H1N1

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H1N1 Preparing for the Flu Season Elisabeth
Whitney Program Coordinator San Francisco CARD
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• Were not sure how severe this flu season will be
• Mild 1957 Type of Pandemic
• Severe 1918 Spanish Flu
• There are no guaranteed medical means to avoid
  the virus
• Vaccines will be available this fall / winter
• For both seasonal flu and H1N1
• Antivirals are options for treatment
• 3. What is H1N1 or Swine Flu?

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Influenza A Little FYI

• Influenza is a highly contagious respiratory
  disease spread by tiny, wet droplets produced
  when a person
• Coughs, sneezes or talks
• Touching your face
• Poor Cough Hygiene Swine Flu or
• When are we contagious? H1N1
• Every year 10 20 of the worlds population
  gets influenza causing associated deaths of from
  500,000 1 million deaths
• In Epidemic years 25 of the population get it
• In the U.S, annual seasonal flu results in
  approx. 36,000 deaths and 114,000
  hospitalizations
• Some 90 of people who die during a regular flu
  season are over 65 years old. By contrast, Swine
  flu (H1N1) disproportionally affects younger
  people

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Influenza A Little FYI

• Who is more likely to get very sick with the flu?
• People with lung disease like asthma
• People with other medical conditions like
  diabetes, heart disease, kidney or liver disease,
  blood cell disease including sickle cell, or
  neurological disease that affects swallowing or
  breathing
• Pregnant women and women who have given birth
  within 2 weeks
• Children age 2 years and under
• Adults age 65 years and over
• People with weak immune systems (due to disease
  or medicines)

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Underlying Conditions
Pandemic Hospitalizations Reported to CDC
Underlying Conditions as of June 19, 2009
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Influenza A Little FYI

• Is it a cold or the flu?

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Clinical Characteristics

• Epidemiological/Surveillance Pandemic H1N1
  Hospitalizations Reported to CDC as of June 19,
  2009

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Course of Influenza in Adults

• 0 1 2 3
  4 5 6 7
  8 9

Day 0 Become infected Day 1 4 Disease
Incubation (average 2 days) Day 1 6 Contagious
(one day before symptoms to 5 days after
symptom onset) Day 2 9 Symptomatic (usually 2
5 days) Day 4 to ? Decreased energy (one week or
more)
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Percent of Visits for Influenza-like Illness
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Influenza Statistics
Data by Epidemiologic Week 43 United
States New cases 6834 Total
cases 57,602 Deaths 1123 California cases
5000 Source http//new.paho.org/hg/images/at
las/en/atlas.html
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Current Conditions
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Novel H1N1 Confirmed Probable Case Rate in the
U.S.
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Novel H1N1 U.S. Hospitalization Rate per 100,000
Population by Age
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CDC Summary

• Uncertain how serious or severe H1N1 will be in
  terms of
• How many infected people will develop serious
  complications or die
• How the virus may affect the U.S. during the flu
  season in fall and winter
• Because this is a new virus (for the given
  population), there will be little or no immunity,
  resulting in more severe and widespread illness
• Vaccines will be available, but may be in limited
  supply
• With this new virus, CDC speculates
• More cases
• More hospitalizations
• More deaths
• for this season . . .

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Most Recent Guidance

• H1N1 Vaccine will not protect against seasonal
  flu
• The FDA has approved the use of one dose of H1N1
  (swine) flu vaccine for persons age 10 years and
  older
• Children 6 months old to 10 years need two doses
  separated by 3-4 weeks, and it is best to use the
  same type of vaccine for the first and second
  dose.
• You may get seasonal and H1N1 vaccinations at the
  same time.
• If your child got a dose of the recalled vaccine
  (ages 6 months to 35 months), you do not need to
  revaccinate them.
• It was recalled for potency not safety reasons!
• H1N1 vaccines are being made available to all
  persons over 3 at the DPH Travel Clinic (101
  Grove Street) by appointment. Call [phone]
  and press 5 to make an appointment.

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H1N1 Vaccination Priorities

• Pregnant women
• Caregivers for children younger than 6 months
• Healthcare and EMS personnel
• People ages 6 months 24 years
• People with underlying medical conditions
  associated with higher-risk of complications
  associated with flu (ages 25 64 years)

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Latest on Vaccines

• Global doses to be manufactured and distributed
  3 billion.
• 2009 H1N1 Influenza Vaccine Supply Status
• November 6, 2009, 130 PM ET
• Doses Allocated as of 11/05/09 35,618,800
• Doses allocated to project areas for ordering
  are those that are at the distribution depots and
  ready for project areas to order.
• Vaccine is allocated to each project area in
  proportion to its population (pro rata).
• Doses Ordered as of 11/04/09 28,036,300
• Doses Shipped as of 11/04/09 26,248,100
• There is a lag time between allocation,
  ordering, and shipment of doses as project areas
  place orders and those orders are processed and
  shipped.
• Vaccine Shipment Status by Project AreaProject
  Areas Total Doses Shipped as of 11/04/09
• California 2,953,000
• Source http//www.cdc.gov/h1n1flu/vaccination/
  vaccinesupply.htm

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Vaccines

• Types of influenza vaccines available this flu
  season
• LAIV
• Inactivated shot
• H1N1 LAIV and seasonal LAIV should not be given
  together
• 2009 H1N1 LAIV may be given at the same time as
  most other vaccines
• people who are allergic to eggs should not get
  the vaccine

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Flu Antiviral Drugs

• There are two commonly used antivirals in the US
• 1. Tamiflu (oseltamivir)
• Do not confuse with Theraflu an over the
  counter cold medication. It is not an antiviral
  medication!
• 2. Relenza (zanamivir)
• Can children take antiviral drugs?

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10 Lessons from the Frontlines

• Investments in pandemic planning and stockpiling
  antiviral medications paid off
• Public health departments did not have enough
  resources to carry out plans
• Response plans must be adaptable and
  science-driven
• Providing clear, straightforward information to
  the public was essential for allaying fears and
  building trust
• School closings have major ramifications for
  students, parents and employers
• Trust for Americas Health, June 5 2009

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10 Lessons from the Frontlines

• Sick leave and policies for limiting mass
  gatherings were problematic
• Even with a mild outbreak, the health care
  delivery system was overwhelmed
• Communication between the public health system
  and health providers was not well coordinated
• WHO pandemic alert phases caused confusion
• International coordination was more complicated
  than expected
• Trust for Americas Health, June 5 2009

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So, What Might be Next?

• H1N1 Could disappear (unlikely)
• H1N1 didnt cause worst case scenarios in So.
  Hemisphere
• H1N1 Could
• Be our next pandemic (it already is)
• Continue to be mild-to-moderate (1957 or
  68-like)
• Increase virility to 1918 pandemic levels

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What Does That Mean to You?

• For a bad flu season (1957 or 68-like)
• Many sick employees, volunteers and clients
• From 25 40
• Higher levels of absenteeism
• Comes in waves
• Possibility of some deaths in the family
• Adverse impact on your organizations operations

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Action Agenda

• Prepare your organization
• COOP works, once sick it is too late
• Identify your mission critical functions
• Those operations that must continue without
  them your organization will not function
• It can be integral to a device or system that
  makes that function possible

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Questions to ask

• How is demand for your product or service likely
  to be affected during and between each pandemic
  wave?
• What are your requirements and commitments with
  suppliers and customers? How might these be
  affected when the pandemic is at its peak?
• What circumstances could precipitate a shutdown
  of your workplace?
• What trigger will you use to re-open the
  workplace?
• Are alternative work arrangements available for
  employees who are not ill but still able to come
  in?
• How will you communicate with your employees at
  different points in the pandemic wave? What
  message will you broadcast?
• Source http//www.ems-solutionsinc.com/pdfs/Le
  ssons-from-H1N1-FirstWave.pdf

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Considerations for Human Resources

• Review and update sick leave policies
• Flu absences may be a long-term issue
• Staff may be absent due to
• Family members that are sick
• Schools and childcare facilities closed
• Most important consideration
• Please stress dont come to work sick!

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Guidelines for Managers Communicating with Staff
about Influenza A (H1N1)

• Consider including medical staff, counselors, and
  peer helpers in group meetings on the topic, to
  respond to questions about health risks and
  protection.
• It is important for staff and families to be
  given facts about the situation and have their
  immediate concerns addressed in order to dispel
  rumors.
• Note that action is an antidote for feelings of
  helplessness.
• Regular briefings in all offices are essential to
  contain staff anxiety as well as rumor
  circulation. Efforts should be made to keep the
  discussion supportive and do not attempt to deny
  or minimize the potential impact on staff.
• Also, pay attention to what is unspoken and to
  staff who may be withdrawn.

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Is Working Off-Site Realistic?

• Needs a robust work-from-home program
• High Speed Internet
• Organization provides equipment
• Work from home at least once a month
• Confirms that person can work from home
• Alternate plans if working remotely fails

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• Volunteer Management
• How do we make it safe for our volunteers to
  continue helping?

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Summary of Education

• Influenza basics
• Workplace strategies cleaning
• Hand washing techniques
• Cover your cough campaign
• Polite social distancing
• Stay home if sick policy
• Virtual meeting strategies
• Strategies to minimize face to face contact with
  clients

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Education Cont.

• Hand Maintenance
• Hand-washing is most effective
• Hand Sanitizers
• Nearly as effective as hand-washing but not
  quite. However, it is a good alternative
• Must be at least 60 alcohol

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Organization Education Campaign

• Potty Posters
• Desk and wall postings
• Staff briefings

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Social Distancing

• Develop guidelines for social distancing
• Floor plans for spreading staff out at least six
  feet from each other
• Investigate shift work and weekend work
• Avoid shared equipment
• Clean often if you must share

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Impact of Social Distancing

• Delay outbreak peak
• Decompress peak burden on hospitals and
  infrastructure
• Diminish overall cases and health impacts

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Cleaning

• Use disinfectants that match the surface needs
• Virus Survival
• Virus lives on hard non-porous surfaces gt 24
  hours
• On porous surfaces 24 48 hours
• Swiss banknotes up to 17 days!

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Cleaning

• High touch Areas and Surfaces require increased
  frequent and more intense cleaning
• Doorbells
• Intercoms
• Handrails
• Door handles
• Elevator buttons
• Steering wheels
• Common controls (levers, buttons)

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Cleaning Infection Control at Work

• Top four germy office work areas
• Telephone
• Keyboard/mouse
• Desk surface
• Doorknob

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PPE Personal Protective Equipment

• Should you wear PPE?
• When Why
• Masks
• N95
• Surgical masks
• Gloves
• Latex
• Nitrile

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PPE Recommendations

• Surgical masks for most organizations
• N95 masks for most health care providers

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Its Time to Prepare!

• Evaluate your preparedness
• HR Dept should create or evaluate plans
• Adapt to different issues and situations
• Communicate effectively (to staff, volunteers and
  clients)
• Keep Informed
• No one knows what will happen
• Different recommendations will surface and
  conflicting information may go viral
• Follow your local Dept. of Public Health
  Guidance

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Keep Current

• 211 good source of information and it is in
  multiple languages
• http//www.211.org/
• For the most current local information
• http//www.sfcdcp.org/flu
• For email answers to your specific questions
• http//www.Fluinfo.dph_at_sfdph.org
• For questions 415-554-2905
• California Department of Public Health (CDPH)
  H1N1 Flu Hotline
• 1-888-865-0564
• The Centers for Disease Control (CDC) website
• http//www.cdc.gov/swineflu/
• World Health Organization (WHO) website
• http//www.WHO.int/csr/disease/swineflu/en/

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Questions?

• However, I stress again, that any specific
  medical or legal questions are best answered by
  the appropriate specialist.
• Thank you!