What is a flu pandemic? What's the risk? What to do?

UPDATE (6-3-10): WHO says H1N1 swine flu pandemic continues; maintain vigilance. They'll reassess when more is known about the Southern Hemisphere's winter flu activity. Predicts H1N1 will be primary flu virus for some time. Reuters article WHO statement NOTE: This summary post now always appears first on my home page.

 

RESOURCE SITE:
 Ideas: How to prepare your household
or business for the swine flu pandemic 

["Why waiting till the last minute to prepare is dangerous"]

 

Quick Summary

Currently, there is a worldwide outbreak - a pandemic - of a new strain of flu. Since it's new, people have little/no immunity and many will get sick (an estimated 2,000,000,000). Direct Impacts: (1) Caring for so many sick, (2) Unusual number of cases in younger age groups, (3) Large absolute number of deaths (though small overall percentage). Indirect Impacts due to so many people either being sick, caring for the sick, caring for children during school closures, or reluctant to go out in public. Overwhelming surge in demand for healthcare. Employee absenteeism may disrupt business. Goals: Avoid the flu. Why? [a] Who wants the flu? [b] You may have trouble getting healthcare because of clinic/hospital crowding. Slow the spread of illness. This reduces strain on healthcare systems; buys time for responses. If sick, stay home. Be prepared with supplies to treat the sick. Be prepared to cope with changes in daily life. Governments can't meet all needs. Be as self-sufficient as practical. Pharmaceutical interventions: There's no cure for flu. A pandemic flu vaccine will take time to manufacture. Even then, there won't be enough. Antiviral drugs like Tamiflu shorten & ease the flu and are effective on H1N1 swine flu for now; but the virus may mutate and make antivirals ineffective. Emphasize NON-pharmaceutical interventions: Space - "Social distancing" to avoid crowds. Stock up on essential goods to reduce need for shopping. Wash hands or use hand sanitizers. Clean frequently-touched surfaces with disinfectants. Businesses: Stock up on operating supplies/materials. Protect your human assets. Plan how to staff essential functions. Scale back non-critical functions. Consult suppliers, transportation companies, utilities, others re: continuity.   Things you may need (a starter list of ideas): Hand sanitizer [Example ] Why? Kills virus. N95 respirator masks [Example ] Why? Blocks inhaling virus. "Surgical" face masks [Example ] Why? If sick, traps coughs. Latex gloves [Example ] Why? Protection if caring for sick. Businesses: Use GoToMyPC for telecommuting. Why? Easy work-from-home. Businesses: Use GoToMeeting for teleconferencing. Why? Easy company/customer meetings.

Background on pandemic risk

There are many strains of flu virus found in humans and animals. When flu viruses replicate, they routinely change (mutate). From time to time, a strain of flu which has never spread among humans develops the ability to do so. Because it's a new strain, people have little/no immunity to it and the virus spreads easily. The result is a worldwide flu outbreak - a pandemic where many people get sick. Having such a large number of sick people has major implications:

• The direct effects related to the sickness itself. Influenza is very infectious; many people will require medical care. (Therefore, many people will need to administer medical care, including within households.)
• The less-apparent, indirect effects ("ripple effects") resulting from:
  
  • So many people being out of their normal roles - either sick, caring for the sick, caring for children while schools/daycares are closed, or "staying in" to avoid exposure to the virus.
  
  
  • The difficulty of ordinary systems to cope with extraordinary demands. There may be temporary changes in how businesses and other institutions operate, driven partly by absenteeism and partly to reduce infection (e.g., cancelling public events).

It's important to understand the scope of the problem. Based on past pandemics, governments assume about 30% of people will get sick. Worldwide, that's about two billion people - 2,000,000,000. The effect on daily life could be big simply because so many people are affected.

 

Some specific concerns:

• Overwhelming impact. By spreading rapidly, the disease could stress many systems and services.
  • In particular, the pandemic likely will cause a surge in the need for health care. But, health care "surge capacity" is limited. Hospitals and clinics may be overwhelmed. Also, during a pandemic we probably can't manufacture medicines and medical supplies fast enough to meet demand.
• Employee absenteeism may cause disruptions in today's specialized, globalized, just-in-time supply chains ... in public services ... in wholesale and retail commerce ... in healthcare ... in other service-based businesses ... in transportation/shipping services, and other areas. These disruptions may, in turn, cause supply problems and economic impacts.
• There may be limited outside help - because there is no "outside." The same crisis is happening everywhere at once. (Governments and non-government aid organizations will be doing all they can to help. But it's not going to be enough.)
  
  • Therefore, much depends upon individuals, communities, and businesses making their own preparations. Being self-sufficient could be critically helpful.
• Misinformation. It's troubling to see how often the pandemic risk is misrepresented or downplayed by messages such as:
  1. The pandemic H1N1 swine flu is "mild" or "similar to seasonal flu." That's true ... and most swine flu victims recover without antivirals or medical attention. BUT:
     
     • Regardless of whether a pandemic flu makes people sicker than normal seasonal flu, it will make many more people sick. Many implications hinge on that fact.
     
     
     • If you have 2,000,000,000 cases, there are significant impacts on healthcare systems and on normal, routine life.
     
     
     • The "mild" H1N1 swine flu virus could become more dangerous at any time, either by random mutations or by mixing (reassorting) with other flu viruses. There's no way to know this in advance. Of particular and great concern: H1N1 could reassort with the H5N1 "bird flu" virus that has become widespread in birds in recent years and is extremely virulent.
  2. Many serious/fatal cases of H1N1 swine flu have "underlying medical conditions" (e.g., respiratory diseases, cardiovascular diseases, diabetes, autoimmune disorders, obesity). True, BUT:
     
     • WHO says some 30-50% of serious/fatal cases DON'T have underlying conditions, but instead are healthy young & middle-aged people.
     
     
     • This is not a good situation, but a large vulnerability. Millions of people have such underlying conditions today vs. in past pandemics (thanks to modern medicine which enables people to live with chronic conditions). Further, in a pandemic, will these people be able to get:
       
       
       
       • Outpatient services: dialysis, chemotherapy, etc.
       
       
       • Prescription medicines: heart conditions, diabetes, high blood pressure, hormone replacement therapy, mental conditions, etc.
       
       
       • Add to that the world's vulnerable populations living in unhealthy/poverty conditions and without good healthcare systems. This is another type of "underlying condition."
     • A vaccine is being developed. True, BUT:
       
       • There's limited production capacity. (Modern medical resources are limited in value if we can't deliver enough of them when and where needed.) [UPDATE 7-21-09: Vaccine manufacturers are getting disappointingly low yields on pandemic vaccine.]
       
       
       • We don't yet know how effective the vaccine will be. (What percent of the time will it actually cause immunity?)
       
       
       • The vaccine will be given to priority groups first. (That may not include you.) U.S. vaccine plan (1.8Mb .pdf).
       
       
       • The virus could mutate so the vaccine - targeting today's version of the virus - becomes less effective.
  
  

Characteristics of flu pandemics

• Widespread illness - including a rapid surge in the number of cases.


• Global spread. Today's mobility accelerates that spread. (Past pandemics have taken six months to spread as far as the H1N1 swine flu has spread in six WEEKS, according to the WHO.)


• Prolonged duration - maybe a year or two - with possibly debilitating effects on business operations and public morale.


• Multiple waves of outbreaks - likely two or more waves, each lasting weeks.


• Severe disease in age groups who are normally less susceptible - young adults, in particular.


• A large number of deaths. (Even with a low mortality rate, a large absolute number of deaths may occur simply because so many people are sick. A small percentage of 2,000,000,000 is a big number, too.)


• The impact is expected to be worse in developing countries.

Reducing the impacts

Pandemics cannot be prevented. But we can take steps to mitigate their adverse effects.

Goal #1: Reduce illness.

• Don't get sick or make others sick.
  
  • To keep from spreading the infection, reduce person-to-person contact.
    
    • If you're sick, stay home!!
    
    
    • "Social distancing" will be encouraged and/or imposed. This may include school closures, daycare center closures, and cancellation of public gatherings/events.
  
  
  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. (No tissue? Cough/sneeze into the bend of your arm.)
  
  
  • Avoid touching your eyes, nose or mouth. Germs spread that way.
  
  
  • Wash your hands often and well.

• Businesses, consider ways to segregate your workforce; internal "social distancing" including telecommuting, relocating some personnel to temporary satellite offices, making temporary changes in workflow, etc.

Goal #2: Delay illness; Slow the spread.
By slowing the rate of transmission, cases are distributed over a longer period ... which lowers and delays the peak ... which reduces the strain on healthcare and other systems ... and buys time for mitigating actions (e.g., vaccine development).

Goal #3: Be prepared.
Be ready to treat the sick and cope with changes imposed on daily activities.

• How well we prepare will directly influence how well we cope and recover.


• Remember: the needs probably will far exceed governments' and hospitals' abilities. So individual planning and preparation is EXTREMELY IMPORTANT.
  
  
  
  • Think about how you might collaborate with your extended family, neighbors, and community.
  
  
  • Since hospitals and clinics likely will be overloaded and must give priority to the most critical, plan on in-home self-care for your family or friends. Some "how-to" resources:
    
    
    
    • CDC - Taking Care of a Sick Person in Your Home
    
    
    • Home Treatment of Influenza - Dr. Grattan Woodson
    
    
    • Pandemic Flu Home Care: A Detailed Guide

There are two types of interventions:
pharmaceutical and non-pharmaceutical.

 

Pharmaceutical interventions.

• There is no cure for influenza.
• Vaccines often can prevent infections. However:
  • A well-matched flu vaccine can only be made after the pandemic strain is known. Even then, vaccine manufacturing capacity is limited.
  • Flu vaccines don't work for everybody.
  • The annual flu vaccine - used to prevent already existing human flu viruses - will not protect against a new flu virus.
  • Added risk: The flu virus could mutate so that the new vaccine no longer matches the virus well.
• Antiviral drugs (e.g., Tamiflu, Relenza) can reduce the length and severity of the flu.
  • Risk: The flu virus could mutate so that the antiviral drugs are less/not effective.

 

Non-pharmaceutical interventions. Given the limited availability of pharmaceuticals, NON-pharmaceutical interventions may be more practical, varied, and can be implemented at the individual level.

• Germ barriers.
• Space/distance is a barrier; social distancing. Avoid crowds. Stockpile necessities to reduce the number of shopping trips. Telecommute to work, if possible. Use delivery services.
  • Personal protective equipment:
    • N95 respirators - Flu viruses usually enter through your nose, mouth, or eyes. N95 respirators help block the viruses by filtering very small particles - including germs - from the air you breathe. Wear it when caring for or otherwise exposed to the sick.
    • Surgical face masks - Mainly helps keep you from spreading germs when you cough or sneeze. Protects other people from your germs. Wear it if you're sick. Use once; don't share.
    • Latex gloves. Flu viruses can live for a while on surfaces. Consider using gloves if you're touching "high traffic" surfaces or caring for someone who has the flu. (If allergic to latex, get nitrile gloves.)
    • Also consider: medical or lab gowns, when caring for the sick.
• Germ killers or removers.
• Thorough, frequent handwashing with soap and water, especially after you cough or sneeze.
• Alcohol-based hand sanitizers. Minimum 60% alcohol content. Especially useful when handwashing isn't available and for immediate, on-the-spot sanitizing.
• Germicidal cleaning agents (disinfectants) for oft-touched surfaces. (Look for products which specifically kill viruses.)
• Ultraviolet air sanitizers. UV-C light neutralizes flu viruses. [Explained.]
• Supplies - Household. Stockpiling can help reduce the spread of a pandemic (by reducing the need to go to the store) and gives peace of mind. Also, if you've taken care of your needs, you're one less person the government has to care for. [See "'Stockpiling' is not a dirty word."]
  • Consider stocking prescription medicines, over-the-counter medicines, N95 respirators, surgical facemasks, alcohol-based hand sanitizers, ingredients for rehydration, etc. For babies/toddlers: diapers, formula & baby foods, etc. In extreme situations (if you assume such), consider basics such as water, food, and heat.
  • Forget the standard "three-day supply." This isn't an ice storm or hurricane. Pandemics typically come in multi-week waves. (What do you do on the fourth day of a "three-day supply?")
• Supplies - Business. Operating supplies. Stockpile or pre-arrange reliable sourcing and delivery of critical parts, ingredients, packaging, office supplies, etc. Also, supplies for disease prevention among employees (hand sanitizers, etc.).
• Logistics - Business.
• REMEMBER: An infectious disease attacks your people, not your buildings and IT networks. Add infectious diseases to your contingency/continuity plans.
• Protect employees from infection. This reduces healthcare costs and healthcare system overload ... and keeps your business operating.
  • Explain to employees how to reduce the spread of germs.
  • Provide hand sanitizers, air sanitizers, disinfectants, N95 respirators, etc.
  • Internal "social distancing" to segregate your staff. Use additional locations/shifts, including temporary offices and working from home. Revise policies, as needed, to enable telecommuting/work-from-home. Telecommuting tools (below) keep employees connected & keep work flowing.
    • GoToMyPC - To access your PC .. network .. data .. email from ANYWHERE.
    • GoToMeeting - To conduct online meetings, conferences & presentations with ANYONE - employees, customers, suppliers, etc.
    • USB flash drives - To manually carry applications and data files for use at other locations.
    • Consider ways to reduce face-to-face contact with outsiders (customers, delivery personnel, etc.)
• Identify essential functions and who performs them. Cross-train for coverage. Assumption: 10-20%+ absenteeism.
• During the pandemic, temporarily scale back or discontinue non-critical functions.
• Think about the impact of your suppliers and customers having high absenteeism.
• Consult suppliers (in advance!) to forestall shortages. Consider alternative/secondary sources.
• Consult transportation companies (in advance!) re: inbound/outbound shipping.
• Consider changes that may occur in demand for your goods/services.
• Expand online, self-service, and delivery options for customers and business partners. (Why? To reduce person-to-person contact.)
• Plan for the possibility of interrupted public services (e.g., sanitation, water, electricity).
• Review your human resources policies in pertinent areas. Confer with labor unions.
• Review your legal ramifications in pertinent areas.
• Review your business insurance in pertinent areas.
• Implement a communication plan - to all stakeholders: Employees, customers, suppliers, shareholders, community, etc. Tell about your plans and actions.

For more information
For more in-depth explanations of the pandemic risk and mitigating plans, read the original version of this post - which discusses:
* What it means to say a pandemic is a "low probability, high impact" event.
* Avoiding simplistic assumptions.
* Indirect impacts of pandemics: Economic and daily living.
* Other complicating factors in a modern day pandemic.
* More about Non-pharmaceutical interventions.
* More about Business Logistics.