CIDRAP Meeting Notes
Filed Under mercialleasing.com |
Margaret Chan’s Presentation Notes:
“Nature has given us a very strong….warning”.
“We must stay on guard”.
“Pandemics are recurring events”.
“Neither the timing or severity can be predicted”.
“(H5N1) circulating since…mid 2003….no end in sight”.
H5N1 has fulfilled all prerequisites for the requirement of a pandemic except one (sustained and efficient H2H).
Seriousness of present situation is not likely to diminish in the near future.
“(H5N1) can survive longer, higher temperature and (is) more lethal to chickens”.
“Relay transmission (wild bird distribution of disease) has been documented”.
2 methods of transmission:
reassortment
“adaptive mutation step wise changes”
“What might we see during pandemic?”:
1) border controls and travel restrictions – can not stop – will only delay,
2) international spread will be rapid,
3) “widespread illness will occur”,
4) “excess mortality will occur”,
5) humans are in a weaker physical condition and less able to fight a major virulent disease as compared to 1918 due to HIV/AIDS, malaria, and TB.
6) “medical supplies will be inadequate at all countries and for many months",
7) “hospital capacity will be inadequate”, 1 billion will fall seriously ill,
8) “economic and social disruption will occur” – not all parts of the world will be affected at the same time.
DISCLAIMER: I have endeavored to be accurate, however, I am human!
H5N1 reservoir is "more complicated".
We have an "ongoing roulette genetic wheel".
H5N1 is the "kissing cousin to 1918 virus".
"I wouldn't bet on my families life on H5N1 not becoming the next pandemic".
Fog of Pandemic Preparedness:
Don't know our capabilities in a pandemic,
Only have a general sense of what next strain will be,
Global JIT problems - example – most insulin is made overseas,
Vaccines – there will no vaccine for the first wave,
Antivirals – Tamiflu production is up, but how productive? – ethical dilemma - prophylaxis vs. treatment,
Waves – Most will never get a vaccine. How do we respond to waves – when distribute supplies? In which wave?
Re: mortality in a pandemic – “We do not have a clue”.
Where do we go from here?
1) We must collectively address the Fog of Pandemic Preparedness.
2) The private sector must be a primary catalyst to force governments world wide to prioritize pandemic preparedness,
3) Don’t try to change the global JIT economy: work around it,
4) Acknowledge, accept , and “plan around” pandemic fatigue,
5) Flexible planning, not rigid plans – emphasize the process.
DISCLAIMER: I have endeavored to be accurate, however, I am human!
Thank you in advance.
Robert Roos http://www.cidrap.umn.edu/cidrap/images/purple-speck.gif News Editor
Feb 8, 2007 (CIDRAP News) – Predictions and observations at this week's conference on business preparedness for pandemic influenza ran the gamut from how fast a pandemic would circle the globe to how well the Internet would hold up, with many topics in between.
The meeting brought representatives from about 200 corporations and other organizations to Orlando, Fla., Feb 5 and 6 to hear a long list of flu and preparedness experts. The meeting was sponsored by the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News.
Dr. Margaret Chan, director-general of the World Health Organization, who videotaped a speech for the conference, said past pandemics took about 6 to 9 months to spread around the world, but the next one is likely to be much faster.
"Most experts predict the global spread of the next pandemic will take about 3 months," she said.
Conservative estimates are that about 20% of the global population will fall ill and worker absenteeism will reach about 35%, Chan added.
A recurring theme at the conference was the need for preparedness advocates to persevere and fight off "pandemic fatigue." Risk communication expert Peter Sandman, PhD, articulated the message in his lecture on Feb 5.
"Pandemic preparedness is a slog," he said. "It's not just climbing a mountain, it's climbing a mountain range. It takes time." By analogy, it took a generation to achieve the widespread use of auto seatbelts, he added.
Among other tips for communicating the importance of pandemic preparedness, Sandman said, "You need to involve your audience. It's much easier to get people to do something than to get them to care. Once they do something, it launches a process that may get them to care."
John M. Barry, author of The Great Influenza, a history of the 1918 pandemic, warned the audience that planning documents do not equal preparedness. He cited the impact of Hurricane Katrina on New Orleans as exhibit A: "If there was an event more planned for than a hurricane hitting New Orleans, I don't know what it is." Barry is a distinguished visiting scholar at Tulane University in New Orleans.
Barry commented on the recent recommendations from the Centers for Disease Control and Prevention (CDC) on nonpharmaceutical measures for battling a pandemic—advice shaped in part by research on the effects of social distancing, mask use, and the like in the 1918 episode.
Though he generally supports the CDC advice, he said, it pays little attention to the possibility that the next pandemic will come in multiple waves. In 1918, the pandemic began with a fairly mild wave in the spring, followed by a far more severe wave in the fall. People who were exposed to the disease in the spring were much less likely to get sick in the fall, he said.
"This greatly, enormously complicates all your planning," Barry asserted. "You can only pull the trigger so many times." (CIDRAP Director Michael T. Osterholm, PhD, MPH, discussed this same dilemma in his talk on the "fog of pandemic preparedness"; see link below.)
In other comments, Barry said the evidence from 1918 shows that quarantine "doesn't work, period." Researchers found that 99 of 120 military camps used quarantine during the pandemic, but it was effective only when rigidly enforced, which occurred in only three or four cases. And 11 of the 21 camps that didn't use quarantine fared better than average.
The question of Internet capacity came up in a discussion on the role of business and government in a pandemic, in which increased telecommuting and millions of homebound children could put heavy pressure on the system.
Rajeev Venkayya, MD, senior director for biodefense on the White House Homeland Security Council, said, "What I'm hearing is that there continues to be concerns about the last mile and also about the backbone," referring to the capillaries and main arteries of the Internet. He added that the Department of Homeland Security (DHS) is looking into the question.
Alfonso Martinez-Fonts, assistant secretary for the Private Sector Office at DHS, had a somewhat different message. "The backbone of the Internet is pretty sturdy," he said. "It's the last mile that's a concern."
A discussion on the role of the media brought a warning on the lack of hospital surge capacity from Greg Dworkin, MD, editor of the Flu Wiki and chief of pediatric pulmonology at Danbury Hospital in Danbury, Conn.
"The idea that if you just plan ahead you can handle the surge [of patients in a pandemic] just isn't so. You can't," said Dworkin. He said hospitals need to huddle with local officials about where to send seriously ill flu patients when hospitals are full. One option he mentioned: closed schools.
In a session on vaccines, antiviral drugs, masks, and respirators, Osterholm raised the possibility that governments would seize privately held supplies of such items in a pandemic emergency. He said he knows of two states where the attorneys-general have talked about that possibility.
"I don't know whether that's likely to hold up," he added.
In the same session, flu vaccine expert Gregory Poland, MD, of the Mayo Clinic in Rochester, Minn., stressed that the H5N1 avian influenza virus—considered the leading candidate to spark a pandemic—is not just one species.
"It's a teeming mass of constantly mutating viruses," Poland said. Noting that the virus has branched into different clades and more narrowly defined subgroups in the past few years, he added that there hasn't been a clade 1 human infection in almost a year, and yet the H5N1 vaccine currently being stockpiled by the US government is based on a clade 1 virus. Poland is director of the Mayo Vaccine Research Group.
In concluding the conference, Osterholm said it was clear that attendees at this year's meeting had a better grasp of the pandemic threat than those who attended the first CIDRAP business conference a year ago.
"We can't let pandemic fatigue get the best of us," though "there will be days when people look at you as if you were one brick short of a load," he said.
http://www.cidrap.umn.edu/cidrap/content/influenza/biz-plan/news/feb0807quotes.html
I"ve not scanned the latest posts yet today. Have the press covered the conference well? Any naysayers?
J.
There was no discussion of this per se that I heard. The consensus was that even if there was a vaccine formula available for production today, and all available facilities were used (which implies some now used for animals), the amount available in the short and medium term for distribution to the world's population would be very small.
http://www.sciam.com/article.cfm?chanID=sa003&articleID=11734C642F4A465CD55504AFEC38110D
He feels that the single largest reason for lethality was the censorship in the American press, and (my words) the failure of the Wilson Administration to allow for more frank dialogue on the topic. An example is the "no worries, just another flu" message given on the East Coast, as compared to the "Wear a mask and live" message from San Francisco. Though San Francisco was the hardest-hit West Coast city, their preparedness took on more significance because the city leaders bucked the censorship and told it like it was. He feels that the lower mortality rates could be attributed to that message. The message, he feels, is the most crucial thing that can be delivered. I don't think any of us would disagree.
He also questioned whether or not a 12-week closure of schools would, in the long run, be either possible or helpful. I think we all feel that way about a three-month isolation regimen. Barry knows his stuff, as his book will surely attest. And by his own admission he is a historian, and not a scientist. Through his book and his numerous speaking engagements and public appearances he is doing quite a bit to help focus public attention on this issue, so we should give him some room to speculate.
This is a combination approach. Essential workers will need to go to work. They will need PPE. Many persons will be able to social distance at work. Many companies are looking at options such as turning the company cafeterias into illness screening areas and then having box lunches delivered to the desks or general areas where people work. There are other kinds of social-distance-at-work options being discussed. Employees who can work from home will be able to exercise that option. Social distancing is not shelter-in-place. It is smart community interaction.
JIT is considered a big problem - especially for overseas materials and supplies. Persons need to evaluate the needs of their businesses and themselves personally. Disease status in Southeast Asia will affect anything shipped from that location. Acquire the items that are essential before a pandemic or be prepared for delays.
http://www.sciam.com/article.cfm?chanID=sa003&articleID=11734C642F4A465CD55504AFEC38110D
Yes - Maggie Fox was there. I did not attend all breakout sessions both days due to time constraints.
Basically all businesses want to stay operational. This pandemic planning process is a response to that desire - whether they are groceries or oil companies. Certainly a retail operation will have different challenges than an accounting firm where much work can be done at home.
I can find out what the groceries are planning and post sometime next week.
The time frame discussed by Dr. Poland refers to a fully licensed vaccine. The President can suspend certain regulations to expedite any vaccine development and production process.
"We need resources and leadership" in vaccine issues. We are still dependent upon 1950s technology.
There will not be enough vaccine for the world's population.
None of this is actually "new" information. Vaccine production is a lengthy process at this time. New technologies must be developed further.
We must rely on hygiene, PPE, and social distancing to fight a pandemic. We must form Network Partners to establish our own support communities. Together, by helping ourselves we help our cities, towns and counties.
We can do this. We can flourish even in the most challenging of times by embracing our families, friends, neighbors, and co-workers.
"Every man must decide whether he will walk in the light of creative altruism or in the darkness of destructive selfishness."
Martin Luther King, Jr.
Public health students taking Dr. Osterholm’s Emerging Infectious Diseases class at the University of Minnesota were givenhttp://farm1.static.flickr.com/127/388341120_55ff371536_m.jpg scholarships to attend the summit provided through grants awarded to CIDRAP. This provided students a great opportunity to view public health collaborations first-hand and hopefully will inspire future public health practitioners and researchers to become more involved in politics and forming networks across sectors.
To view what the students had to say about the summit, visit the U of M SPH Blog site:
Student Insights from the Pandemic Flu Summit. U of M School of Public Health Blog. http://blog.lib.umn.edu/sphpod/panflu/ (http://blog.lib.umn.edu/sphpod/panflu/)
Thanks for attending the meeting and the notes.
Informative, interesting and encouraging.
JT
Breakout Session –
These issues are also applicable to disasters, not only a pandemic.
This was an extremely productive session. The presenters were excellent. They were knowledgeable and patient with many questions.
The session chairperson made a presentation that listed the considerations for supply chain issues:
“You are only as good as your weakest link.”
Planning –
Essentials – to my business, to customers, to suppliers
Workers
Duration
Dispersion and support
Families
Adaptive use
Preparedness – develop mitigating strategies
Network of preparation
Large and small
Outsources
Pandemic Response
Disease containment
Cross sector interdependencies
Cascading effects
Risk communication
Cooperation and collaboration
Recovery
Multiple waves
Worker and family losses
Workforce and reconstruction & competition
Government and community support
Inter-business support
*** Key point:
Planning is about the process. Structure the ability to adapt.
Early School Closings May Not Be Best Flu Fighter, Author Says
"....There were three such pandemics last century, the most deadly
coming in 1918 when about 50 million people died worldwide.
Closing schools early on ``is not an answer,'' Barry told
about 300 attendees at the Pandemic Business Planning Summit in
Orlando, Florida. ``It will not solve the problem; at best it
will take some of the top off the disease and stretch it out
over a longer period.''
Cities and U.S. army troops that were likely to have been
affected by the milder first wave recorded fewer deaths than
uninfected populations, Barry said. The milder ``first wave''
might have skewed perceptions of how well cities like St. Louis
minimized pandemic deaths using school closings, he said...."
I shouldn't have asked. :(
I've deleted my response because it would have been inflamatory.
J.
"Yes - I find this comment - hmmm - not consistent with what I have experienced as a parent. Over the last 20+ years my children have brought home many diseases from school.
Instead, this is an example of the inaccuracies of data that may be of record from 1918. I believe the 1918 pandemic is a study of disease but not the definitive case example."
Well put. Admirable restraint.
I agree about 1918. There's no reason why we must limit our actions to what was done or not done in 1918. We know a lot more now about outbreaks, epidemics and even other pandemics. You or Osterholm said we're in a uique position in history of seeing the development of a pandemic. Part of that is the unique position of choosing from a vast array of facts and experiences to synthesize a viable and hopeful defence.
J.
A large international company.
30 billion in revenue
23 terminals on the East Coast of the
1200 retail outlets
24,000 contractor personnel
Issues to consider when creating Disaster/Pandemic Plan:
Diversity of workforce
Turn-over of workforce
Types of products sold
Diverse operating environments
Many industrial locations
Methodology:
Identify risk (i.e. Pandemic potential)
Agree risk needs to be managed
Develop knowledge base
Estimate task force, working group and business and facility level teams
Communicate actions
Position Disaster/Pandemic task force as reportable to top manager of organization –
representatives from all major divisions
Plan – Review plans with key suppliers and customers to ensure integration
Establish critical risks and ability to manage people, assets, financial functions, supply chain
Identify critical operations – businesses, facilities, personnel, suppliers, and customers
Adapt existing plan to establish integrated communication
Establish:
Additional policies
Stockpiles for medicines
Method to determine and report containing outbreaks in critical business facilities
Contingency systems and mechanisms for home based work
Foster ethic of social distancing and infection control
Identify and communicate triggers
Exercise plans (notify, table-top exercises, “live” drills)
Action
Analyze learnings from exercises and incorporate into plans
Ensure preparedness is maintained
Collateral Benefits of Planning
Improved organizational capability for crisis management and business continuity
Reduced absenteeism from seasonal illness through awareness and peer pressure
Enhanced integration between company and contractors across lines of business
*** Major point
Large companies need to assist subcontractors and suppliers in preparing pandemic plans.
“Larger companies are bringing smaller companies along.”
Sandman asks:
What are you going to do to cope in a pandemic?
Reuters - “There will be a lot of misinformation out there”.
Canadian Press - “There will be a frenzy”.
Sandman asks:
Where would you go for your news?
Flu Wiki - According to ---- study “70% would go online.”
Bloomberg - “We will be calling various companies because our audience is business. We will be reporting information from health authorities."
Sandman asks:
Will you be trying to keep people from panicking or encourage altruism?
Canadian Press – “When crisis happen we start to re-define ourselves.”
Most important point!!!
Flu Wiki - “We are part of a larger on-line community.”
http://www.sfcdcp.org/UserFiles/File/InfectiousDiseasesAtoZ/Business._Pan_Flu_Continuity_Plan.10.19.06.doc
but it wasn't specified, what type of pandemic is being talked about,
I assume.
Say CAR,say CFR.
Pandemic isn't the same as pandemic.
I assume the confusion is deliberate.
Multinational corporation
New risks exist – we are global and there is “geo-complexity”.
You inherit risk from suppliers and others.
Some statistics:
1) 73% of businesses that have a prolonged disruption of 10 days or more suffer long term impact.
2) 43% of businesses suffering a disaster never recover enough to resume business.
3) Of those who do re-open, only 23% are in business 24 months later.
Methodologies:
Recognize the dynamic aspects of the changing landscape.
Identify enterprise risk “interdependencies” at strategic level.
Integrate risk management with mission, strategy, and planning to drive decision support into operating model.
Establish a more transparent view of risks across the corporation or agency to facilitate key trade-off decisions in developing a risk mitigation strategy.
Balance efficiencies and effectiveness with robustness to meet overall management targets.
Create cross-domain risk management capability, business intelligence and situational awareness.
Develop partnerships whenever possible to share and mitigate risk.
Organizational Preparedness:
A decision support system that systematically identifies, quantifies, and measures operational risks and their potential impacts from a network perspective and provide alternatives to reduce the impact of a disruption and return operations to normal as quickly as possible is essential.
Pandemic preparedness is not accomplished in a vacuum.
This is an opportunity to address all business interruption.
Major point:
You inherit risk from suppliers and others – limit risk transfer.
not the strain, the severety.
Some conference people seem to have a 1968-like pandemic in mind,
while others are thinking about a 1918-type or worse pandemic.
Ahh, we should create another word for such a severe pandemic
to end this confusion which is going on now since years.
It also sounds like the JIT practices used to produce / ship food to grocery stores may be affected as well....?
Yes - this was discussed in length by many.
This is a combination approach. Essential workers will need to go to work. They will need PPE. Many persons will be able to social distance at work. Many companies are looking at options such as turning the company cafeterias into illness screening areas and then having box lunches delivered to the desks or general areas where people work. There are other kinds of social-distance-at-work options being discussed. Employees who can work from home will be able to exercise that option. Social distancing is not shelter-in-place. It is smart community interaction.
JIT is considered a big problem - especially for overseas materials and supplies. Persons need to evaluate the needs of their businesses and themselves personally. Disease status in Southeast Asia will affect anything shipped from that location. Acquire the items that are essential before a pandemic or be prepared for delays.
Is Barry a scientist? Maybe not a microbiologist, virologist, chemist or whatever. But certainly, based on the summary Scott provided, he's an epidemiologist.
Will school closure help? In the macro, global economic, long term view, perhaps not. In the micro, indiference-curve laden, subjective family view - definitely the kids will be staying home.
J.
Great way to avoid dogma and generate new ideas is to obtain the views of many, many people. Great way to do that is to set up an internet forum.
CDC, are you listening to FT?
Who is her immediate replacement, if or when she become part of the 40%? Does CDC have a deep bench?
J.
:)
I found Dr. Gerberding to be very "normal". She laughed, smiled, used 1 syllable words :D , and joked.
The basic focus of her talk was to encourage persons not to rely on "dogma" when planning and coping for a pandemic. Her example of the anthrax situation was to demonstrate that a set of assumptions about a particular problem may be limited based on "dogma" or prescribed methodologies.
We need to keep an open mind and think "outside the box" when considering all aspects of pandemic.
The conference was very well done. The speakers were all very experienced and easy to talk to. They were receptive to questions, even "dumb" ones. In addition, the attendees were a very interesting group.
The first day at breakfast I sat next to an administrator of 3 hospitals. Her concerns were about personnel, the amount of people coming to the hospital for assistance, and getting advance notice of the start of the pandemic. She has ordered the small children's respirators to protect the staff.
I also had conversations with persons employed with pharmaceutical, chemical, telecommunication, public heath, large industry, physician, attorney, and NGO entities. All of them seemed concerned and very serious about addressing the problem at hand.
This planning and preparedness effort is critical disaster planning.
It was made very clear by Osterholm that the timing, exact viral strain, and virulence of the pandemic strain is unknown. Also very clear is that this threat is real.
There are valiant efforts ongoing in many areas to lessen morbidity and mortality. I thank CIDRAP and all of the participants for a most enlightening conference.
"Never in the field of human conflict was so much owed by so many to so few."
Winston Churchill
Speech made in the House of Commons
as the Battle Britain peaked on August 20, 1940.
Here's the quote of the day from Osterholm I think:
"I wouldn't bet on my families life on H5N1 not becoming the next pandemic".
Great way to avoid dogma and generate new ideas is to obtain the views of many, many people. Great way to do that is to set up an internet forum.
CDC, are you listening to FT?
Who is her immediate replacement, if or when she become part of the 40%? Does CDC have a deep bench?
J.
Most entities are planning 3 deep on the bench. They are identifying and cross training, if necessary, to achieve this. One very large company has 10 deep on the bench.
I assume.
Say CAR,say CFR.
Pandemic isn't the same as pandemic.
I assume the confusion is deliberate.
The conference was about business preparedness for an avian influenza pandemic. The strain is unknown at this time.
"3) Don’t try to change the global JIT economy: work around it,"
Thanks so much, Florida1!!Don't worry about it -- we won't hold you to every detail. ;)
Here's the quote of the day from Osterholm I think:
"I wouldn't bet on my families life on H5N1 not becoming the next pandemic".
Consulting for FluTrackers at this conference was also LAS, who is a public health official in Florida and advisor to FT.
Another excellent presentation.
Discussed lessons learned from 2001/2 anthrax episodes for disaster planning and evaluation.
“Beware of dogma”
She discussed SARS as an example of how connected the world is today.
“..years away from ‘scalable’ vaccine.”
Most important - personal protection (PPE).
CDC’s own pandemic drill assumes 40% of employees may not report to work at some point during a pandemic.
Robert Roos http://www.cidrap.umn.edu/cidrap/images/purple-speck.gif News Editor
Feb 6, 2007 (CIDRAP News) – Orlando, FL – Julie Gerberding, MD, director of the Centers for Disease Control and Prevention (CDC), today challenged health and business leaders to stay focused on the "marathon" of preparing for an influenza pandemic.
Gerberding, speaking at a conference on business preparedness, said it's not possible to maintain high public interest in the pandemic threat indefinitely, but leaders must keep preparing anyway.
The question for planners, she said, is "How do we run this marathon when we're living in a society that only wants to sprint?" Gerberding spoke at "Business Preparedness for Pandemic Influenza: Second Annual Summit," sponsored by the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News. The meeting drew leaders from about 200 companies to Orlando, FL.
To suggest why the pandemic threat represented by the H5N1 avian influenza virus is taken so seriously, Gerberding recalled how SARS (severe acute respiratory syndrome) put the world on edge in 2003.
The disease spread internationally after several people became infected while staying on the same floor of a Hong Kong hotel as an infected man from China. Despite the dramatic way it crossed the world, scientists learned that SARS "is really not very transmissible," Gerberding said. The incubation period and the generation time between cases are long, and the attack rate (how many exposed people become infected) is very low.
Flu, in contrast, has a very short incubation period and a high attack rate, and people can transmit the disease before they feel sick, she said. "Think about the reality of trying to quench an influenza outbreak given those numbers and the connectivity of the world. It's a very, very daunting challenge."
In discussing the difficulty of maintaining focus on a health threat, Gerberding also recalled other threats that have seized the attention of the CDC and the public in recent years.
For a year or so after the anthrax attacks in the fall of 2001, the hot topic was "anthrax, anthrax, anthrax, anthrax" and terrorism preparedness, she said. "And finally someone said, 'Let's change the subject,' and what did we talk about next? Well, smallpox, smallpox, smallpox, smallpox. We moved from one topic to another without recognizing that we needed an 'and' in that sentence."
Gerberding said the CDC has come up with a list of 1,600 tasks under the heading of pandemic preparedness. The recent publication of guidance on community mitigation (nonpharmaceutical) measures was just one of those.
To stay on task, leaders need to overcome complacency—their own, if not the public's. "What we have to do here is accept human nature and reality," she said. "We're not going to be able to keep this issue in the news indefinitely, or on everyone's plate. But . . . it's our responsibility to keep this issue moving forward so that when people back away from it, we don't."
Preparedness requires careful planning—distasteful as it may be—followed by exercises to test the plans, Gerberding went on to say. Last week the CDC conducted a major exercise that was very instructive, she said.
The 24-hour live exercise—not a tabletop simulation—involved about 1,000 people, with 150 people staffing the CDC operations center. The drill required officials to make decisions about whether to declare a public health emergency, how to explain the difference between an emergency and a pandemic, and whether to change the handling of sick airline passengers—which would have immense effects on the travel industry.
"As we struggled with the decisions we had to make, there was not a bone of complacency in anyone's body," she said. "We learned why it was so important, why it was hard. . . . It really made the situation real." The exercise was opened to the news media, in part so that reporters would understand the seriousness of the risk and not become complacent themselves, she added.
"We thought it was a tremendously successful exercise," noted Gerberding.
The agency is planning to follow up with another exercise involving both federal agencies and state and local public health, she said. Further, "In May we'll exercise an even broader group of people in Atlanta, on the premise that the pandemic has arrived in Atlanta and CDC is functioning with a 40% loss of its work force."
http://www.cidrap.umn.edu/cidrap/content/influenza/biz-plan/news/feb0607gerberding.html
Instead, this is an example of the inaccuracies of data that may be of record from 1918. I believe the 1918 pandemic is a study of disease but not the definitive case example.
Early School Closings May Not Be Best Flu Fighter, Author Says
"....There were three such pandemics last century, the most deadly
coming in 1918 when about 50 million people died worldwide.
Closing schools early on ``is not an answer,'' Barry told
about 300 attendees at the Pandemic Business Planning Summit in
Orlando, Florida. ``It will not solve the problem; at best it
will take some of the top off the disease and stretch it out
over a longer period.''
Cities and U.S. army troops that were likely to have been
affected by the milder first wave recorded fewer deaths than
uninfected populations, Barry said. The milder ``first wave''
might have skewed perceptions of how well cities like St. Louis
minimized pandemic deaths using school closings, he said...."
1) Tamiflu and relenza effective against H5N1 in animals in studies.
2) Tamiflu effectiveness against H5N1 in humans unclear due to inefficient reporting, given late in disease progression, dose?, treatment length?
3) Tamiflu effective in humans for seasonal flu.
Poland - "Despite a 10 year warning we do not have a licensed vaccine (for H5N1)".
Poland - After the start of a pandemic it will be "months" before a vaccine will be available.
Important issue - "How will be distribute (vaccines)".
Osterholm asks:
When would you expect the 1st vaccine to be available?
Poland - "Minimum - months. More likely - 1 to 2 years for H5N1 for which we have (vaccine) candidates".
Poland - Avian influenza is a "quasi-species - a constant mass of constantly mutating viruses."
Poland - "Clade 1 stockpile (for H5N1 infections) for which in humans is no longer occuring.
Poland - Vaccine application will require at least 2 doses because there is no "herd immunity".
Group recommended respirators over surgical masks. "When you are not sure, take it to a higher level".
3M : "No inventory of respirators". Most PPE made in Southeast Asia.
Osterholm concluding remarks:
"In the end it is what happens to our families that matters most."
2007 SUMMIT COVERAGE: Businesses must overcome 'fog' of pandemic preparedness
Jim Wappes http://www.cidrap.umn.edu/cidrap/images/purple-speck.gif Associate Managing Editor
Feb 7, 2007 (CIDRAP News) – Orlando, FL – As businesses develop pandemic preparedness plans, they need to cut through a "fog" of uncertainty about exactly what pandemic influenza will look like and how their companies will be able to respond to it, infectious disease expert Michael Osterholm, PhD, MPH, said at a summit in Orlando Monday.
Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP), publisher of CIDRAP News, said that several factors cloud the preparedness landscape:
How our communities will mitigate damageOsterholm spoke at CIDRAP's "Business Preparedness for Pandemic Influenza: Second National Summit," held this week for hundreds of leaders in business, government, and academia.
He took his "fog of pandemic preparedness" concept from the theory of the "fog of war," a state of ambiguity soldiers can find themselves in when they doubt their own capabilities and feel unsure of their adversary's capabilities and intentions.
Pandemic planning can produce its own haze as planners grapple with issues like ensuring their supply chain or determining government's role. "We talk about what we might do or can do, but we really don't know," Osterholm said. "There are so many uncertainties."
This extends to experts' estimates of how a pandemic might behave. "We have only a general sense of what the next pandemic influenza strain is capable of doing in terms of human illness or subsequent collateral damage," he said.
Add to that today's just-in-time economy, in which supplies arrive as they are needed so that companies minimize storage costs. "It is the reality of today's economy," Osterholm said. "It's what MBAs are made of." That reality, though, means that "even a hiccup" of disruption will mean serious shortages, he predicted.
Another layer of mist comes in the form of making decisions about vaccines and antiviral drugs.
"Pre-pandemic" vaccines can be stockpiled in the hope that they may provide some protection against the influenza strain that ultimately causes a pandemic. However, as pointed out by vaccine expert Gregory Poland, MD, in another summit presentation Monday, a vaccine targeted to the specific pandemic strain would take months to develop and distribute.
In addition, said Poland, director of the Mayo Vaccine Research Group in Rochester, Minn., drug companies—even at maximum worldwide production—could deliver only enough vaccine to inoculate 1% to 2% of the world's population.
The result, said Osterholm, is that "the availability of protective vaccine during the first wave of a pandemic just won't be there." He added, "For most of the world's population, a vaccine will never be available throughout the duration of a pandemic."
Osterholm lauded companies like Roche for increasing production of antiviral drugs like osteltamivir (Tamiflu), but said it remains unclear how effective these drugs will be against H5N1 if it becomes the pandemic strain.
Even if companies stockpile antivirals, they face another dilemma: when to use them. If they were to withhold them during a first pandemic wave anticipating a more severe second wave that didn't happen, people would question the decision, Osterholm said. Likewise, leaders could decide to distribute stockpiled drugs during the first wave, only to discover that the second is more severe. "When do you blow your wad?" he asked.
And with estimates of the mortality rate in a pandemic ranging widely, Osterholm surmised, "We don't really have a clue" about how many people will succumb.
Adding to that miasma is the state of US healthcare. In part because of a shortage of workers and the physical limitations of medical centers, the system has little "surge capacity" for the huge influx of patients a pandemic would cause. "We have basically taken [the healthcare] system and sucked it to the bone," Osterholm said.
Shining some light into the pandemic cloud, however, is the recent document on community mitigation measures by the US Department of Health and Human Services (see links below). "You don't want to have a [pandemic planning] policy inconsistent with this document," Osterholm said.
Other steps businesses can take, according to Osterholm, include:
Maintain flexibility. Osterholm recognized the uncertainty involved in pandemic planning and stressed that plans need malleability so they can adapt to the elusive realities of a pandemic. "Anyone who develops a concrete plan is making a mistake," he said. "Be capable and be flexible."You're not stuck to a plan," he said. "You're stuck to a process."
Personally - I am happy that my notes, hand written in a semi-lit room, appear to be very accurate. Dem at FW has quoted me as a source of his remarks. :) It is difficult to take notes when you are on stage!
http://www.cidrap.umn.edu/cidrap/content/influenza/biz-plan/news/feb0707panfog.html
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