Pandemic Plan

In parts of UK, severe swine flu already is worse than last year

In the UK, while general levels of suspected swine flu seem low, a surge in severe cases already exceeds the peak levels of last year in some areas ... and has medical leaders worried they can't handle the potential caseload. Already, 15 patients have died and more than 100 are in intensive care.

From The Independent:

Intensive care specialists said that the NHS was under greater pressure than 12 months ago. There has been a surge of cases admitted to hospital in the last 10 days and in the North-west the numbers are above those at the peak of last year's pandemic.

...In the North-east, the situation is "as bad as or worse than" at the peak last year, according to public health specialists. Most of those affected are aged 18-35.

...The numbers of severely ill patients have taken specialists by surprise because monitoring suggests low levels of swine flu in the community.

...Bob Winter, president of the Intensive Care Society and a consultant in Nottingham, said: "Something different is happening this year. The last 10 days have seen a sudden surge of activity. The numbers in intensive care are increasing across the UK. In the north west they are more than at the peak of the pandemic.

"We have told the Department of Health that this is emerging as a serious issue. We suggested the groups convened last year for swine flu critical care planning should be reconvened. The disease seems disproportionately severe."

Richard Firmin, director of the the UK's main ECMO centre at Glenfield Hospital, Leicester, with five beds, said: "It is very busy, even busier than last year. The way we are headed we are not sure we will have enough capacity. We have 15 beds open altogether – we didn't need more than 12 last year. We have pretty much activated all those who can do it.

"No one was expecting it to be worse this year than last year."

...[Dr Firmin added,] "We have already had to escalate [provision of ECMO beds] two steps beyond what we had last year. Things are at least as bad as they were last year in intensive care generally, as well as ECMO. What we don't know is whether this is the peak or there is worse to come. Our feeling is it is probably going to get worse. If it gets a lot worse we could be in a lot of difficulty."

Supply chain: a two-part problem

I was talking to someone this weekend about the need to stock up on basic healthcare items and foodstuffs in anticipation of more widespread H1N1 pandemic swine flu in coming months (or weeks). This is in case employee absenteeism begins to disrupt the production or transportation of goods.

This person commented, "Can't I just wait until I need these things and then order them for delivery?" That was a logical question, given today's options to have medical supplies, groceries, and emergency supplies ordered online or by phone and shipped to your home or business. Some local stores do this. It's certainly available from well-known online stores like Amazon.com, drugstore.com, the new Alice.com, and emergency preparedness sites like Nitro-Pak.

It was a logical question. But my immediate thought was, "What if the stores don't have [whatever] to ship?"

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.

By building your inventory, you're part of the solution

Do this - If you like peanut butter, buy a jar of peanut butter every week for the next 10 weeks. Mark each jar with the date you bought it. The next time you need peanut butter, use the first/oldest of these jars - and buy a replacement jar (and date it).

So what do we have here? We have a 10-jar supply/stockpile of a long-shelf-life food staple - in perpetuity. If you continue the process of "use the oldest and replace with another" (manufacturers and accountants call this "first in, first out" or FIFO), you will always have a 10-jar supply of peanut butter. Always. It never gets stale, having to be thrown away. You waste no money. You just buy in advance. It's as if you put part of your grocer's inventory in your pantry.

Global commerce during a flu pandemic; the downsides

Globalization has brought us many benefits. It gives access to raw materials and lower-cost labor. It opens additional markets in which to sell.

But any serious flu pandemic will show us some downsides of globalization.

From a Time magazine article, including comments from Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP ).

Indeed, the greatest risk from a pandemic might not turn out to be from the swine flu virus itself - especially if it ends up being relatively mild - but what Osterholm calls "collateral damage" if governments respond to the emergency by instituting border controls and disrupting world trade. Not only would the global recession worsen - a 2008 World Bank report estimated that a severe pandemic could reduce the world's GDP by 4.8% - but we depend on international trade now for countless necessities, from generic medicines to surgical gloves. The just-in-time production systems embraced by companies like Wal-Mart - where inventories are kept as low as possible to cut waste and boost profit - mean that we don't have stockpiles of most things. Supply chains for food, medicines and even the coal that generates half our electricity are easily disruptable, with potentially catastrophic results. Though we'll likely hear calls to close the border with Mexico, Osterholm points out that a key component used in artificial respirators comes from Mexico. "We are more vulnerable to a pandemic now than at any other time over the past 100 years," he says. "We can't depend on ourselves."

Most people are not thinking about such indirect consequences - not the sickness itself but the impact of having so many people sick at once.

For want of a nail.... Example #2

Here's another real-world example of how a little break in a supply line can have a big impact. (The pandemic-related concern about supply chains, of course, is that high absenteeism during a pandemic might cause companies to fall behind in their production, failing to deliver the parts or ingredients which customers need. In turn, this might cause ripple effects downstream.)

The July 20, 2007 Wall Street Journal published an article titled, "A Key Strategy of Japan's Car Makers Backfires," which begins:

For want of a piston ring costing $1.50, nearly 70% of Japan's auto production has been temporarily paralyzed this week. Blame it on kanban, the just-in-time philosophy of keeping as little inventory on hand as possible.

Boeing still needs 1,000 "nails"

I wrote on June 19th ("For want of a nail....") about a problem Boeing was having getting enough high-quality titanium bolts for its new 787 Dreamliner.

Granted, these aren't garden-variety bolts you'd pick up at the local hardware store. They're titanium fasteners, made-to-order.

But these aren't headphone jacks in the armrests. They're key parts; they hold the airplane together. You'd think they'd be on the critical list of "must have" components.

And this isn't a quickie, rush project. The 787 Dreamliner is Boeing's first all-new plane in 12 years. (And it's sort of important financially, already attracting more than $100 billion in orders.)

This is Boeing. The fasteners are being made by Alcoa Inc. These are veteran manufacturers working on a multi-year production job.

The plane was officially unveiled yesterday at the company's Everett, Washington plant. Reuters reports:

The plane is not scheduled to begin flight testing for at least another six weeks, and still needs its internal power and control systems fitted and functioning. It also needs about 1,000 temporary fastening bolts replaced by permanent ones, which Boeing said it will start work on immediately.

For want of a nail....

An article in today's Wall Street Journal - "Boeing's Nuts-and-Bolts Problem" - begins:

When Boeing Co. engineers first set about developing their new 787 Dreamliner, their biggest concern was whether they would be able to pull off making enormous sections of the wings and fuselage out of carbon-fiber plastic.

What they didn't count on was a shortage of nuts and bolts to hold it all together.

Major components, such as the new airplane's wings, are arriving from Japan, Italy, South Carolina, and elsewhere held together by temporary fasteners. That's because Boeing can't get enough high-quality titanium bolts from it's primary supplier, Alcoa Inc.

While customers are pushing Boeing to hurry production, Boeing officials say suppliers' ability to deliver parts will ultimately determine how quickly it can build airplanes.

Aussie study says millions more high-filtration masks needed for pandemic

An Australian study suggests millions of additional high-filtration face masks are needed in that country's pandemic stockpile for healthcare workers. The study says current supplies are likely to be inadequate. Describing a domino effect, the study says that without adequate protective gear, more people will become infected which, in turn, will deplete stockpiles of antiviral drugs sooner.

While much attention has been focused on pandemic-related drugs, "the crucial thing is if there's an epidemic, masks will protect the drug stockpile," according to Professor Lindsay Grayson, president of the Australasian Society for Infectious Diseases and senior investigator in the study.

Presently, the Australian federal government's national stockpile has at least two million of the high-filtration masks, plus at least 40 million standard surgical masks.

As a further argument supporting a larger mask stockpile, the researchers noted that, unlike drugs, masks can be used for other purposes and don't go out of date.

The study was a collaboration between nine hospitals around Australia, according to the Australian Broadcasting Corporation.

Now vs. 1918: Looking beyond the obvious

A couple of days ago, I noted that some people believe we're much better equipped to deal with a pandemic today than we were in 1918. Some even think a severe 1918-scale pandemic is not possible. I think it's dangerous to make that blanket statement. In fact, some of today's conditions may put us at a disadvantage.

Those who think a severe pandemic can't happen again happily note that we have much better medical knowledge and resources than in 1918. It's been pointed out, however, that it doesn't matter if we have modern medical tools, if we can't deliver enough of them when and where needed. A pandemic will cause a surge in the need for health care. But our "surge capacity" is limited.

As I wrote last month, sickness-related issues - like avoiding sickness, treating the sick, and coping with an overloaded health care system - deal with the most direct consequences of a pandemic. We don't want to make the mistake of just thinking about the direct effects of a pandemic - those which are more readily visible. Rather, we need to look downstream at the relatively hidden indirect effects - the ripples, the domino effects.