lastly, the government announced that vaccine may be released a week earlier than previously thought and the first doses will go to healthcare workers.
The CDC reported that from April 26 to August 29th, 47 children have died from laboratory confirmed H1N1 infection. This past week, Cornell University reported the death of a 20 year old student and three days ago, an 11 year old child died in Mesquite, Texas.
A Harvard Business School study reported that 25% of businesses in their study do not offer paid sick leave, 65% do not offer paid time off to care for sick family members and 79% do not offer paid leave to care for children home fro school. These results are slightly improved from US Department of Labor statistics from several years ago that pointed to 48% of paid workers without paid sick leave.
On a conference call for clinicians last week, the CDC spoke about revised guidance for treatment which stresses early treatment for people who are hospitalized even if flu is only suspected but not confirmed. In these cases, physicians should not wait for laboratory confirmation but should start Tamiflu or other antiviral treatment immediately. This should also be done in sick high risk persons including children less than 5, elderly adults, pregnant women and people under 19 years old on chronic aspirin therapy. On the conference call it was recommended that physicians also be very proactive with patients who have neuromuscular disease perhaps giving them a prescription in advance to be filled immediately if they have any symptoms of the flu. They also discouraged routine preventative use of antiviral medications at this time except in specific circumstances (healthcare workers without personal protective equipment, persons at high risk in households with a sick person).
On a lighter note, civility may be a casualty of the new H1N1 flu. Last week, the French Health Ministry began recommending that "la bise", the French cheek to cheek little kiss that is used to say hello and goodbye, should be discouraged. And today, USA Today is reporting that the NCAA has suspended the mandatory pre and post match handshakes required in Volleyball matches (the other college sport with required handshakes is wrestling and no decision has been made there yet).

HOUSEKEEPING ITEM:

If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to me at sweiss@MedPrepGroup.com

ANALYSIS:

Its good news that single dose vaccination is producing good immune results for several reasons. First, if only one dose of vaccine is necessary, more people can get the shot, there will be more to go around. Second, from a public health perspective, it is much easier to get people in for one shot than to get them in for a first shot and a second one 3 weeks later. This is especially true with young adult, college age people.

The rise in case numbers in some parts of the country to almost maximal levels normally seen only during the height of flu season is very concerning. This may lead to a severe strain on our healthcare system and much anxiety and concern within society.

One of the national experts on the behavioral aspects of disease, Steven Crimando, is part of our team. He often reminds business planners that the psychological effects of an event may greatly overshadow the effects caused by the actual disease. If we look back over past disasters with a disease or medical component, there can be hundreds of psychologically affected people for every one person actually affected by the illness. These psychologically affected people or "worried well" show up in emergency departments and utilize resources. Their bodies may be reacting to stress and producing symptoms similar to common flu symptoms (fatigue, not feeling well, diarrhea, chest tightness, etc.) Some of these people will be your employees so it is important to consider the psychological aspects of the pandemic when designing your pandemic plans. Steven is available to assist you in this area.

As the temperature continues to drop across the US and conditions favoring viral survival and spread continue to improve (influenza viruses survive longer in colder weather), we will continue to see increasing numbers of flu cases across the country. We will see large numbers of people getting sick and if the southern hemisphere gives us any clue, we will see disruptions in production and supply chains due to worker absenteeism. New models have been recently reported on worker absenteeism. The British have moved their estimate of worker absenteeism down to about 15%, folks at the CDC speak about 20-25%. We are recommending that businesses plan that 20% of their workforce will be absent for 3-5 days over the course of the next 6 months. That's a good starting place to do planning with the caveat that this number may rise or fall depending on what the virus does.

ADVICE:

If you are a small business, you must do some pandemic planning or at least pandemic thinking now. Recent media reports suggest that large numbers of small businesses have done little to no pandemic planning. Small businesses with a single person in a critical job, and no redundancy, face significant issues if those critical people become ill and there has been no planning.
Look at your H.R. policies and how you create a culture of worker health. Do you enable workers to make good choices and stay home if they are sick or do they get penalized for making a good choice? The statistics on paid sick time are not particularly encouraging in this area. It will serve you well to enable sick employees to choose to stay home and not come to work but this may require tough decisions that have financial impact.
Pay attention to your high risk employees. Early data clearly links pregnancy, obesity and diabetes to severe illness and death. Focus employee education program on this high risk group.
Plan for the psychological effects of this disease outbreak. Review your plans from this point of view. If you need assistance, we have experts in this area that can help.
If you find yourself desperately trying to catch up with pandemic planning for your company, call us. We can help bring you up to speed quickly. Look at our tools listed below.

TOOLS:

Pandemic Planning Assistance - We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jumpstart your planning or take a look at your current plans with a fresh set of eyes.

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update - Sept 7th

2009-09-07T12:51:00.000-04:00

Novel Influenza H1N1 Update

Dr. Stuart B. Weiss

INFLUENZA UPDATE

WHO PANDEMIC ALERT LEVEL 6

Sept 7, 2009

SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com

Hang onto your hats....flu is here already!

We monitor many information sources across the country and the world and we are getting clear reports that the flu is here and the number of cases is rising.

Current Situation:

Since schools and universities have been opening for the school year, there have been many reports of children and young adults with influenza like illnesses. There have been reported cases of outbreaks or clusters over the past two weeks in 11 states. For example, in the State of Washington, reports indicate that as many as 2000 students at a university have reported influenza-like illness. There are also sporadic case reports of outbreaks in K-12 schools, especially in the southeast.
Some emergency physicians are reporting seeing cases of flu-like illness in the emergency department. One physician in Texas wrote that a third of the patients he saw in the emergency department a few days ago had flu. Another physician from Massachusetts also is seeing patients already. The vast majority have routine symptoms of flu and do not require hospitalization.
The CDC reported on Sept 4th that there is increased flu activity in the nation, especially in the southeastern states where many school districts resumed classes on August 10th.
Vaccine for the new flu strain should be approved and available in the US in October. Early data from a study at Novartis showed that 80% of test volunteers had a good immune response after only 1 shot of their Celtura vaccine. China announced that it has approved a single dose vaccine made by Sinovac.
The WHO reported that novel H1N1 influenza outbreaks in the southern hemisphere have started to wane. Looking back, most cases were mild but there were cases of severe viral pneumonia in previously healthy young people (similar to what was seen in April/May at the beginning of this pandemic)
The WHO published a lessons learned briefing note on August 28th that summarizes the findings from the southern hemisphere (see below)
Health Experts are predicting that up to 1/3 of the world's population (2 billion people) may contract this new flu.

HOUSEKEEPING ITEM:

If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to alert@MedPrepGroup.com

ANALYSIS:

On August 28th, the WHO published a briefing note that summarized the findings from the experience in the southern hemisphere over the past few months. Here are their findings and our comments on what was observed:

Novel H1N1 is the dominant virus strain in most parts of the world overtaking seasonal strains. There was not alot of co-circulation although there was some and we will have to monitor this closely in the northern hemisphere
The virus has not mutated to a more lethal form and the overwhelming majority of sick people experience mild illness (that keeps them out of work for an average of 3-5 days -sw)
Even if the disease stays mild, such large numbers of people are susceptible to the virus that it could still severely impact society.
Healthcare systems may be overwhelmed by people requiring ICU care. For people who develop severe viral pneumonia, prolonged intensive care is required and in the US, we do not have a large reserve of ICU beds. Many hospitals function at close to capacity in their ICU's especially in the winter. In the southern hemisphere, for our healthcare clients, problems included ICU personnel shortages (due to illness), ventilator shortages, ECMO shortage (for treatment of ARDS), ICU capacity shortage. In addition, significant utilization of pediatric emergency departments was seen in April/May and should be anticipated this winter as well.
Drug resistance to Tamiflu is not a problem so far. There have been sporadic cases reported but that is completely expected and very rare. Acquisition of Tamiflu resistance by sharing of genetic material between seasonal H1N1 (which is almost 100% Tamiflu resistant) and pandemic H1N1 has been a concern. One study in Ferrets suggested that novel H1N1 doesn't seem to share genetic material well with seasonal H1N1 so perhaps we won't see widespread Tamiflu resistance emerge.
Pattern of illness points to a younger population for novel H1N1. Most people who catch this are younger than 50 years old with deaths in elderly rare. Most cases of severe illness are in younger people compared with seasonal influenza. A report in August 2009 analyzed 574 fatal cases worldwide and found the average age was 37 and 51% of the deaths were between 20-49 years old. About half of the deaths were in patients with underlying medical conditions. While obesity and diabetes were the most common conditions identified it is not clear whether these were contributing factors themselves or whether people with diabetes and obesity have more heart disease and lung disease making them more susceptible. Other factors included asthma and heart disease.
Pregnancy is a consistent risk factor for severe disease across many countries.
HIV and novel H1N1 - studies from two countries seem to indicate that people with HIV who are on HIV medications are not at increased risk for severe or fatal illness.

ADVICE:

Schools are reopening and we are seeing a resurgence of flu cases. It is really important for you to have looked at your human resource policies and your supply chain. Since pregnancy is a consistent risk factor, you must plan for protecting your pregnant employees. As I wrote in the last update, there are nine areas that we advise our clients to look at: HR, Corporate Governance, Incident Management, Security, Communications, Finance, Operations, Corporate Services and Information System. For each of these areas, take a look at your policies and procedures from the point of view of worker absenteeism. How will these areas function if large numbers of people are out for 3-5 days during October through February/March. Look upstream at your suppliers and downstream at your distributors to develop work-around solutions should they experience interruptions from absenteeism.

TOOLS:

Virtual Medical Director - Ensure that you have medical decision support if you do not have an in-house medical director. Look into our Virtual Medical Director program. We have affordable decision support plans that you can enroll in.

DC3 will be available next week. This is the software we have been busily designing over the past two months. It will take the place of the WHO Pandemic Phases and give you intelligent Organizational Levels to link your trigger based action plan to. DC3 incorporates expert medical opinion that is updated regularly into the logic and will advise you on actions you should be taking and help you assess your readiness. Drop me a note if you would like to see it.

Global Disease Surveillance - MedPrep has teamed with a global surveillance company to provide geomapped specific surveillance for corporations who want site specific news and information. Through this system, we monitor over 30,000 information sources and provide you with intelligence and analysis on influenza and 259 other infectious diseases.

If you need last minute pandemic planning help, drop me a note. We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jumpstart your planning and initiative or take a look at your current plans with a fresh set of eyes.

Virtual Medical Director

If you don't have a corporate medical director, our Virtual Medical Director program may be a good solution for you. Our Virtual Medical Director service provides you with 24 hour access to physicians and experts trained in emergency medicine, disaster medicine, business continuity, occupational health and mental health crisis management to give you situation updates, analysis and advice. Contact us for further information.

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update - novel H1N1 (2009)

2009-08-09T22:35:00.000-04:00

Novel Influenza H1N1 (2009) Update

MedPrep Consulting Group LLC

Dr. Stuart B. Weiss

INFLUENZA UPDATE

WHO PANDEMIC ALERT LEVEL 6

August 9, 2009

SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com

CDC changes its guidance on how long to stay home, Federal officials issues new guidance on school closures and vaccine clinical studies begin.....boy its been a busy week.

Governments in North America have really turned up the heat on pandemic flu preparedness. President Obama is in Mexico for talks with the President of Mexico and the Prime Minister of Canada. A big topic on their agenda is mutual cooperation in responding to the resurgence of H1N1 expected in the next 6-8 weeks.

Current Situation:

The CDC issued new guidance regarding how long sick individuals should stay home from work. The CDC issued new guidance based on the epidemiological data from the spring outbreak of novel H1N1 (2009). The new recommendations for non healthcare settings recommends that sick individuals stay home until they are free from fever (without fever reducing medicine) for 24 hours. This is a change from previous recommendations that they stay home for 7 days or fever-free for 24 hours, whichever was longer. Based on data from the spring, the average length of time people had fever was 2 -4 days so this new recommendation would result in 3-5 days of absenteeism in most cases. The new guidance can be found at: http://www.cdc.gov/h1n1flu/guidance/exclusion.htm
Federal officials issued new guidance for school closure. It can be found at: http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm The new guidance discusses that if the H1N1 comes back with the same illness pattern and is not causing worse disease, the benefits of closing schools may not outweigh the negative aspects of children left home alone, parents missing work to watch the children, students missing meals and interruptions in education. If the flu comes back worse, there is a stronger case for closures. There is much more guidance in the document.
There was much discussion about vaccines and vaccine safety in the media this past week. The WHO held a press conference on this topic this past Thursday. The reported that there are 7 manufacturers with clinical trials in progress in 5 countries (China, Australia, UK, Germany and U.S.). They should have study results in September. That should lead to vaccine being licensed for use by late September / early October. WHO information on vaccines can be found at: http://www.who.int/csr/disease/swineflu/notes/h1n1_safety_vaccines_20090805/en/index.html
Health Experts are predicting that up to 1/3 of the world's population (2 billion people) may contract this new flu.

HOUSEKEEPING ITEM:

If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to alert@MedPrepGroup.com

ANALYSIS:

The updated guidance from the CDC on how long to stay home makes sense based on the data from the Spring outbreak. While this is based on the data showing that the maximal amount of viral shedding occurred when people had fever, there still was lower levels of viral shedding for up to ten days after people were symptom free. Therefore, workers who return to work must be counseled to practice good cough/sneeze etiquette, hand hygiene and to avoid close contact with people with known increased risk (pregnant workers, workers with underlying medical cardiac or respiratory conditions, workers living or caring for others at increased risk). We have sent updated policy recommendations to our clients to bring their policies into alignment with this new information. You should make certain that you have looked at your policies as well.

There continues to be concern over vaccine safety. We will know much more as clinical trials continue but I want to stress that there are many years worth of experience with influenza vaccines and much is known about their safety. Some of the vaccine being produced uses the same production methods as seasonal flu vaccine and should have the same excellent safety profile. There are some new techniques being used that includes adding a component to improve immune response with less vaccine (called adjuvanted vaccine). These are newer techniques that need more study. In general, these vaccines should be very safe. I want to caution however, in any large scale, mass vaccination program, even extremely rare side effects may be present due to the large number of people being vaccinated. When we look back at the swine flu vaccination program in 1976, there were 30 people that got a severe neurological complication called Guillain-Barre syndrome. While this was a tragedy for those people, it was only 30 out of 40 million. So while those cases received alot of press, they were extremely rare events. In addition, vaccine production has gotten much better in the past 30 years and you can be certain that there will be close surveillance of this new H1N1 vaccine when it is given to large numbers of people.

While we are talking about rare side effects, there will be another type of adverse event that will be reported and that is something that is temporally associated to the vaccine even though it doesn't actually have anything to do with the vaccine. This means that a person may develop a medical condition by chance close to the time when they received a vaccine. People may then make the assumption that the vaccine caused the problem when that was not the case.

Finally, take a look at the new school guidance. It encourages school officials to carefully weigh the benefits of closing schools before doing so. Since the virus is so wide spread, at this point, it may not be very useful to close schools unless the virus starts causing more severe disease.

ADVICE:

I have been advising you to take action in planning for quite some time now. Schools will reopen soon and we will see a resurgence of flu cases once that happens. By this time, you should have at least looked at your human resource policies and your supply chain. There are nine areas that we advise our clients to look at: HR, Corporate Governance, Incident Management, Security, Communications, Finance, Operations, Corporate Services and Information System. For each of these areas, take a look at your policies and procedures from the point of view of worker absenteeism. How will these areas function if large numbers of people are out for 3-5 days during October through February/March. Look upstream at your suppliers and downstream at your distributors to develop work-around solutions should they experience interruptions from absenteeism.

Now is the time to be preparing. Don't wait until September or October to review your plans.

If you need help, drop me a note. We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template and shortly, we will be releasing our new trigger decision model to replace the WHO Pandemic Phases. We can help you jumpstart your planning initiative or take a look at your plan with a fresh set of eyes.

Virtual Medical Director

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update - novel H1N1 (2009)

2009-07-26T21:10:00.001-04:00

Novel Influenza H1N1 (2009) Update

MedPrep Consulting Group LLC

Dr. Stuart B. Weiss

INFLUENZA UPDATE

WHO PANDEMIC ALERT LEVEL 6

July 26, 2009

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Uh-oh, are we seeing a drift in circulating flu virus, and what happened to the summer influenza hiatus?

This year, the flu season has continued in the Northern Hemisphere over the summer, a time when flu is typically non-existent. In the Southern Hemisphere, some concerning changes have occurred in the circulating H3N2 virus.

Current Situation:

Although cases continue to rise in the Southern Hemisphere, case counts will no longer be reported as they are not very meaningful.
In some countries in the Southern Hemisphere, the novel H1N1 virus is the dominant strain and in others, there is concomitant spread of both seasonal influenza and novel H1N1.
On Friday, a news story out of Canada reported that Canadian employers are seeing huge increases in H1N1 related employee absenteeism as well as confusion on sick time policies.
The CDC released a report about 4 children with novel H1N1 virus infections that developed neurological complications such as seizures or confusion/lethargy.
Reports from the Southern Hemisphere suggest the presence of a new H3N2 flu variant that has drifted. This could lead to a vaccine mismatch for the fall seasonal influenza vaccine in the Northern Hemisphere is this new H3N2 becomes dominant (see analysis below).
Samples of the novel H1N1 virus continue to show no genetic changes in the virus.
Several clinical trials are beginning to test new H1N1 vaccines. These trials are testing single and two dose regimens and different amounts of administered vaccine. These studies should take about 3 months to complete.
There was much news about "worst case scenarios" from the CDC this past week. Although the worst case scenario is scary, it is worst case, not most likely case. As planners, worst case scenarios are useful in planning but too much emphasis should not be given to the worst case.
MIT has a wonderful paper on novel H1N1 which summarizes what is currently occurring and reviews past pandemics. It is well worth the read. You can find it at: http://esd.mit.edu/WPS/2009/esd-wp-2009-07.pdf
The Advisory Committee on Immunization Practices (ACIP) will meet in Atlanta on July 29th and is expected to develop guidance for who should be prioritized for the new H1N1 vaccine when it is available.

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ANALYSIS:

In the United States over the summer, we really haven't had the usual flu hiatus. In both summer camps and military bases, there have been continued outbreaks of this new virus. Twenty states are still showing widespread influenza activity, all of it related to the new H1N1 virus. This is leading many to predict that once schools reopen in a little over a month, we may see a real spike in the number of novel H1N1 cases. This spike in new cases in young people is a real possibility and would occur in late August or September, a full month or two before we have vaccine available. This spike would lead to employee absenteeism as parents are forced to stay home with sick children.

The fact that the CDC reported finding neurological complications in children with the new H1N1 virus infection is concerning. Although all 4 children fully recovered, having large numbers of children develop seizures or confusion will stress our medical care system significantly.

In the United States, Federal officials are moving towards a voluntary mass flu vaccination program for the fall. That is a massive undertaking with many logistical nightmares, not the least of which is that the vaccine may come out two months after the number of flu cases begins to spike. The Federal government is ramping up for a bad flu season this year and so should you.

Lastly, the development of a new drifted H3N2 seasonal flu strain is concerning. As I have written about before, influenza viruses are very prone to genetic changes as they spread. Small genetic changes result from a drift while large genetic changes result from a shift. These small genetic drifts can sometimes make a virus different enough that the vaccine for it doesn't work. If this new drifted H3N2 becomes the dominant strain this coming fall/winter and we end up with an ineffective vaccine, then we will have a particularly bad seasonal flu season regardless of what the new H1N1 does. This will need to be watched as the Souther Hemisphere flu season continues.

ADVICE:

Plan for supply chain interruptions. It is very important for you to plan for supply chain interruptions this fall. With just-in-time delivery of much of the inventory in the U.S., there is no extra inventory to carry us through supply chain interruptions. Review how you will keep your company going if deliveries slow or stop for a period of time.
Look at your sick time policies. When reviewing these policies, look closely at your requirement for physician notes if your employees are out for a certain number of days. Many companies require such notes after 3 or 4 days of illness. You can expect that during a bad flu season, public health authorities will be recommending that people only seek medical care when they have severe illness so getting return to work notes will be problematic. At a recent exercise we ran in New York, we heard from many health care providers that they were inundated with people wanting a return to work notes.
Turn up the heat on your planning efforts. You only have a month or two before we will see the spike in cases from schools reopening. You must review your pandemic policies and trigger based action plan.
Develop a trusted source for important medical information and analysis. If you have a corporate medical director, include them in the planning process. If you do not have this resource in-house, hire us to serve as your Virtual Medical Director if you wish. See below for information.

Virtual Medical Director

If you don't have a corporate medical director, we'll be your medical director. Our Virtual Medical Director service provides you with 24 hour access to physicians and experts trained in emergency medicine, disaster medicine, business continuity, occupational health and mental health crisis management to give you situation updates, analysis and advice. Contact us for further information.

Pandemic Planning Services

If you need assistance with pandemic planning, we offer a full range of materials and services including policy templates, FAQ's, development of trigger based actin plans, refinement of plan triggers, plan audits, employee educational programs, exercises, etc. Give us a call or send me an email if you want more information.

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update H1N1-(swine)

2009-07-13T23:06:00.000-04:00

MedPrep Consulting Group LLC

Dr. Stuart B. Weiss

INFLUENZA UPDATE

WHO PANDEMIC ALERT LEVEL 6

July 13, 2009

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What are we learning from the Southern Hemisphere?

As the H1N1 (swine) flu season continues in the Southern Hemisphere, case numbers continue to rise and it appears that the H1N1 (swine) flu is the dominant circulating virus.

Current Situation:

Cases continue to rise in the Southern Hemisphere. There are currently 94,512 confirmed cases in the world although many countries have stopped active testing.
In many countries the new H1N1 virus is causing between 90% and 98% of flu cases and is becoming the dominant virus at this time.
Vaccine development continues. CSL, the only flu-vaccine maker in the Southern Hemisphere announced that it will start human studies on a 2 dose vaccination regimen on July 22nd. The doses will be given 3 weeks apart.
Millions of Argentines are staying home from work due to flu illness and concerns. School winter vacation has already been doubled. The government is urging people to avoid crowds. Pregnant and other vulnerable government workers have been sent home for 15 days
Bolivia has extended the school winter break, Peru has started the winter school break a week early.
Three cases of Tamiflu resistant virus have been reported. Two patients were on Tamiflu when the resistance developed, the third patient was not.
6 Companies are working on an H1N1 vaccine including Sanofi-Aventis, Novartis AG, Baxter International Inc, GlaxoSmithKline, Solvay and nasal spray maker MedImmune, now part of AstraZeneca. Clinical trials in the U.S. will start soon.

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ANALYSIS:

There are several developments that are interesting to watch in the Southern Hemisphere. First is the fact that the new H1N1 (swine) flu virus is becoming the dominant circulating strain, pushing aside regular seasonal flu. We will need to watch closely to see if this pattern continues through their winter. The problem for the Southern Hemisphere countries is that the seasonal flu vaccine that they currently have is not effective against the new H1N1 (swine) virus, the strain that is causing most of the illness.

The second development is a bit more predictable. Worker absenteeism has increased due to fear and illness and because schools are being closed. Many winter school vacations have been extended. We should anticipate that same response in the Northern Hemisphere next winter.

In the United States, Federal officials are considering a mass flu vaccination program involving 600 millions doses of vaccine, 2 shots for each citizen. That is a massive undertaking with many logistical nightmares. The Federal government is ramping up for a bad flu season this year.

The fact that the new H1N1 (swine) flu virus is still spreading in the warmer Northern Hemisphere and the rapid spread through the Southern Hemisphere should lead you to seriously plan for a bad flu season. Hopefully, an effective, safe vaccine for the new H1N1 (swine) flu virus will be available before the flu season returns in the Northern Hemisphere.

Lastly, the development of Tamiflu resistant strains was in the news last week. Two of the cases were in patients receiving the medication. The development of Tamiflu resistance is not unexpected in patients on the medication. The third was in a 16 year old girl who traveled from San Francisco to Hong Kong who had not been on Tamiflu. This was more concerning as it could have represented the emergence of a resistant strain however, multiple viral samples have been tested and no other resistant strains have been identified leading experts to believe that these were sporadic isolated events. This will need to be watched as the flu season continues.

In a previous update, I wrote about a new modeling software project that we are involved with that will allow you to assess your company's current state of readiness as well as help determine your trigger level. This will take the place of tying your plans to the WHO Pandemic Phases. Our team just returned from a meeting with our collaborating team at Georgia Institute of Technology (Georgia Tech) and we are very excited about this work. The new formula and modeling platform will assist you in your planning and implementation phases. I will write more about this as we get closer to release.

ADVICE:

Ensure that someone follows the developments of H1N1 (swine) over the next few months. This is still an evolving outbreak. No one knows how the new H1N1 (swine) virus and the other circulating flu viruses will react. It looks like the new H1N1 (swine) is the dominant virus but that could change.
Communicate with your Southern Hemisphere offices. If you have offices or employees in the Southern Hemisphere it is very important to communicate with them. They are going through the worry and stress over H1N1 (swine) that we went through in May. Share with them strategies to prevent the spread of illness (hand hygiene, cough/sneeze etiquette, social distancing, etc.). Let them know that you are concerned about their wellbeing and are following the situation.
Continue your planning efforts. Over the next few months in the Northern Hemisphere, you should be planning for continuity of operations during a significant employee shortage and with interruptions in supply chain. Anticipate that the Northern Hemisphere will have a bad flu season with many business interruptions. Anticipate that we may not have vaccine available for the new H1N1 (swine) flu virus at the beginning of the flu season. Take time to look at HR policies on sick time and return to work. Look at how you will handle employees that come to work sick or are exposed to sick workers. There is some CDC guidance on this or you can contact us for assistance. Take time to figure out how you will implement social distancing and hand hygiene. Think about your cleaning needs.
Develop a trusted source for important medical information and analysis. If you have a corporate medical director, include them in the planning process. If you do not have this resource in-house, find someone now that you can call on. We can serve as your Virtual Medical Director if you wish. See below for information.

Virtual Medical Director

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update H1N1-(swine)

2009-06-26T06:50:00.000-04:00

MedPrep Consulting Group LLC

Dr. Stuart B. Weiss

INFLUENZA UPDATE

WHO PANDEMIC ALERT LEVEL 6

June 26, 2009

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So what's going on in the Southern Hemisphere?

The H1N1 (swine) flu season continues in the Southern Hemisphere where case numbers continue to rise however, flu continues to spread in the Northern Hemisphere as well.

Current Situation:

The WHO reports 55,867 confirmed cases in 109 countries. Remember, in countries with large outbreaks, the absolute number of cases is less important than the disease outbreak pattern. In many parts of the world, there is insufficient public health infrastructure to accurately test or count new cases.
Leaders in case counts in the Southern Hemisphere are: Australia, Chile and Argentina with 421 new cases in Australia and 203 new cases in Argentina in the past two days.
On Thursday, the CDC posted new interim guidance for businesses. It outlines guidance for preventing flu in "low risk" employees (i.e. office employees) You can find this guidance at: http://www.cdc.gov/h1n1flu/guidance/workplace.htm
Spread within U.S. summer camps has caused several to close already and has raised concerns of outbreaks this summer at camps.
Egyptian health authorities warn pilgrims to Mecca (Saudi Arabia) of the dangers posed by H1N1 (swine) and suggest that pilgrims will be quarantined upon return.
There are issues in China with travelers showing even a minor elevation in temperature being quarantined in less than hospitable locations.

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ANALYSIS:

With Influenza falling out of the media throughout most of the U.S.. its easy to forget that it is spreading and causing concern through much of the world. As expected, the number of cases in the Southern Hemisphere has continued to rise however the number of cases in other parts of the world also continues to rise. Its an interesting pattern. We continue to have cases in the U.S. and the CDC reported recently that 99% of the cases of influenza-like illness are now caused by the new flu virus. As expected, seasonal flu has died way down, but the H1N1 (Swine) continues.

As discussed earlier there are a couple of possible scenarios for the fall. I'd like to go over them again since I was asked about them on a recent conference call. The first scenario is that the H1N1 (swine) doesn't change much but returns with increased circulation next fall, at the same time that seasonal flu begins to circulate again. Since the two viruses seem to affect different populations and having one doesn't seem to protect you from the other, we may see the two become additive. H1N1 (seasonal) affecting infants and older people and H1N1 (swine) affecting young adults. That could lead to a really bad flu season with twice as many deaths and hospitalizations. This would completely overwhelm our healthcare system and lead to significant increase in employee absenteeism.

The second scenario is that the H1N1 (swine) acquires Tamiflu resistance from the H1N1 (seasonal) virus and comes back but now we can't treat it as easily. That would lead to more deaths and a still worse flu season. The last scenario is the really bad one where the H1N1 (swine) mixes with Avian H5N1 and gains its lethality. This is least likely due to several missing factors in the H1N1 (swine) virus but if it happened, it would lead to a highly lethal rapidly spreading virus.

Regardless of which scenario occurs, we will have disruptions this coming fall. It would be wise to plan over the summer for worker absenteeism. You can be certain that if H1N1 (swine) affects children and causes deaths, parents will be quick to keep their children home from school. In the early days of the H1N1 (swine) outbreak, back in May, one bank on Texas reported to us that they had up to a 70% absenteeism rate due to schools being closed.

So don't take your eye off this dark cloud on the horizon. We will continue to help you follow this evolution over the summer.

ADVICE:

Ensure that someone follows the developments of H1N1 (swine) over the summer. This is still an evolving outbreak. No one knows how this virus and the other circulating flu viruses will react.
Communicate with your southern offices. If you have offices or employees in the Southern Hemisphere it is very important to communicate with them. They are going through the worry and stress over H1N1 (swine) that we went through in May. Share with them strategies to prevent the spread of illness (hand hygiene, cough/sneeze etiquette, social distancing, etc.). Let them know that you are concerned about their wellbeing and are following the situation.
Communicate with Employees traveling to China and parts of the Middle East. We have seen reports that China is screening travelers and quarantining people with even minor elevations of temperature in location lacking clean food and water. There are also reports of other countries that are also screening travelers and mandating quarantine.
Continue your planning efforts. Over the summer, you should be planning for continuity of operations during a significant employee shortage and with interruptions in supply chain. Even if flu just comes back in its current form with two strain circulating simultaneously, it will be a bad flu season and we will have interruptions. Take time to look at HR policies on sick time and return to work. Look at how you will handle employees that come to work sick or are exposed to sick workers. There is some CDC guidance on this or you can contact us for assistance. Take time to figure out how you will implement social distancing and hand hygiene. Think about your cleaning needs.
Revise your triggers for your trigger based action plan. If you have linked your plan activation to WHO phases, it is time to uncouple those plans and design new triggers. Be certain that your triggers take into account information not only on the disease but also on community resilience, corporate resilience and corporate impact. We have developed a formula for htis which I will write more about in the next Influenza Update.
Develop a trusted source for important medical information and analysis. If you have a corporate medical director, include them in the planning process. If you do not have this resource in-house, find someone now that you can call on. We can serve as your Virtual Medical Director if you wish. See below for information.

Virtual Medical Director

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

H1N1 Influenza Update #26

2009-06-11T12:53:00.002-04:00

MedPrep Consulting Group LLC

Dr. Stuart B. Weiss

INFLUENZA UPDATE #26

WHO PANDEMIC ALERT LEVEL 6

June 9, 2009

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WHO Raises Pandemic Alert to 6 (Pandemic Phase)

The WHO has just raised the Pandemic Phase level to 6 indicating a global Pandemic is occurring. This has been expected since the spread of illness in Australia has been on the community level.

Analysis:

Remember, this change only relates to the amount of spread of the new H1N1 (swine) virus and not to the severity. Dr. Margaret Chan, the Secretary General of the WHO, emphasized that we do not know how this virus will behave in the developing world. She also stressed that countries must prepare for additional waves of influenza in countries as this pandemic runs its course.

Advice:

Brief your executives to this change and its meaning
Continue to refine your plans over the summer time in the Northern Hemisphere.
Develop a new decision matrix based on a combination of factors including spread, severity, corporate impact, threat, human behaviors and other factors
Refine your trigger based action plan with the new assumption that there may be limited to no advance warning before the virus arrives at your doorstep.

Virtual Medical Director Program:

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

H1N1 Influenza Update #25 (B) - WHO Info

2009-06-09T14:19:00.000-04:00

MedPrep Consulting Group LLC

Dr. Stuart B. Weiss

INFLUENZA UPDATE #25 (B)

WHO PANDEMIC ALERT LEVEL 5

June 9, 2009

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WHO Update

I know you recently received an update but today's WHO press briefing was very interesting and yielded some new information.

The press briefing was held with Dr. Keiji Fukuda, the WHO Asst. Director General for Health Safety and Environment.

The two points he made were:

Changing Pandemic Phase Definitions: The decision was made to stay with the current Pandemic Phase definitions but to augment any announcements on phase changes with additional information on severity and how countries should tailor their responses.
Moving the Phase 6: Today Dr. Fukuda said that the WHO is "very close" to declaring a Pandemic (Phase 6) due to activity in Australia. In Victoria, Australia, there are the expected outbreaks in schools and institutions and additional outbreaks in people who are not students or involved with the institutions. This signifies community level activity and meets the definition of a pandemic (sustained community level outbreaks in two WHO regions).

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ANALYSIS:

Don't be caught off guard when the WHO moves to Phase 6 in the next day or two. Remember that this doesn't mean anything about severity or worsening of the disease in any way. It just speaks to spread, which was the original intent of the pandemic phases in the first place. With that said, watch for unexpected reactions by some governments around the globe.

ADVICE:

Brief your executives on what a move to Phase 6 would mean for your company.

Virtual Medical Director Program:

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update #25 - H1N1-(swine)

2009-06-09T12:33:00.000-04:00

MedPrep Consulting Group LLC

Dr. Stuart B. Weiss

INFLUENZA UPDATE #25

WHO PANDEMIC ALERT LEVEL 5

June 9, 2009

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It ain't over yet!

Even though some folks in North America are relaxing and we now have a Lessons Learned report from the Trust for America's Health, things are still heating up in other parts of the world.

Current Situation:

The WHO reported 25,288 confirmed cases in 73 countries. Remember, in countries with large outbreaks, the absolute number of cases is less important than the disease outbreak pattern. In many parts of the world, there is insufficient public health infrastructure to accurately test or count new cases.
In the U.S., there are 13,217 probable or confirmed cases with 27 deaths in all 50 states plus the District of Columbia and Puerto Rico.
Australia continues to lead the pack with the most cases outside of North America. The case count continues to grow at a rapid pace. A prominent infectious disease specialist estimated that were were many more unconfirmed cases
India reported its first confirmed case in New Delhi and reports a total of 10 cases across the country (see analysis below). India also reported that two travelers to Hyderabad are in isolation with confirmed H1N1 flu.
Cases numbers continue to grow in South America. Chile is up to 411 cases, Argentina reports 202 cases. There are also smaller numbers of cases in other South American countries.
The Trust for America's Health published a lessons learned report last week. You can read it at: http://healthyamericans.org/report/64/pandemic-flu-frontlines

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ANALYSIS:

Lessons Learned reports are typically published after an event has resolved when folks have a chance to relax and reflect on what occurred. So when the Trust for America's Health (TFAH) report came out, we heard a sigh of relief from some planners. Things must be resolving, they said, I don't see H1N1 in the media and now we have lessons learned. Its an easy trap to fall into. The key to being ready for whatever our fall flu season looks like is to use this outbreak as a dry run. We must learn as much as we can and use that knowledge to improve our preparedness for the fall.

The TFAH report had some good points in it. There are ten lessons and ten gaps:

The lessons are straightforward and should not come as a surprise to any of you:

Investments in pandemic planning and stockpiling antiviral medications paid off
Public Health departments did not have enough resources
Response plans must be adaptable and science-driven
Providing clear, straightforward information to the public was essential
School closings have major ramifications for students, parents and employers
Sick leave and policies for limiting mass gatherings were problematic
Even with a mild outbreak, the healthcare system was overwhelmed
Communication between public health and health providers was not well coordinated
WHO pandemic alert phases caused confusion
International coordination was more complicated than expected

The gaps include core areas that must be addressed to improve U.S. preparedness:

Maintain the Strategic National Stockpile of antiviral medications
Enhance vaccine development and production capability
Ensure that all Americans could be vaccinated in a short period of time
Improve planning and coordination
Improve strategies for school closings, sick leave and community mitigation
Global coordination - build trust, technologies, and policies internationally to encourage science-based, consistent decision making
Provide enough funding for on-the-ground response
Stop health department layoffs
Improve healthcare system surge capacity
Ensure that all Americans will receive care during an emergency

There was also discussion this week about increasing swine surveillance. Previously, almost all resources were directed to monitoring bird populations for avian influenza. Very few programs monitored pigs for influenza and most swine farmers ignore influenza outbreaks since it doesn't usually cause significant illness in pigs. As I have written about previously, pigs serve as a great mixing vessel for viruses so more surveillance will be a good thing.

This disease continues to be a disease of young people. 60% of cases and 42% of hospitalized cases are in people 5-24 years old. With this pattern, even if the virus doesn't become more lethal when it returns in the fall, it may still cause significant impact in businesses as parent stay home to care for sick kids or young employees in their early twenties become ill.

Lastly, a comment about the numbers coming in from countries around the world. People seem to be erroneously putting much emphasis on these case numbers. Remember, in Australia, which is a main WHO collaborating center for Flu, it was estimated that for every one confirmed case, there are between 2-10 unconfirmed cases. In the U.K, the estimates are at least 2x as many cases as are confimred. Now apply that to a country like India. We recently did work in Mumbai where 60% of the city's population live in slums without electricity, running water or health care. Its difficult to imagine that public health officials would have any idea of what is actually going on with flu cases. Its a similar case in many countries with gaps in their public health infrastructure. So remember to look at disease patterns and not just case numbers to follow this outbreak.

ADVICE:

Practice Employee Protection Strategies over the summer. Use this time to practice good social distancing and hand hygiene. Try a "Social Distancing" day in which employees do not shake each others hand, or don't come closer than 6 feet to each other. Its actually harder than it seems. Another idea is to teach employees to clean their workspaces. One company has developed a strategy called "Wipedown Wednesdays" in which cleaning supplies are available each Wednesday for employees to clean their workspaces. Remember, the three germiest areas of your workspace are usually your phone, keyboard and mouse.
Ensure that someone follows the developments of H1N1 (swine) over the summer. This is still an evolving outbreak. No one knows how this virus and the other circulating flu viruses will react.
Arrange for a medical advisor before next flu season. Regardless of how H1N1 (swine) evolves, it will be back in the fall. You will need to make medical decisions on how best to protect your employees and keep your business going. Involve your medical director in your planning efforts. If you don't have a medical director, sign up for our Virtual Medical Director Program and we'll be your medical director.
Continue your planning efforts. I know I keep repeating this but now is the time to write missing policies, test plans, run exercises. Consider this H1N1 (swine) outbreak as a dry run for a worse fall flu season.

Virtual Medical Director Program:

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update #24 - H1N1-(swine)

2009-06-01T20:16:00.000-04:00

MedPrep Consulting Group LLC

Dr. Stuart B. Weiss

INFLUENZA UPDATE #24

WHO PANDEMIC ALERT LEVEL 5

June 1, 2009

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So what's going on in the Southern Hemisphere?

As flu season gets underway in the Southern Hemisphere, things heat up in Australia and South America. Will this push the WHO to declare a pandemic?

Current Situation:

The WHO reported 17410 confirmed cases in 62 countries. Remember, in countries with large outbreaks, the absolute number of cases is less important than the disease outbreak pattern. In many parts of the world, there is insufficient public health infrastructure to accurately test or count new cases.
In the U.S., there are 10,053 probable or confirmed cases with 17 deaths in all 50 states plus the District of Columbia.
On Saturday, the CDC posted new interim guidance for businesses. You can find this guidance at: http://www.cdc.gov/h1n1flu/guidance/workplace.htm
The number of cases in Australia has risen significantly and now doubles about every two days. The head of public health at the University of New South Wales said that the virus has clearly gained a foothold in Australia and is spreading through various communities. It was estimated that fro every confirmed case in Australia, there are between 2-10 unconfirmed cases.
Cases numbers continue to grow in South America. Chile is up to 276 cases, Argentina reported 35 new cases over the weekend for a total of 115. There are also new cases in Brazil and Peru.

HOUSEKEEPING ITEM:

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ANALYSIS:

With Influenza falling out of the media throughout most of the U.S. and with numbers of new cases slowing down across much of the country, its easy to take your eye off this ball. That would be a mistake. This is a new virus that is just now entering into its favorite season in the Southern Hemisphere, namely winter. With that in mind, it is not unexpected that cases in Australia would double every 2 days or that cases in South America would continue to climb. It will be important to follow the evolution of this virus over our summer to anticipate what our next flu season will look like. Most flu experts expect this strain to play a major role in next winter's flu season. So the unanswered question remains......will it turn more deadly or stay the same. At this point, nobody knows. We must also remember that for people with underlying medical problems or pregnant women, the current form of the H1N1 (swine) virus can cause serious illness. So don't take your eye off this dark cloud on the horizon. We will continue to help you follow this evolution over the summer.

ADVICE:

Ensure that someone follows the developments of H1N1 (swine) over the summer. This is still an evolving outbreak. No one knows how this virus and the other circulating flu viruses will react.
Arrange for a medical advisor before next flu season. Regardless of how H1N1 (swine) evolves, it will be back in the fall. You will need to make medical decisions on how best to protect your employees and keep your business going. Involve your medical director in your planning efforts. If you don't have a medical director, sign up for our Virtual Medical Director Program and we'll be your medical director.
Continue your planning efforts. I know I keep repeating this but now is the time to write missing policies, test plans, run exercises. Consider this H1N1 (swine) outbreak as a dry run for a worse fall flu season.

Virtual Medical Director Program:

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC

Influenza Update #23 - H1N1-(swine)

2009-05-27T15:03:00.003-04:00

MedPrep Consulting Group LLC

Dr. Stuart B. Weiss

INFLUENZA UPDATE #23

WHO PANDEMIC ALERT LEVEL 5

MAY 27, 2009

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Has the virus peaked in the U.S.? Perhaps, but watch for

flare-ups.

The CDC announced yesterday that the number of new cases of H1N1 (swine) have dropped off in most of the U.S. except for NY, NJ and New England. They also cautioned that local flare-ups (like we are seeing here in NY) may still occur through the summer. The WHO continues to move away from the current Phase definitions.

Current Situation:

The WHO continues to look at its current Pandemic Phase definitions. On yesterday's press conference, the WHO said that a panel of expert scientists would be consulted to help develop a new definition.
The WHO reported 12,954 confirmed cases in 46 countries. Remember, in countries with large outbreaks, the absolute number of cases is less important than the disease outbreak pattern. The CDC reiterated that same point, that it is more important to follow patterns of illness than actual numbers.
In the U.S., there are 6764 probable or confirmed cases with 10 deaths on the CDC website and 12 deaths listed in various media reports.
On Saturday, the CDC posted new interim guidance on the use of facemasks and respirators. You can find this guidance at: http://www.cdc.gov/h1n1flu/masks.htm
The number of cases in Australia doubled overnight to 59. This country is being watched closely since the flu season is just beginning in the Southern Hemisphere.
The CDC reports that it has not seen any H1N1 (swine) that is resistant to Tamiflu or Relenza.

HOUSEKEEPING ITEM:

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ANALYSIS:

With the number of new cases slowing down in most of the U.S., we may have moved past the peak of an outbreak. Remember that for infectious disease outbreaks similar to flu, the number of new cases follows a bell shaped curve with new cases increasing rapidly until the outbreak comes to a peak and then new cases slow down. This is not true in NY, NJ and New England where new cases of flu continue to be found at a much higher rate than expected for this time of year. The other important characteristic to remember is that we may see flare-ups or local pockets of outbreak even as spread across the country overall slows down. Flu virus is expected to spread somewhat unevenly in different communities.

On the WHO press briefing call yesterday, the WHO indicated that it is still struggling to develop more meaningful Pandemic Phase criteria. The WHO will call on an expert panel of scientists to assist them with the development of new criteria which they hope to get out soon. We have spoken to many of our clients about this same issue. As we assist them with the development of their trigger based action plans, several issues have come up. This gets a bit complex so bare with me. As I have written previously, we have been recommending that companies develop a set of triggers with an associated decision matrix that are not directly tied to WHO Pandemic Phases. The decision matrix you develop helps your executives decide which trigger to activate. Built into the matrix are the criteria of viral spread, severity and impact. This matrix must be individualized for each company since corporate impact varies depending on where your facilities are located and what public health infrastructure is present in those areas.

Each trigger has a set of actions associated with it that fall into one of five domains: People, Facilities, Communications, Mission Critical Activities and Technology. Within each action, there is an associated policy, procedure and FAQ.

So overall, the decision matrix drives the trigger decision. The trigger drives the specific associated actions. And the actions are made up of an associated policy, procedure and FAQ.

I hope I haven't confused everyone but this is a process that we go through with our clients over the course of weeks to months depending on the complexity of their corporate structure. If you have any questions about this, please drop me an email.

Lastly, as mentioned above, the CDC has come out with new facemask guidance. While there is nothing new or earth shattering about the new guidance, you should familiarize yourself with it. Basically it recommends that for community settings with a new flu virus, no masks are needed. For occupational settings, avoid close contact and practice good cough/sneeze etiquette. If you cannot avoid close contact, wear a mask. There is a good table that summarizes the guidance within the guidance.

ADVICE:

Develop your action plan with triggers that are based on spread, severity and impact. Don't wait until the new WHO phase definitions come out. Start working on this now. Take this opportunity to uncouple your plan from WHO Phases and build a decision matrix and triggers based on the combination of spread, severity and impact.
Expect some irrational behaviors in countries around the globe as they attempt (unsuccessfully) to keep the virus out.
Ensure that someone follows the developments of H1N1 (swine) over the summer. This is still an evolving outbreak. No one knows how this virus and the other circulating flu viruses will react.

Virtual Medical Director Program:

If you don't have a corporate medical director, we can be your medical director. Our Virtual Medical Director service provides you with 24 hour access to physicians and experts trained in emergency medicine, disaster medicine, business continuity, occupational health and mental health crisis management to give you situation updates, analysis and advice. Contact us for further information.

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com

Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC