Pandemic Plan

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

UPDATE (Nov. 29, 2009): Something that bears watching - the "D225G receptor binding domain mutation" - a change in some H1N1 swine flu viruses that causes them to infect the lungs instead of the upper respiratory area, causing very severe lung disease. The concern: will this version of the H1N1 virus become more common? UPDATE (July 17, 2009): You must decide for yourself, but I believe we've entered a phase where the majority of pandemic preparations should be completed very soon. The flu pandemic is underway and spreading quickly worldwide. As the number of sick people grows, it may become increasingly difficult to make pandemic plans and obtain supplies. It's better to be prepared for something that doesn't come than to be unprepared for something that's overwhelming. ["Why waiting till the last minute to prepare is dangerous"] 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 

 

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.

European officials extend shelf life of Tamiflu

According to a report in the UK-based Manufacturing Chemist, the European Medicines Agency (EMEA) has extended its authorization for using the antiviral drug Tamiflu, as swine flu continues to spread. The EMEA...

...has recommended that the shelf life of Tamiflu capsules be extended from five to seven years. This will formally apply to newly manufactured Tamiflu capsules and EMEA has also recommended that capsules already on sale be sold for two years beyond their current five-year expiry date, should the World Health Organisation (WHO) declare a pandemic [which could happen any day -Chirp]. Also, in such circumstances, EMEA said patients who have Tamiflu capsules that have recently expired should not dispose of them.

The agency has also advised that after a WHO pandemic declaration, Tamiflu should be used to treat babies under one-year-old plus pregnant or breast-feeding women, sweeping away earlier official cautions.

GlaxoSmithKline increases production of antiviral Relenza

GlaxoSmithKline today said it has increased production levels of its antiviral drug Relenza in response to the outbreak of the potential pandemic flu strain H1N1. The London-based pharmaceutical company said in a statement that it is working with the World Health Organization and U.S. drug agencies to gain a better understanding of the new strain.

Glaxo’s zanamivir drug, which is marketed under the name Relenza, is already stockpiled by governments since it was used to deal with the global spread of avian influenza in 2003.

Roche gives Tamiflu supplies to its U.S. employees

All 5,300 U.S. employees of Swiss drug-maker Roche Holding AG have been given supplies of its flu drug Tamiflu to use during any influenza pandemic, the company told Reuters.

Roche's U.S. employees had on-site doctor appointments and a mandatory online influenza tutorial before being given the prescription antiviral drug.

"We don't know who may get sick, who may not get sick, so we thought it was important to protect all our employees," said Mike McGuire, Roche's vice president for anti-infectives.

Tests planned on new antiviral options: peramivir and injectable Relenza

Bloomberg reports that health officials are planning to experiment with new drugs in an effort to find better ways to treat lethal bird flu infections.

The World Health Organization and an international network of doctors want to use BioCryst Pharmaceuticals Inc.'s experimental peramivir antiviral to treat patients infected with the H5N1 avian influenza virus and other severe flu infections, said Frederick Hayden, a WHO medical officer. The group may also use an injected form of GlaxoSmithKline Plc's Relenza, now sold as an inhaler, he said.

Drs. Webster & Govorkova: "it would be prudent to develop robust plans"

The New England Journal of Medicine (NEJM) yesterday published a commentary by Drs. Robert Webster and Elena Govorkova of St. Jude Children's Research Hospital (Memphis, TN). (Thanks to NEJM for making this and two related articles freely available. Journals are not always so minded.)

Drs. Webster and Govorkova open by saying:

There is no question that there will be another influenza pandemic someday. We simply don't know when it will occur or whether it will be caused by the H5N1 avian influenza virus. But given the number of cases of H5N1 influenza that have occurred in humans to date (251 as of late September 2006) and the rate of death of more than 50%, it would be prudent to develop robust plans for dealing with such a pandemic.

Cardinal Health To Manufacture Tamiflu for Roche

Cardinal Health, Inc. announced today that it has signed agreements to manufacture and package the antiviral drug Tamiflu for Roche. Cardinal Health will manufacture 75 mg capsules of Tamiflu on behalf of Roche at one of Cardinal Health's manufacturing sites in Europe.

The added production comes amid reports of inadequate supplies of Tamiflu should a pandemic develop in the short term.

Another neuraminidase inhibitor being developed

One of the medical approaches to fighting a flu pandemic is a class of drug called neuraminidase inhibitors. Currently, there are two neuraminidase inhibitors on the market - oseltamivir, made by Roche and sold under the brand name Tamiflu, and zanamivir, made by GlaxoSmithKline and sold under the name Relenza.

Tamiflu is available in capsule form (and liquid for patients who need it). Relenza is inhaled. Tamiflu is the more popular of the two, but is difficult to make in quantity.

Now, a third kind of neuraminidase inhibitor could be on the way that is made from synthetic materials already available on a commercial scale.

Is there a role for Tamiflu in personal pandemic planning?

With respect to buying a personal supply of Tamiflu (or other pandemic supplies), I think (1) it's not a bad idea and (2) you should have the opportunity to buy a personal supply without feeling guilty because you've heard specious arguments against it.

But as much as anything, I'm drawing your attention to the "personal Tamiflu supplies" debate because it is a valuable communications lesson. We're seeing way too much misinformation and outright disinformation [Glossary] regarding a possible influenza pandemic. Quite often, the problem comes from medical experts, governments, and others in public policy roles. This debate over Tamiflu is a prime example.

Over the last couple of days, we noted that some people object to the idea of individuals buying a personal supply of the antiviral drug Tamiflu for use during a possible flu pandemic. [Post #1: The list of objections.] [Post #2: Analysis of the objections.]

Looking at this as both a policy issue and a risk communications issue, risk consultants Peter Sandman and Jody Lanard have reviewed 19 of these objections. I gave a large sampling of their comments in Post #2 above. But I suggest you read their discussion in full.

Of the 19 typical objections, Sandman & Lanard think 18 are specious arguments. However, they do accept the premise of the other objection - what they call the scarcity/rationing argument. This says that "society as a whole is better off if the government has all the Tamiflu."

I'm not sure even that argument is valid. In this post, I'll explain why.

The dilemma of personal Tamiflu stockpiling - Part II

Yesterday, we noted that some people object to the idea of individuals buying a personal supply of the antiviral drug Tamiflu for use during a possible flu pandemic.

Looking at this as both a policy issue and a risk communications issue, risk consultants Peter Sandman and Jody Lanard have reviewed 19 of these objections in a 37-page analysis. Yesterday, I listed the 19 objections for you to think about for yourself.

As I noted yesterday, these are experts talking. Sandman & Lanard have consulted for the World Health Organization and the U.S. Centers for Disease Control and Prevention, among many others.

With this article, I think their main purpose was to warn public leaders about the risk of losing public trust when they use illogical arguments. As a byproduct of that discussion, they're also telling you and me why most arguments against personal Tamiflu stockpiling are without much merit. It's valuable insight for all parties.

Their article - "The Dilemma of Personal Tamiflu Stockpiling" - notes two serious dilemmas. First, should there be an international stockpile or national stockpiles? Second, should there be national stockpiles or personal stockpiles? Their discussion focuses on the second question - basically, should the stockpiles be nationalized?