H1N1: Preparing to be resilient
The H1N1 virus is sweeping the Southern Hemisphere. According to the July 9 edition of New Scientist, "H1N1 virus seems to be replacing the seasonal flu viruses that circulated till now - classic pandemic behaviour. This raises concerns that seasonal flu vaccine, which some companies are still making, may be useless when the northern hemisphere's flu season arrives later this year."
Australian public health authorities are reporting 60 to 90 percent of flu cases are due to the H1N1 virus, depending on the region.
This morning's Daily Telegraph of Sydney headlines, "Swine flu threatens to wipe out workforce." The report continues, "Health authorities have lost the battle against swine flu, conceding it now makes up about 60 per cent of all influenza cases. And it is only going to get worse as businesses already feeling the impact brace for bigger numbers in staff absenteeism... It is expected to be the worst flu season on record with numbers expected to skyrocket in coming weeks. Health experts yesterday warned workplaces will be hard hit with every worker off at least twice this winter with flu symptoms. Currently 100 out of every 1000 workers are off sick - an increase of 20 per cent from last year..."
Argentina is facing a similar situation, where the Buenos Aires Herald's headline reads, "Argentina almost paralyzed by H1N1." While mortalities remain at or below averages for seasonal flu, the New Scientist report, above, suggests we should not depend on this continuing.
(See WHO map of H1N1's current scope and impact. See July 6 WHO case count by nation.)
White House Flu Summit
Yesterday, calling in from the G8 summit in Italy to the Flu summit in Maryland, the President warned, "It's clear that although we were fortunate not to see a more serious situation in the spring when we first got news of this outbreak, that the potential for a significant outbreak in the fall is looming.... We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation. And the most important thing for us to do in this process is to make sure that state and local officials prepare now to implement a vaccination program in the fall, but also that they are working on an overall public communications campaign with the White House and the possibilities that we may need to be dealing with schools that are seeing significant outbreaks of H1N1."
"And we've looked at past cases of this being properly handled and situations like this being improperly handled, and one of the most important differences is where it's well handled, state and local officials have complete ownership over this issue, they are providing good ideas to the federal government, they are critical links to inform us what's working and what's not..." (Underline by Philip Palin.)
"We may end up averting a crisis. That's our hope. But I think that if we are all working together in a thoughtful, systematic way based on the best science possible, that even if this turns out to be a serious situation, we can mitigate the damage and protect our neighbors and our friends and coworkers."
(The President's complete remarks and a video of the flu summit are available from the White House blog. More information on the Flu Summit and related is available from www.flu.gov)
Nurturing Resilient Readiness and Response
In late August last year, HSPD-21was released as policy guidance. It states, "The four most critical components of public health and medical preparedness are biosurveillance, countermeasure distribution, mass casualty care, and community resilience."
Biosurveillance systems are tracking H1N1. Countermeasures, such as Tamiflu, have been distributed. Mitigation measures, such as social distancing, were seriously exercised in several jurisdictions during the initial outbreak. A new vaccine is under development, but may not be ready in time.
Mass casualty care and community resilience are not sufficiently ready. In fact, the media frenzy combined with the mild outcomes of the initial H1N1 outbreak may have undermined resilience efforts. Yesterday's Flu Summit was an effort to kick-start serious and sustained attention to resilience for the second wave of the contagion coming this fall/winter.
HSPD-21 describes community resilience as the "demand side" of a health emergency, "Where local civic leaders, citizens, and families are educated regarding threats and are empowered to mitigate their own risk, where they are practiced in responding to events, where they have social networks to fall back upon, and where they have familiarity with local public health and medical systems, there will be community resilience that will significantly attenuate the requirement for additional assistance."
(The complete text of HSPD-21 is available from the Department of Homeland Security.)
Unfortunately, the work to nurture community resilience had barely begun, was delayed by the change in administrations, and has been further complicated by the economic recession.
Assuming we have about 100 days before H1N1 returns with some vengeance, to what would you give priority in building community resilience?
Additional coverage of yesterday's Flu Summit and related reports:
H1N1 threat has not passed (FoxNews)
Mass campaign against pandemic may begin in fall (Washington Post)
Obama warns of return of swine flu in the fall (New York Times)
Swine flu summit focuses on preparedness (Atlanta Journal Constitution)
Swine flu vaccination program may target schools (WebMD)
Swine flu's life cycle defies traditional pattern (Miami Herald)
Businesses hit as swine flu takes over (Australian Broadcasting Corporation)
More swine flu coming our way (The Times, South Africa)
Special powers in Chile to drive down H1N1 cases (MercoPress)
Remarks by Secretary Napolitano on HSPD-5 and H1N1 (DHS release)
