Homeland Security Watch

News and analysis of critical issues in homeland security

July 10, 2009

H1N1: Preparing to be resilient

Filed under: Biosecurity,Preparedness and Response,State and Local HLS,Strategy — by Philip J. Palin on July 10, 2009

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)

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Comment by William R. Cumming

July 10, 2009 @ 8:23 am

Note for the record that Congress passed and the President signed a special appropriation for H1N1/Swine Flu of $7.7 Billion. NO word yet on how that appropriation will be allocated or apportioned by OMB! Of course hoping OMB officialdom are reading HLSWatch.com and understand the seriousness of the challenges to come from this virus in the fall.

Comment by christopher tingus

July 10, 2009 @ 10:47 pm

When the intial cases broke out, I approached senior management at Coca-Colar seeking a depiction of its concern for its consumers by offering a face mask w/the Coke logo found in every 12 can pack or similar packaging to enable us – the global citizenry – to utilize Coca-Cola’s extensive global marketing and get masks out to many people who just would not have access.

As Mr. & Mrs. Citizen Joe, we globally have supported Coke-Cola day after day, decade after decade and senior management dismissed my suggestion on behalf of the global populace which more often than not does not have a face mask stored….

As a 35+year senior international new business development consultant in an array of project initiatives globally, (we) Mr. & Mrs. Citizen Joe reiterate our request directed to the business community asking it to portray its social consciousness towarda its loyal customers and step forward with an initiative which will get these hospital quality face masks to we who have supported Coca-Cola and other producs as well….

Christopher Tingus
aka Mr. & Mrs. Citizen Joe
64 Whidah Drive
Harwich (Cape Cod), MA 02645 USA

pls google: christopher tingus

*Mr. President,

The good ‘ol fellas on Wall Street led by Paulson seemed to easily misplace $750 million….Paulson et al and the business community can surely fund the distribution of hospital quality facemasks and if contrary to the same, then pass the cost of a facemask off to the consumer for at least the consumer will have a facemask to help prevent further outbreak!

Comment by christopher tingus

July 10, 2009 @ 10:53 pm

correction: $750 Billion..not million.

Comment by William R. Cumming

July 11, 2009 @ 2:43 am

Note for the record that the H-95 protective masks have never been analyzed for protection against H1N1/Swine Flu nor have any others. Employment of masks requires rotation maximum every two hours. Also masks largely to protect patient from infected medical personal not the reverse.

But hey mask sales worldwide are way up.

Comment by christopher tingus

July 11, 2009 @ 6:00 am

Well, the manner in which this country prints “fiat dollars” it best immediately appropriate monies and test the masks for their protective H1N1. One Life saved would be well worth…

However if in fact the mask was not found to be as protective as some medical professionals have advised me, yes, as a businessman I would thoroughly enjoy seeing someone’s global sales flourish in this worsening environment….

If the business community adopted my suggestion or some idea of further enlightening the public through advertising i.e., the CEO & President of Coca-Cola or others on television in a one-minute information H1N1 ad or Hollywood celebs, the public would take this all much more seriously. Just as the economy promises to worsen, many more lives will be challenged from this global challenge.

William, thanks for your input!

I will interview more here in the Boston medical community to listen to their perspectives as to the effectiveness of wearing the masks other than a method of heightening the public’s awareness which has been my objective, not the commercial sales benefit….Here on the street, we have heard not too worry as it is not spreading to many and a vaccine is being prepared. Apparently, as usual, we are misinformed and have much to be concerned….

Christopher Tingus

Comment by christopher tingus

July 11, 2009 @ 7:26 am

William and others passionately concerned about the well being and safety of our citizenry…

Pls see: Flu.gov and specifically reference H1N1 and masks. I believe that you will find merit per the government’s suggesting in wearing a mask and this is not all about booming mask sales, though admittingly as a global consultant, my creativity and intersts obviously lean in that direction as well!

Before approaching senior management at Coca Cola and making my suggestion that one mask be placed in each 12 can packaging distributed globally with Coca Cola’s long standing distribution network to be employed in helping to get masks in everyone’s daily discipline as news of H1N1 affecting more and more becomes breaking news…

I have spoken to many in the well respected healthcare community and the majority are favorable….

From reading Flu.gov the use of face masks is one of numerous recommendations oneof which is to simply wash hands frequently and many state that if a face mask is not available especially if the business community turns its cheek in getting these masks out to loyal consumers, coughing and sneezing should be done into one’s elbow, not covering with hands….

We, Mr. & Mrs. Citizen Joe expects the government to keep us informed as well as the 21st century global business community in one minute updates and other creative advertising ideas to promote a clearer understanding of a “pandemic” which we are worried about…very worried as we saw school administration’s close schools and young people die from the virus.

Now that we hear that the vaccine may not be effective or other, let’s have masks distributed even with the corporate logo emblazoned on the mask or what is it, you in the business community are fearful that CNN and Fox may show one of us who has perished wearing your logo…

We understand the perils of a pandemic and would like to see a government and busines community who does not turn its cheek as usual and after all, the virus will affect you as well. We are very worried. Public information is a necessity and its must be factual and clear. We are tired in the lack of transparency!

These days we have fewer and fewer government and business community folks we can trust?? We see only 10% of the government stimumus monies distributed when we were told by the Pelosi-Frank mentality of big government knows best of the urgency of getting the monies into Main Street USA and we see here on the street, for instance, a Governor, one aspiring to run for President, taking romantic strolls along the streets of Argentina while the folks in South Carolina and no one else including DHS is informed of his awol.

These days, there are far too many other instances to mention where Mr. & Mrs. Citizen Joe feel that those working for the government have forgotten that they are the servent, not the master!

We need to be kept informed. The CDC does not suggest that wearing a mask would be a waste of time.

I concur that adopting the idea would be a surge in sales of hospital quality masks, 12 can Coca Cola packaging would skyrocket with Pepsi for instance taking notice and likely causing them to feel a sense of “community” directing the packaging of the same helping us when others or ourselves are sneezing and coughing, further enlightening us Mr. & Mrs. Citizen Joe as to not only the seriousness of our worsening economy, but to the fact that government, the global business community and all of us can clasp hands and show compassion for our family, friends and neighbors.

The uncertainty unfolding is cause for alarm!

We are not only worried about the WMD’s in Pakistan which the “Brutes of Tehran” and the Taliban supported by the “KGB Putinites” as I refer to them seek control to use and create mightmares for all of us no matter where located in the world or the fact that the Egyptian President will step down shortly while Egypt is being besieged by the fundamentalists which if power is stolen from the good versus evil scenario would upset the balance in the Middle East – if in fact one sees any stability in the Middle East as I have never seen it walking the streets of Hebron or Jericho or my strolling the markets in Cairo…

We are worried about H1N1 not only about the many thugs around us who lust for power and corruption.

Mr. President, maybe Coca Cola can design a mask for you personally with the Presidential Seal along with the Coca Cola logo of course! We would feel more comfortable if we see you in public service announcements wearing your mask and bringing us a smile with of course a caffeine-free, diet Coca-Cola in hand!

Let’s all keep informed by referencing updates on Flu.gov

God Bless all!

aka Mr. & Mrs. Citizen Joe
64 Whidah Drive
Harwich, MA (Cape Cod), MA 02645 USA

Comment by Pat Longstaff

July 12, 2009 @ 8:56 am

Community resilience for the flu, let’s see. The community should be developing a DIVERSITY of sources for critical goods and services. The provision of emergency services should be facilitated at the right SCALE. Information channels that will be TRUSTED should be planned. A few local demonstration scenarios with NO Blame Game would be good – it is important to gather real data about what might go wrong. Specifically,
1. Make sure that there are TRUSTED sources of information for the community and all sub-communities (any minorities, religious groups who are not mainstream, etc). This many NOT be government for all these groups. Set up communication links from public health agencies to all community groups that allows for TWO-WAY communication so that trustable information about the outbreak and need for services can get to the right people. Plan to collect both data and stories about what is working and what is NOT working (many people learn from stories and not data). Make sure that the people who get this info from the ground do not horde it but pass it on immediately. Use local media but they must be trained to go into a different mode than their usual MO – they cannot compete for info, they must cooperate. Make sure they have emergency staff (probably volunteers) who they can activate to get trustable info to their readers and listeners/viewers. Make sure that public health services know how to communicate in ways useful to the community – PLAIN English, and other languages. Make plans for dealing with FALSE information (it will happen fast and spread like wild fire).
2. Push delivery of service down as far as possible. Do not depend on centralized C&C. Have supplies spotted around so that services can be delivered without long commutes and local shortages that encourage Black Market services.
3. Have plans for reduced public services for transportation, garbage collection, etc. Perhaps encourage local neighborhoods to take over these services temporarily. (I know there are liability issues here and they need to be dealt with before the crisis.) The more local groups take ownership of their safety (with appropriate info) the more resilient they become for the next crisis.

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