Pandemic Planning - How to Prepare Your Business for the Upcoming Flu Season

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Pandemic Planning - How to Prepare Your Business
for the Upcoming Flu Season

Presented by William L. Lang, MD, MHA
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• We may see lots of flu activity in September and
  OctoberOn the other hand, we may not. CDC
  Briefing, August 21, 2009
• While the current flu outbreak is within the
  range of what were expecting, we really dont
  know what the trajectory will be CDC
  Briefing, September 8, 2009

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• KEY UPDATES

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Bottom Line Up Front

• H1N1 continues to show unusual characteristics
• More easily transmitted than seasonal flu
• Severity variable, but generally less severe than
  seasonal flu
• Can rarely cause serious disease/death in healthy
  young adults
• Can cause serious disease/death in typical
  high-risk populations
• Predominant flu in southern hemisphere (in peak
  flu season)
• Currently, essentially all flu in northern
  hemisphere is Swine
• Occasional reports of anti-viral resistance
• Issues for Northern Hemisphere flu season
• H1N1 will circulate, and will likely be
  predominant
• No reason to expect increased virulence
  but expect high attack rate

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What is the current status?

• The breadth of spread is unprecedented
• World-wide pandemic in only 8 weeks previous
  record 6 months
• Virus still circulating in US Widespread
  transmission in 3 states
• But, virulence remains relatively low to moderate
• No genetic markers of high virulencebut viruses
  can mutate
• Southern Hemisphere season not as bad as feared
• Parallels to 1918 pandemic (50M deaths)
• Began with a non-virulent flu in spring became
  deadly in fall
• Some evidence that both have predilection for
  lung
• There are important distinctions
• 1918 virus was Avian origin. Avian viruses
  generally more virulent
• 2009 virus is Swine origin. Swine viruses
  generally less virulent

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Next Step Get Ready For Flu Season

• Deal directly with pandemic fatigue
• After hype of spring outbreak, but little impact,
  many people are complacent, even cynical
• Watch for new media emphasis thru fall
• Fairly active S. hemisphere flu season a
  harbinger?
• Headlines to expect
• Parallels to 1918 Vaccine difficulties Young
  person deaths
• Even if much is media hype, it doesnt mean risk
  is negligible
• Take a lessons learned approach
• Use H1N1 as a reason to update business
  continuity plans
• Emphasize importance of
• Solid information in a crisis not just media.
  Media is often hype!
• Having good information allows good rumor control
• Review importance of hand and respiratory
  hygiene!

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• ADDITIONAL INFORMATION
• And
• BACKGROUND

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What is this outbreak?

• Basic virus type is H1N1
• This is a common type of flu, but immunity is
  based on the individual strain variants not virus
  type
• Since this is new strain variant, there is little
  natural immunity
• Not all H1N1 is H1N1-Swine!
• Seasonal H1N1 is different
• Some seasonal H1N1 is drug resistant
• Current terminology is 2009 H1N1
• Initially called Swine Flu but that terminology
  dropped
• Swine is correct nomenclature based on virus
  origin, but
• incorrectly implied that swine/pork is source of
  infection

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Cases

• Case counts now of little significance
• More important to watch flu surveillance data
• Routine flu screening systems track
• Relative rates and types of flu in screening
  populations
• Changes in virulence Pneumonia Flu
  deaths/hospitalization
• Current surveillance data related to H1N1-swine
• Only flu virus currently in significant
  circulation in US
• Peak transmission in Junebut increasing since
  mid-August
• Widespread flu in 11 states also throughout
  Mexico
• Insufficient data to be sure H1N1-swine will
  dominate in fall/winterbut all signs indicate
  that it will

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Current Flu Curve
reported to CDC this week were 2009 influenza A
(H1N1) viruses.
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Current Extent in US
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Official Status

• WHO (Pandemic Phase)
• As of June 11, Phase 6 Community-level
  outbreaks in at least two WHO regions global
  pandemic is under way.
• Public Health Emergency of International
  Concern (4/26)
• Focus has changed from spread to severity.
• Current phase system based on spread does not
  address severity
• U.S. Government
• HHS declared Public Health Emergency (4/26)
• CDC is not using U.S. Response Staging
• This has not merited full Pandemic Plan
  activation.

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How is this Flu different than Usual?

• Increased attack rates
• Low general immunity
• High attack rate, especially high in younger
  people
• Severity is highly variable
• Usually mild flu except those with underlying
  chronic disease
• Genetic markers not associated with high
  virulence
• But stories of severe disease in healthy young
  people
• This flu is sensitive to oseltamivir or zanamivir
  
• Most recent seasonal flu was 98 resistant to
  oseltamivir
• Needs new vaccine Under development
• Mid-October 50M End of Year 200M doses per
  person???
• Targets High infection risk high severity risk

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How is this flu similar to usual flu?

• Transmission
• Respiratory secretions surfaces/airborne
  droplets
• Incubation period / Infectivity period
• Incubation average 1½ days (90 within 3 days)
• People can be infectious from about 24 hours
  before symptoms start and up to 7 days after
  onset of symptoms
• Usually ok to return to work/school when afebrile
  gt 24 hours
• Symptoms
• Typical flu symptoms
• Effects can be much worse in those with chronic
  disease
• Treatment
• Antivirals are effective

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Is this THE Pandemic Flu we all fear?

• Contrast Reasonable Worst Case with
  Likely Scenario
• Former always gets top billing
• The US Government has an obligation to set
  preparations for reasonable worst case
  (consider Katrina lessons)
• CDC very clearly acknowledges that worst case is
  not the likely scenario
• Likely scenario is still significant flu season
• Think 2004 more than 1918
• But 1918 is not totally out of the realm of
  reason!
• A two-wave season is possible

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What should organizations do?

• Begin preparations for a significant flu season
• Refresh training on controlling transmission
  riskit makes sense all the time, not just when
  flu fear comes up!
• Cover mouth when coughing/sneezing
• Use paper tissues and throw them away when done
• Wash hands frequently and/or use a hand sanitizer
• Encourage social distancing, especially if ill.
  4 to 6 feet is enough.
• Encourage culture of prevention
• Anyone who develops a fever or respiratory
  illness within 7 days after possible exposure
  should stay home.
• Usually no need to seek medical care those at
  high risk need early care
• Dont go to a clinic/hospital without contacting
  the facility first
• Consider personnel policies that balance
  productivity with prevention
• For international travelers dont forget
  malaria!

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Should we change travel/meeting plans?

• Emphasize basic infection control
• Use hand sanitizers frequently provide for
  meetings
• Avoid shared magazines / blankets / pillows /
  etc.
• Dont travel if you have respiratory illness
  symptoms
• International travel
• All international travelers should consider
  carrying single stand-by treatment course of
  antiviral
• Many nations are screening travelers to/from
  affected countries some screening all travelers
• Some nations isolating /quarantining those with
  fever or exposure risks
• Some airlines refusing to accept travelers with
  fever or other obvious symptoms without a medical
  clearance

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Operations Considerations

• For all organizations
• Review and update pandemic plan
• Do not base actions solely on WHO Phases
• Base actions on severity of disease and local
  factors
• Consider an organizational anti-viral plan
• Must consider supply, storage, distribution,
  administration
• Establish decision-process for who/when to use
  anti-virals
• Confirm availability/security of pre-arranged
  anti-virals
• Expect expiration date extensions
• Use event as a teaching opportunity
• Review respiratory/hand-hygiene for all personnel
  
• Breadth of spread means all locations at some
  risk

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Operations Considerations

• For sites not in proximity to known cases
• No change in operations
• Management should choose a trusted source of
  information and continue to monitor closely
• Begin preparing employees for upcoming flu
  season combat Pandemic Fatigue
• Ensure travelers are briefed on precautions to
  minimize risk of bringing disease home

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Operations Considerations

• Sites in proximity to known cases
• No change in operations
• Minimize gatherings in close conditions
• Social distancing - 1 to 2 meters (4 to 6 feet)
• Have plans for handling ill employees
• Establish policy that employees should not to
  come to work with fever and respiratory symptoms
• Practice very careful hygiene / social distancing
  if exposed to someone with a respiratory illness
  at home
• Institute specific plans for handling personnel
  developing symptoms while at work
• Follow local public health guidelines, including
  having plans to screen employees if directed by
  local public health

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Operations Considerations

• Consider worst case scenario
• Duties, obligations, and fiduciary
  responsibilities
• What operations are essential
• What resources are essential to operations
• People
• Logistics and materials
• Utilities and communications
• Strategies for mitigating personnel impacts
• Examples Telework or shiftwork
• Enhances social distancing
• Decreases exposure via public transit

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Key Points

• We dont know how bad this will be
• Dont listen to the hype and dont react to every
  horror story
• but dont ignore the possibilities
• Combat Pandemic Fatigue thru preparedness
• Good pandemic preparedness is good general
  preparedness
• Good information is key
• Trusted sources
• Trusted and targeted analysis

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• Questions?
• If you have accessed audio through your
  computer speakers, enter your question in the QA
  pane on the right side of your screen. Hit submit
  to send.
• If you have accessed via telephone, you may
  submit your question online or raise your hand in
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  to ask your question live.

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• Reference Slides

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Utility of Screening Tests

• Screening only needed for hospitalized patients
  with influenza-like illnesses
• Most screens are AB tests
• If positive, treat with antivirals
• Send sample to State lab unless H1N1 already
  known predominate in locality
• Rapid tests sensitivity 50-70 negative test
  cannot rule out H1N1
• Treatment decision based on local epidemiology
  and patients contacts
• If Screen can separately identify flu type B (not
  common)
• Positive B and negative A rules out current swine
  flu strain
• Positive A must be handled as above
• Many governmental reference (e.g., state,
  national) labs now have diagnostic capability

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Vaccine Issues

• Little antigenic cross-protection from current
  flu vaccine
• Seasonal flu vaccine will not prevent H1N1-2009
• Being vaccinated, however, can help rule out
  seasonal flu if ill
• Season flu still a risk, especially later on, so
  still need regular vaccine
• H1N1 vaccine production underway
• Initial low vaccine yields but better with new
  strains
• Still waiting on final clinical studies to
  determine doses/dosages
• Early indications One dase,15 micrograms is
  effective
• Expect addl info late September and decision in
  early/mid October
• Initial clinical studies have shown no red
  flags
• No licensed adjuvant in US adjuvant would
  require EUA and add one month to the availability
  projections trials are ongoing
• Domestic production typically 20 of need but
  increased this year
• Early June Novartis announced a H1N1 cell-based
  vaccine
• Unclear what production capacity will be using
  Optaflu platform

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Additional epidemiology information

• Only 5 of cases older than 51 years of age
• Cross-reactive antibody to H1N1 flu (swine flu)
  detected in 6-9 of adults aged 18-64 years and
  in 33 of those aged gt 60 years
• Study of California cases requiring hospital
  care
• 2/3 have underlying risk factor
• 2/3 had positive rapid antigen flu tests
• Consistent with seasonal flu 50-70 sensitivity
  of rapid tests
• Median hospital stay 4 days
• No cases of secondary bacterial infection
• 27 had received seasonal flu vaccine

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Anti-viral Resistance

• Small number of oseltamivir-resistant isolates
• 21 as of September 10
• 14 of 21 cases given oseltamivir for prophylaxis
• 4 of 21 were in immunocompromised patients.
• No secondary transmission has been confirmed to
  have occurred from these patients
• Mutations do not appear due to drug pressure.
• Guidelines on fewer indications for prophylactic
  use of oseltamivir may be coming.
• These cases have no implications for treatment of
  H1N1-2009 cases

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Agility Recovery Solutions
Presented by Bob Boyd, CEO

• Every Business Should Be Prepared
• 10 Steps to Prepare Your Business for a
  Pandemic
• Overview of Agilitys Recovery Solution

BUSINESS AS USUAL. NO MATTER WHAT.
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Why Should You Have A Pandemic Plan?
Reputation impacts customers and
vendors Revenue losses and costs of an
outage Responsibility to customers,
shareholders, employees community Requirement
some audits require a plan Regulation some
regulation requires a pandemic plan
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Steps to Prepare for a Pandemic

1. Maintain a healthy work environment.
2. Be informed.
3. Communicate openly and proactively with
   employees.
4. Identify a pandemic team.
5. Identify essential job functions.
6. Cross-train employees.
7. Prepare for telecommuting needs.
8. Diversify your supply chain.
9. Update sick, family and medical leave policies.
10. Prepare financially.

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Business Continuity Is About The Future.

The future of your family. The future of your
business. The future of your community.
BUSINESS AS USUAL. NO MATTER WHAT.
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Agility Has A Simple Vision

• We imagine a day when every business will rest
  easier knowing its future is more
• secure.

IMAGINE.
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Forrester Wave Vendor Summary 3/27/06
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Agility.
BELIEVE. We believe every business should have
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QUESTIONS?

• Type question in the question pane on the right
  side of your screen and then hit submit to send.
• If you have accessed via telephone, you may
  raise your hand in the small tab on the right
  side of your screen, to ask your question live.

866.364.9696 Bob.Boyd_at_AgilityRecovery.com
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Upcoming NPM Webinars September 23 Social
Media - What Role Does it Play in Business
Preparedness and Recovery? John P. Shea, Public
Information Officer, FEMA September 30
Creating a Culture of Preparedness R. David
Paulison, Former Administrator of FEMA
REGISTER TODAY at www.agilityrecovery.com