Monday, August 31, 2009

UK: NHS To Create National Drug Stockpile


# 3689



While the UK has stockpiled antivirals for the treatment of influenza, they (according to this Times’ report) don’t have a deep, multi-faceted, national strategic drug stockpile.  


The NHS is now accepting bids from generic drug manufacturers to assure a supply of those drugs that would be needed, for pandemic and non-pandemic uses, should supply chain interruptions occur.


The US has a strategic stockpile with antivirals, antibiotics, chemical antidotes, antitoxins, life-support medications, IV administration, airway maintenance supplies, along with medical and surgical items. 


The realization appears to be hitting home that concerns over supply chain interruptions, due to a pandemic or other disaster, are something well worth preparing for.



NHS prepares for pandemic with stockpile of medicines

Tom Bawden

Drug manufacturers and wholesalers have the chance win business worth tens of millions of pounds as the National Health Service prepares to create a huge stockpile of essential medicines in readiness for a flu pandemic.


The Department of Health has invited companies to tender for contracts to procure and manage more than two billion doses of about 450 essential medicines, such as penicillin, morphine, diazepam and insulin, in case a pandemic shut down the manufacturing and distribution network.


Some of the planned orders, such as those for 465 million aspirin tablets and 770 million paracetamol tablets, are related to the feared pandemic, since their consumption rises in line with the number of people with flu.Other medicines, such as glucose drips and warfarin blood-thinning drugs, are not related to flu but are essential for a hospital to function normally and for unnecessary deaths to be prevented.

(continue . ..)


CAMJ Editorial: The H1N1 Vaccine Race


# 3688



CMAJ is the Canadian Medical Association Journal, and their editorialists have taken the Canadian government to the woodshed more than once over government health policies.


Last year (see CMAJ : A Scathing Assessment Of Canadian Pandemic Preparedness) they called Canada’s epidemic surveillance and reporting system a `national embarrassment’.


Today they run an editorial criticizing the decisions which have led to delays in the approval of an H1N1 vaccine for this fall, calling the Canadian vaccine strategy `flawed’.



August 31, 2009

The H1N1 vaccine race: Can we beat the pandemic?


Canada proudly claims to be the first nation with an influenza pandemic plan — a response, in part, to the lack of vaccine during the 1976 swine flu scare. We are told that there is a guaranteed supply of pandemic vaccine from a domestic source.1 But this is only the first step.


The bigger issue is: Will we be able to immunize vulnerable populations in time?


Under the current plan, the answer is “No.” Vaccines must pass a regulatory process for licensing, and Health Canada, the licensing authority, has decided to treat this virus like a new subtype rather than a variant H1N1 strain, requiring a more extensive review and a slower rollout.

(Continue . . . )



The Canadian government made the decision earlier this summer to go with an adjuvanted vaccine – one that contains immune boosting additives that reduce the amount of antigen required for each shot. 


The problem is, these adjuvants are not currently approved for use in Canadian flu shots, and the approval process will delay distribution of the vaccine until November . . . or later.   


CMAJ is arguing that while an adjuvanted vaccine makes sense in order to assure enough vaccine for the entire nation, a `fast-track’ approval of an unadjuvanted vaccine should be in place to get vaccine to high risk individuals in October.


The editorial sums it up this way:


Time is running out. Only by providing fast-track standard vaccine might high-risk groups be protected in a timely way, while the general public awaits the arrival of the adjuvant vaccine. Without an immediate change in policy, high-risk groups in Canada will be waiting for protection, while their US and European counterparts are vaccinated. Health professionals must have access to standard vaccines by early October and to adjuvant vaccine no later than mid-November to protect the public.


Health Canada seems to have forgotten that while being first with a plan is good, being fast to vaccinate will save lives.



Whether there is time, the inclination, or even the opportunity to change to a duel track vaccine approval process is something, I guess, we’ll have to wait to see.

WHO Updates Egypt & Global H5N1 Case Numbers



# 3687


The WHO (World Health Organization) has updated their H5N1 `human bird flu’ tracking by adding the two human infections reported out of Egypt this past weekend (see here and here).


Here is today’s Egyptian update.


Avian influenza - situation in Egypt - update 22


31 August 2009 -- The Ministry of Health of Egypt has reported 2 new confirmed human case of avian influenza A(H5N1).


The first case is a 2 year-old female from Menofyia Governorate. Her symptoms started on 23 August. She was admitted to a fever hospital on 26 August, where she received oseltamivir treatment. The patient is in a stable condition.


The second case is an 14 year-old female from Damitta Governorate. Her symptoms started on 21 August. She was admitted to a fever hospital on 23 August, where she received oseltamivir treatment, and is in a stable condition.


Investigations into the source of infection indicated that both cases had close contact with dead and/or sick poultry.


The cases were confirmed by the Egyptian Central Public Health Laboratories.


Of the 85 cases confirmed to date in Egypt, 27 have been fatal.


The WHO’s cumulative report on confirmed human infections has been updated as well, with 440 cases now noted.   Noticeably absent, of course, are any updates in 2009 from Indonesia.


Despite numerous reports of human infections quite early in the year, the Indonesian government has refused to comment, or confirm any human infections with the virus this year.  


Indonesia continues to withhold H5N1 virus samples from the WHO, and the rest of the world as well, with that standoff well over 2 years old.  


The numbers in this chart, therefore, need to be taken with a sizeable grain of salt.   It is likely that we are missing cases from other countries as well. 


The good news is that the H5N1 virus remains primarily a disease of birds, and has not learned to transmit efficiently from human to human. 



(click image to view larger)

Pandemic Video Roundup



# 3686



Every 6 months or so I present a round up of pandemic flu related videos from responsible and reliable sources around the Internet (That's a personal determination on my part, and quite arbitrary).


The last time I did so was in January of this year, before the emergence of the novel H1N1 virus. At that time, the focus was on the H5N1 bird flu virus and the advice being tendered was for a more severe pandemic than we appear to be facing today.   


Many of those videos are still of interest, and you may view the list here


Today I’m presenting a revised list, with an emphasis on the pandemic at hand.


Our first stop is at, the HHS’s main portal of pandemic flu information for the public.   Here you will find 3 recent videos providing advice for pregnant women, businesses, and the general public on dealing with the H1N1 pandemic virus.


Know What to Do About the Flu Webcast Archive

Special Webcast for Pregnant Women and New Moms


[View captioned version]

August 27, 2009

Know What to Do About the Flu Webcast – Pregnant Women and New Moms

On August 27, an expert panel discussed how pregnant women and new mothers can prepare for the H1NI flu. Email questions were answered by the panel during the broadcast.


August 20, 2009

Know What to Do About the Flu Webcast – Business Guidance



Dr. Toby Merlin, CDC

Dr. Till Jolly, DHS

Travis Sullivan, DOC

Ann Beauchesne, U.S. Chamber of Congress


August 4, 2009

Know What to Do About the Flu Webcast



Secretary Kathleen Sebelius, HHS

Secretary Janet Napolitano, DHS

Secretary Arne Duncan, DoEd

Rear Admiral Anne Schuchat, CDC



HHS Youtube Channel


Check out the 10 finalists for the HHS Flu PSA Contest (see Vote For Your Favorite PSA).






Ready Older Americans Video - 5 minutes - 20Mb

Older Americans Video
(5 minutes) - Flash Format – 20Mb

Ready Pets Video - 5 minutes - 16Mb

Ready Pets Video
(5 minutes) - Flash Format – 16Mb

Americans with Disabilities Video - 5 minutes - 18Mb

Americans with Disabilites
(5 minutes) - Flash Format – 18Mb

Americans Instructional Video - 3 minutes - 12Mb

Ready America's Instructional Video
(3 minutes) - Flash Format – 12Mb

And From Around the Net.

BUSINESS NOT AS USUAL - Prepared by Public Health Seattle and King County (leaders in pandemic awareness and preparation in the US), this 20 minute video is a free download from the Internet or is available as a  free DVD. 

While probably  geared to a more severe pandemic than we may be facing  . . .  If you watch just one video . . . make it this one.


A CONVERSATION WITH JOHN M. BARRY - Historian and author John M. Barry, whose seminal work The Great Influenza: The Epic Story of the Deadliest Plague in History has probably done more to enlighten us on the events of the 1918 Spanish Flu than other book in history, visited MIT (Massachusetts Institute of Technology) and participated in a conversation about his book.


Michael Greger, M.D.

Michael Greger, M.D.


Bird Flu: A Virus Of Our Own Hatching - The lecture based on his critically acclaimed book on bird flu, by Michael Greger. MD.  An entertaining speaker who deals well with a disturbing subject; factory farming practices that have exacerbated the growth of zoonotic diseases worldwide. 

His book is freely available online here, and is highly recommended.


Utah Public Service Announcement -  Only 30 seconds, but it packs a wallop, this TV spot has been running on local channels in that state for several months.


The Plan -   How prepared are you to weather a disaster?   Larimer county, Colorado has a particularly proactive health department.   This 15 minute video created by the Pueblo City-County Health Department in Colorado,  gives a good intro into planning to deal with a pandemic. 

Check out the other videos on this page.  Broadband and dialup speeds are supported.


Countdown To Crisis- Hosted by First Responder Products, this film takes a hard look at Arizona's pandemic planning, and their annual Coyote Crisis drill.  I first plied my skills as a paramedic in Scottsdale Arizona, so I'm heartened to see how seriously they are taking this threat.

Sunday, August 30, 2009

Lancet: Atypical H1N1 Presentation In Children



#  3685


Viral infections during the winter months are as ubiquitous as they are difficult to identify.  Doctors see them every day, but most of the time, their etiology remains uncertain.  


You’ve picked up a virus.”, may very well be the most common  utterance of a GP during the flu season.


Testing can be expensive, inaccurate, and often an exercise in futility.  Most viral infections run their course in 3 to 5 days, and are over and done with before any laboratory tests can come back. 


Office tests, such as the RIDT (Rapid Influenza Diagnostic Test) are notorious for their inaccuracies.   The CDC recently released guidance for physicians explaining why a NEGATIVE test should not be used to exclude influenza as a diagnosis.




Essentially, a positive test will generally be correct.  A negative test may miss 50% of influenza cases, and so doctors are advised to use clinical evaluation to make the diagnosis.


The problem, of course, is that the symptoms for influenza are pretty much the same as the symptoms for a great many other viral infections; fever, malaise, body aches, cough.


What looks like `flu’ could just as easily be parainfluenza, a rhinovirus, respiratory syncytial virus, metapneumovirus, or adenovirus – to name a few.


Complicating matters this year is the novel H1N1 virus, which has swept across the globe over the summer.   While it is a mild-to-moderate illness in the vast majority of patients, in some small percentage of people it produces severe – even life threatening symptoms.


With no reliable rapid detection test, physicians (and the public) are called upon to make a diagnosis based on clinical symptoms.  


That may prove difficult, as we learn from this Lancet article, since the novel H1N1 virus can produce atypical symptoms in a surprisingly high percentage of patients.


A hat tip to Niko on Flutrackers for posting this study.


Clinical characteristics of paediatric H1N1 admissions in Birmingham, UK


S Hackett a, L Hill a, J Patel a, N Ratnaraja b, A Ifeyinwa b, M Farooqi b, U Nusgen c, P Debenham c, D Gandhi c, N Makwana b, E Smit a d, S Welch a


Our experience of the first wave of paediatric H1N1 swine-origin influenza admissions in Birmingham, UK, shows that presentations can be atypical, severity is often associated with underlying disease, and rates of secondary bacterial infection are low.


We reviewed the 78 available case notes of 89 children positive for H1N1 influenza by PCR admitted to hospitals across our three Trusts between June 5 and July 4, 2009.

(Continue . . . .)




A confusing array of symptoms reported in Pediatric Patients


In the UK the HPA (Health Protection Agency) produced a case definition of H1N1 for doctors to use to make a clinical diagnosis of the illness.  That called for a temperature ≥38°C or a history of fever and two other symptoms of cough, sore throat, rhinorrhoea, limb or joint pain, headache, vomiting or diarrhoea, or a severe or life-threatening illness


According to the researchers, To have followed the HPA algorithm would have meant that 40% of children with H1N1 influenza would not have been diagnosed.


It should be noted that this study involved kids sick enough to be admitted to the hospital, and yet 20% of them had no fever, and about 25% no cough.


A dilemma, obviously, for physicians. But most are pretty adept at telling when a child is really sick.


We don’t have good data on the spectrum of symptoms being experienced by those with milder illness, although it is likely to be similarly nebulous and diffuse.


Which may prove a big challenge for individuals and families who must decide, based on symptoms, whether to stay home from work or school to avoid spreading the virus. 

Infected individuals can range from being completely asymptomatic, to mild to moderately symptoms, to severely ill. 


And not everyone will present with `classic’ flu symptoms. 


Which is the main reason why health officials have accepted that there is no reasonable way to contain, or halt, the spread of influenza in our communities.


It is the master of disguise, can operate in `stealth mode’, and is impossible to reliably identify 100% of the time.

Saturday, August 29, 2009

2nd Egyptian Bird Flu Case Announced Today


# 3684




On the same day that we learned of Egypt’s 84th H5N1 `bird’ flu infection, we now are getting word of their 85th case – this time a 14 year-old girl from Damietta.  


Once again, it is Dutchy (@Dutchy123 on Twitter) posting on Flutrackers that brings us this translation from the Arabic.


This is the 34th human infection of the year out of Egypt, which is a considerable jump from the total of only 8 cases reported in that country in all of 2008.    Although the rate of infections has slowed during the summer months, unusually, we are still seeing cases in August.

The H5N1 virus is endemic in Egypt’s poultry, and over the past 3 years more than 1,000 bird culls have been reported by authorities.




85 of human infection with bird flu and a high incidence of swine flu virus
Health 29/08/2009

Cairo - 29 - 8 (KUNA) - Egyptian health authorities announced today the No. 85 of human infection from bird flu since the disease appeared in Egypt until now.


The Undersecretary of the Ministry of Public Health for preventive Dr. Amr Kandil told reporters that the new infection is a girl 14 years old from the village of Damietta (North Delta) as a result of coming into contact with infected domestic birds.


He pointed out that after the onset of symptoms and high temperature, cold and cough has been reserved girl in the hospital and give it proper treatment of the drug "Tamiflu", stressing that their health was good and stable.


The bird flu has appeared in Egypt in February 2006 and resulted in the deaths of 27 cases.


On the other hand revealed Spokesman for the Ministry of Health, Dr. Abdel-Rahman Shahin said the emergence of 13 new cases of HIV (HIV 1 that 1) is known internationally as the swine flu, bringing the total cases since the disease appeared in Egypt last June and so far 716 cases.


He said in a press statement released here today that among the cases, 12 cases of Egyptians, including two cases coming from Saudi Arabia and the state coming from Libya and 8 cases associated with infectious positive cases detected by the case not linked epidemiologically.


And the Shaheen, said that cases of recovery amounted to 579 and the status of the case and one death and the rest of the cases are receiving treatment in hospitals and their conditions are all stable and healthy new ones.


CIDRAP Sponsored Summit



# 3683




CIDRAP is one of my favorite sources for information on pandemic influenza, and other emerging infectious diseases.  Their news reporting is always top-notch, with terrific writers like Robert Roos, Lisa Schnirring, and Maryn McKenna.


Plus CIDRAP’s overviews of H1N1 and H5N1 influenza are constantly updated and second to none.


Novel H1N1 Influenza (Swine Flu)

Avian Influenza (Bird Flu): Agricultural and Wildlife Considerations
Avian Influenza (Bird Flu): Implications for Human Disease


In September CIDRAP Business Source will conduct a 2-day seminar for businesses on dealing with the H1N1 pandemic.    This promises to be quite an event, with numerous breakout sessions and presentations by some very big names in the world of infectious diseases.


Scheduled or invited to speak include such luminaries as Dr. Michael Osterholm (moderator),  Hon. Kathleen Sebelius (Invited), Dr. Robin Robinson of BARDA (Invited), Robert Bazell NBC News, Lisa Koonin MN, MPH CDC, and many more. 


Flublogia is well represented, as well, and I’m pleased to announce that my buddy and fellow blogger Scott McPherson will be presenting Will Telework Work?: Keeping Information Technology up if People Go down and fellow blogger, author, and reporter extraordinaire Maryn McKenna will be moderating a panel on Your Organization's Anticipation of, and Response to, the Media's Coverage.

(And Congratulations to Maryn for her recent DART Center Ochberg Fellowship!)


Here are the details of the seminar, and information on how to register to attend.



Keeping the World Working During the H1N1 Pandemic

Protecting Employee Health, Critical Operations, and Customer Relations

September 22-23, 2009
Minneapolis, MN
We're beyond theory, and on to reality and execution.

For the first time in our history an influenza pandemic is on a collision course with the global just-in-time economy. Are you ready?

We're convening pandemic response experts in public and private sectors who know their business and are ready to act. We'll tackle with candor, urgency, and practicality how to brace our enterprises for the months ahead.

By participating in this summit, you will:

  • Interact with pressure-tested peers willing to share what's worked for them
  • Get the straight story on vaccines, antiviral drugs, and infection control
  • Benchmark pandemic HR policies on sick leave, pay, travel, & HIPAA
  • Identify work-around tactics to deal with supply-chain shortages
  • Turn guidance into actions that will keep you in business
  • Go back to work with best-of-class knowledge and resources


Be prepared to work.

New This Year: Healthcare System Track

This track addresses the nuts and bolts of responding to H1N1 influenza in a healthcare setting and is designed specifically for professionals working in healthcare systems and facilities.

  • Supply Chain Inventory Gaps: Community Planning, Vendor Agreements, Supplies, Antivirals/Vaccines, Stockpiles
  • Maintaining Workforces: How to Address Staffing, Sick Time, and Credentialing/Privileges
  • Reducing Risk of Transmission: Protecting Employees and Patients Through Respiratory Protection, Protocols, and Compliance Monitoring
  • Communications: Keeping Employees, Patients, Public Health, Media, and the Community Informed

In addition, a Human Resources Track is being finalized and will be posted soon.

The Pathogen Less Taken


# 3682



While millions of people have been infected by the novel H1N1 virus over the summer, the far-less-transmissible H5N1 `Bird’ flu virus is still out there in the wild, and still occasionally infecting humans.


The WHO remains at Pre-Pandemic Level III on the H5N1 virus, with confirmed human infections this year from China, Vietnam, and Egypt. 


Indonesia, as you may already know, ceased reporting on their human H5N1 infections last year. We still get occasional news reports of `suspect cases’, but officially they haven’t seen any confirmed cases since 2008.

Of course, no one believes that.


Egypt, which has been far more open and transparent about their H5N1 situation has now reported 33 human infections this year, with 3 fatalities.  


Today we learn (hat tip Dutchy on Flutrackers) of another child in Egypt diagnosed with the H5N1 virus.  This is their 84th known human infection. Nearly all of the victims this year have been toddlers, under the age of 5.


For reasons that are not yet clear, the mortality rate in Egypt has dropped dramatically this year, with 90% of those infected recovering.  Whether this is due to better (or perhaps, earlier) treatment, or due to a milder form of the virus in Egypt, isn’t known.


While seemingly good news, a less virulent virus is believed to be more easily transmitted in a community, since the victims are less ill and more likely to come in contact with others.   


With the pandemic H1N1 virus also circulating, there are concerns over the possible reassortment of these two viruses (see FAO: Concerns Novel H1N1 May Spread In Poultry), particularly in places like Egypt, Indonesia, and China.



Saturday, August 29, 2009

84th bird flu case confirmed

A new human bird flu case was confirmed in Egypt on Friday 28/8/2009, taking to 84 the number of infections in the country.


A 20-month girl from Berket al-Saba, Menoufiya governorate, tested positive for the virus, Health Ministry's undersecretary for preventive affairs Amr Qandeel said.


The child showed bird flu-like symptoms after contacting with infected poultry, the official said.


She was admitted to Manshiyet al-Bakri hospital and given the anti-viral Tamiflu drug, he added.

Vote For Your Favorite PSA


# 3681



The HHS has been soliciting homebrew PSA’s (Public Service Announcements) for this fall’s flu campaign over the summer, with a $2500 prize going to the best one submitted.


More than 200 entries were received, and the HHS selection committee has narrowed the field down to 10. 


It is now up to the public to vote for their favorite PSA.  Voting will run through September 16th.  


Go watch them all, and vote for your favorite.  The videos are on the HHS’s Youtube Channel.


All of these PSAs are extremely well done, and some are very clever.   They run 30 seconds apiece (except for 1- 60 second entry).  


My congratulations to all of the entrants.  Nicely done.





H1N1 Rap  by Dr. Clarke

H1N1 Rap by Dr. Clarke


Flu Sounds PSA

Flu Sounds PSA





Be Aware of the Invisible - PSA

Be Aware of the Invisible – PSA








Help Stop Flu

Help Stop Flu


Flu Droplets

Flu Droplets





Simply Fighting the Flu Virus

Simply Fighting the Flu Virus

In A Medpedia Family Way


# 3680



I’m pleased to announce that, overnight, my blog was added to the news and analysis section of Medpedia. Basically, this means that my essays will be mirrored on the Medpedia site along side dozens of other medical & health related blogs.


It is an honor to be asked, and included.   


Thank you, Medpedia.




   AFD Medpedia Page


About The Medpedia Project

The Medpedia Project is a long-term, worldwide project to evolve a new model for sharing and advancing knowledge about health, medicine and the body among medical professionals and the general public. This model is founded on providing a free online technology platform that is collaborative, interdisciplinary and transparent.


Users of the platform include physicians, consumers, medical and scientific journals, medical schools, research institutes, medical associations, hospitals, for-profit and non-profit organizations, expert patients, policy makers, students, non-professionals taking care of loved ones, individual medical professionals, scientists, etc.



In other housekeeping issues, I’ve removed some links from my sidebar of blogs and sites that have not updated in the past couple of months, and have eliminated a couple of linked lists to my older blogs. 


I’ve added a RECENT COMMENTS section to the sidebar, with links to the last 6 comments.  I’ve also reduced the number of blogs shown on the `front’ page of my blog to 5, which will hopefully speed up the load time of the page.


Older blogs can be accessed by going to the bottom of each page, and selecting OLDER POSTS, or through the Archive drop down list in my sidebar.

Friday, August 28, 2009

WHO Briefing Note #9 & Weekly Update


# 3679


The World Health Organization (WHO) has moved from reporting twice a day on the novel H1N1 influenza pandemic, to once-a-week updates, and `briefing notes’ roughly every week or so.


Given the vagaries of reporting of cases and fatalities from around the world, that makes sense. 


The numbers from the WHO have never really accurately portrayed the spread and impact of the virus, and the deeper into this pandemic we get, the less these numbers represent the true picture.


Still there is useful information to be gleaned from these weekly updates.  



Pandemic (H1N1) 2009 - update 63

Weekly update

In the southern hemisphere, most countries (represented by Chile, Argentina, New Zealand, and Australia) appear to have passed their peak of influenza activity and have either returned to baseline levels or are experiencing focal activity in later affect areas; while a few others (represented by South Africa and Bolivia) continue to experience high levels of influenza activity.


Many countries in tropical regions (represented by Central America and tropical regions of Asia), continue to see increasing or sustained high levels of influenza activity with some countries reporting moderate strains on the healthcare system. In temperate areas of the northern hemisphere (represented by North America, Europe, and Central Asia), influenza and respiratory disease activity remains low overall, with some countries experiencing localized outbreaks. In Japan, the level of influenza activity has passed the seasonal epidemic threshold, signaling a very early beginning to the annual influenza season.

(Continue . . . )





Of greater value, perhaps, are the briefings which offer us overviews on a variety of pandemic related subjects.  Today’s – on lessons learned from the first wave - is particularly interesting.



Preparing for the second wave: lessons from current outbreaks

Pandemic (H1N1) 2009 briefing note 9

28 AUGUST 2009 | GENEVA -- Monitoring of outbreaks from different parts of the world provides sufficient information to make some tentative conclusions about how the influenza pandemic might evolve in the coming months.


WHO is advising countries in the northern hemisphere to prepare for a second wave of pandemic spread. Countries with tropical climates, where the pandemic virus arrived later than elsewhere, also need to prepare for an increasing number of cases.


Countries in temperate parts of the southern hemisphere should remain vigilant. As experience has shown, localized “hot spots” of increasing transmission can continue to occur even when the pandemic has peaked at the national level.


H1N1 now the dominant virus strain

Evidence from multiple outbreak sites demonstrates that the H1N1 pandemic virus has rapidly established itself and is now the dominant influenza strain in most parts of the world. The pandemic will persist in the coming months as the virus continues to move through susceptible populations.


Close monitoring of viruses by a WHO network of laboratories shows that viruses from all outbreaks remain virtually identical. Studies have detected no signs that the virus has mutated to a more virulent or lethal form.


Likewise, the clinical picture of pandemic influenza is largely consistent across all countries. The overwhelming majority of patients continue to experience mild illness. Although the virus can cause very severe and fatal illness, also in young and healthy people, the number of such cases remains small.

Large populations susceptible to infection

While these trends are encouraging, large numbers of people in all countries remain susceptible to infection. Even if the current pattern of usually mild illness continues, the impact of the pandemic during the second wave could worsen as larger numbers of people become infected.


Larger numbers of severely ill patients requiring intensive care are likely to be the most urgent burden on health services, creating pressures that could overwhelm intensive care units and possibly disrupt the provision of care for other diseases.

Monitoring for drug resistance

At present, only a handful of pandemic viruses resistant to oseltamivir have been detected worldwide, despite the administration of many millions of treatment courses of antiviral drugs. All of these cases have been extensively investigated, and no instances of onward transmission of drug-resistant virus have been documented to date. Intense monitoring continues, also through the WHO network of laboratories.

Not the same as seasonal influenza

Current evidence points to some important differences between patterns of illness reported during the pandemic and those seen during seasonal epidemics of influenza.


The age groups affected by the pandemic are generally younger. This is true for those most frequently infected, and especially so for those experiencing severe or fatal illness.


To date, most severe cases and deaths have occurred in adults under the age of 50 years, with deaths in the elderly comparatively rare. This age distribution is in stark contrast with seasonal influenza, where around 90% of severe and fatal cases occur in people 65 years of age or older.

Severe respiratory failure

Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections. In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays.

During the winter season in the southern hemisphere, several countries have viewed the need for intensive care as the greatest burden on health services. Some cities in these countries report that nearly 15 percent of hospitalized cases have required intensive care.

Preparedness measures need to anticipate this increased demand on intensive care units, which could be overwhelmed by a sudden surge in the number of severe cases.

Vulnerable groups

An increased risk during pregnancy is now consistently well-documented across countries. This risk takes on added significance for a virus, like this one, that preferentially infects younger people.


Data continue to show that certain medical conditions increase the risk of severe and fatal illness. These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression.


When anticipating the impact of the pandemic as more people become infected, health officials need to be aware that many of these predisposing conditions have become much more widespread in recent decades, thus increasing the pool of vulnerable people.


Obesity, which is frequently present in severe and fatal cases, is now a global epidemic. WHO estimates that, worldwide, more than 230 million people suffer from asthma, and more than 220 million people have diabetes.


Moreover, conditions such as asthma and diabetes are not usually considered killer diseases, especially in children and young adults. Young deaths from such conditions, precipitated by infection with the H1N1 virus, can be another dimension of the pandemic’s impact.

Higher risk of hospitalization and death

Several early studies show a higher risk of hospitalization and death among certain subgroups, including minority groups and indigenous populations. In some studies, the risk in these groups is four to five times higher than in the general population.

Although the reasons are not fully understood, possible explanations include lower standards of living and poor overall health status, including a high prevalence of conditions such as asthma, diabetes and hypertension.

Implications for the developing world

Such findings are likely to have growing relevance as the pandemic gains ground in the developing world, where many millions of people live under deprived conditions and have multiple health problems, with little access to basic health care.


As much current data about the pandemic come from wealthy and middle-income countries, the situation in developing countries will need to be very closely watched. The same virus that causes manageable disruption in affluent countries could have a devastating impact in many parts of the developing world.

Co-infection with HIV

The 2009 influenza pandemic is the first to occur since the emergence of HIV/AIDS. Early data from two countries suggest that people co-infected with H1N1 and HIV are not at increased risk of severe or fatal illness, provided these patients are receiving antiretroviral therapy. In most of these patients, illness caused by H1N1 has been mild, with full recovery.


If these preliminary findings are confirmed, this will be reassuring news for countries where infection with HIV is prevalent and treatment coverage with antiretroviral drugs is good.


On current estimates, around 33 million people are living with HIV/AIDS worldwide. Of these, WHO estimates that around 4 million were receiving antiretroviral therapy at the end of 2008.

They Walk Among Us



# 3678


I’m hearing a good deal of consternation on the net, and in my travels in the `real’ world, over the use of `fever’ as the determining factor in whether it is safe for a flu patient to return to work or school.


The CDC originally stated that students and employees with suspected H1N1 should stay home for 7 days, or 24 hours after symptoms disappeared . . which ever was longer.


This recommendation was based, I’m certain, on studies that have shown that adults shed the flu virus for about 7 days.  Children may potentially shed the virus for several days longer.


Recently, the CDC changed their recommendations to staying home until 24 hours after the abatement of (an untreated) fever.  


In other words, stay home until 24 hours after a fever disappears without the use of aspirin, Tylenol, or ibuprofen.


This has immediately raised concerns that flu victims who may still be shedding virus, are being told it is okay to return to work or school. 


Critics also point out that we’ve seen reports that some percentage of H1N1 patients never develop a fever to begin with.


Fever, critics maintain, is an imperfect gauge of infection.


And they are right, of course. 


Using fever as a criteria will, no doubt, allow some infected people to walk among us; at work, at school, at the mall . . .  and these people will probably be shedding some quantity of virus, and may go on to infect others.


Of course, we also know that those infected with the flu virus can begin shedding virus 24 hours before they show symptoms, and that some percentage of infected remain asymptomatic for the full course of the infection.  


They walk among us, too.


Like it or not, there is no easy litmus test for infection (and viral shedding) when it comes to influenza.   The array of symptoms (or lack thereof) displayed by those infected with the H1N1 virus preclude any kind of 100% accurate `checklist for infection’.


Sure, we could lock up everyone who sneezes, coughs, or spikes a fever for 2-weeks.  But even that wouldn’t catch those who are shedding the virus before developing symptoms, or those who remain asymptomatic for the full course of their illness.


So the new guidelines are a compromise, based on the knowledge that there is nothing that can be done to completely stop the spread of the virus. 


The best you can hope for is to slow it down.


The belief is, that those who are the sickest (i.e. coughing, sneezing, fever) are probably shedding the most virus.  And so keeping them home, away from work or school, makes sense.


Fever is an easy enough symptom for most people to check.  It is an objective sign, one that can be measured with a thermometer.  It may not catch all of those who are shedding the virus, but it probably catches the most contagious among them.


With thousands of people walking among us quietly shedding the virus it simply makes little sense to tell those who are probably only shedding very low amounts of the virus – but who feel well enough to work or study - to stay home for a full week. 


Of course, if you are coughing your head off, sneezing every 5 minutes, or running to the bathroom 3 times an hour . . . you might want to give yourself an extra day or two to recover. 


We are allowed to use some common sense here. 


So yes, using fever as a criteria for staying home is a compromise. It balances public safety with economic and societal considerations.  It isn’t perfect, by any means.


But as compromises go, it is a reasonable one.  


Which is why it is so important to remember to wash your hands frequently, clean and disinfect shared objects like phones, keyboards, and door handles, and to try to maintain some space between yourself and others during a pandemic.


All of these steps are basically delaying actions, which will hopefully help keep you and your family virus-free until a vaccine can become available later this fall. 

As imperfect as all this may be, for the next couple of months they are going to be your best defense against this virus.

Thursday, August 27, 2009

FAO: Concerns Novel H1N1 May Spread In Poultry



# 3677


The discovery of novel H1N1 influenza in Turkeys this past week in Chile has raised concerns that poultry may become another possible avenue for reassortment of the pandemic virus with other flu strains.


Reassortment is the mechanism where two different flu viruses infect the same cell simultaneously, and swap genetic material, producing a new, hybrid virus.


The pandemic virus wending its way around the globe is a reassortment of human, swine and avian flu viruses, and previous pandemics have been launched by similarly derived mutations.


In recent months we’ve seen herds of pigs in Argentina, Canada, and now Australia that have picked up the virus, presumably from infected humans.


We worry most about pigs because they are uniquely susceptible to human, swine, and bird flu strains – making them a likely `mixing vessel’ for influenza’s.


But reassortments can occur in any host;  humans, swine, birds . . . any host capable of being infected by influenza viruses. 


Reassortant pig


The danger here isn’t that pigs, or turkeys will get and transmit the novel H1N1 virus to people – there is already plenty of that virus floating around the human population - it’s that they could enable a reassortment of the virus to occur.


While this is a theoretical concern, no one knows how likely it is to actually happen.  We know it does happen, but a reassortment that results in a biologically `fit’, and easily transmitted virus would seem to be a fairly rare event.


Else we’d be hip deep in new viruses all the time.


Today, from the UN’s Food and Agriculture Organization (FAO), we get this report on concerns over this reassortment possibility .




H1N1 flu in turkeys may spread


Poultry connection strengthens global H1N1 pandemic

Photo: ©FAO/Ami Vitale

H1N1 virus confirmed in turkeys at Chilean farms.

27 August 2009, Rome - The detection of an H1N1 virus in turkeys in Chile raises concern that poultry farms elsewhere in the world could also become infected with the pandemic flu virus currently circulating in humans, FAO said today.


Chilean authorities reported on 20 August that the pandemic H1N1/2009 virus was present in turkeys in two farms near the seaport of Valparaiso, Chile. The flu strain found in the poultry flocks is identical to the H1N1/2009 pandemic strain currently circulating among human populations around the world.


No threat to humans


However, the discovery of the virus in turkeys does not pose any immediate threat to human health and turkey meat can still be sold commercially following veterinary inspection and hygienic processing.


“The reaction of the Chilean authorities to the discovery of H1N1 in turkeys — namely prompt reporting to international organizations, establishing a temporary quarantine, and the decision to allow infected birds to recover rather than culling them — is scientifically sound,” said FAO’s interim Chief Veterinary Officer, Juan Lubroth.


“Once the sick birds have recovered, safe production and processing can continue. They do not pose a threat to the food chain,” said Lubroth.


Disease monitoring

The current H1N1 virus strain is a mixture of human, pig and bird genes and has proved to be very contagious but no more deadly than common seasonal flu viruses. However, it could theoretically become more dangerous if it adds virulence by combining with H5N1, commonly known as avian flu, which is far more deadly but harder to pass along among humans.



“Chile does not have H5N1 flu. In South-East Asia where there is a lot of the virus circulating in poultry, the introduction of H1N1 in these populations would be of a greater concern,” said Lubroth.


This is one reason why FAO encourages improved monitoring of health among animals and ensuring that hygienic and good farming practice guidelines are followed, including protecting farm workers if animals are sick and not allowing sick workers near animals.

(Continue . . . )


From Here To Immunity



# 3676


Despite calls by the Whitehouse’s PCAST (Presidents’ Council of Advisors on Science and Technology) Report To The President On US Preparations for the 2009-H1N1 Influenza to have at least some vaccine filled, finished, and delivered by September - according to the CDC’s director Dr. Thomas Frieden - vaccine deliveries are unlikely before mid-October.


This report from Reuter’s Maggie Fox.


No flu vaccines before mid-October, CDC predicts

Wed Aug 26, 2009 10:14pm EDT

By Maggie Fox, Health and Science Editor


WASHINGTON (Reuters) - Scientific advisers to President Barack Obama may have asked the government to speed up the availability of swine flu vaccines, but they are unlikely to be ready before October, the new head of the U.S. Centers for Disease Control and Prevention said on Wednesday.


And imperfect tests for the pandemic H1N1 virus means it will be impossible to get precise numbers on how many people are infected, said Dr. Thomas Frieden.


(Continue . . .)



The expectation right now is to have somewhere around 45 million doses of vaccine available by mid-October, and that millions more doses will come available in the weeks that follow.


With nearly 50 days to go, and a good deal of uncertainty left in the manufacturing process, those numbers (and the delivery date) could fluctuate further. 


Assuming that sizable quantities of vaccine are delivered to the states in mid-October, hundreds of state and local health departments will begin the enormous and complicated task of dispensing the vaccine into the arms of the most `at-risk’ Americans. 


This priority group consists of roughly 42 million people.

Pregnant women (4 million)

Household contacts of Infants < 6 mos (5 Million)

Health Care Workers With Direct Patient Contact (9 Million)

Children aged 6mos – 4 yrs (18 million)

Children under 19 with chronic medical conditions (6 Million)

And no one knows how smoothly or quickly that will go.  


Most people believe, erroneously, that once they get a flu shot they are protected from influenza.  In truth, it is a bit more complicated than that.


Seasonal flu shots, when they are well matched to the circulating strain, produce reasonable immunity in healthy young adults between 70% and 90% of the time.  


The immune response is generally not as robust in the elderly, younger children, and some people with chronic illnesses or compromised immune systems.


If the vaccine isn’t well matched, those numbers go down.  


And it takes a couple of weeks after the flu shot is received before the body develops sufficient antibodies to ward off infection.


With a novel virus . . . or for a child getting their first seasonal flu shot, it generally takes 2 shots about 3 weeks apart, followed by another 2 weeks for the body to create antibodies.


There may be some limited immunity  that develops a couple of weeks after the first shot, but maximum protection takes time to develop, and is expected about 2 weeks after a booster shot.




We are awaiting clinical trial data to tell us if 2 shots will be required with this new virus.  For now, the assumption is that it will; at least for children and young adults.


For those who are able to get their first shot in mid October, followed by a second booster shot in early November, full immunity probably won’t develop until near Thanksgiving.


The big question facing public health officials is how fast can they get the vaccine out into the arms of the public, once the vaccine becomes available. 


And no one really knows the answer to that.   


It isn’t going to happen overnight, however.  It may take weeks to get the first round of shots into those at highest risk, and months before everyone in the target group (159 Million Americans) that wants the vaccine, can get the vaccine.


Which means that `immunity by Thanksgiving’ meme we’re hearing this week is a best case scenario, and will only apply to a limited number of `high risk’ Americans.


A large number of Americans may not be offered the protection of a vaccine until after the New Year.


A vaccine is an important tool in our fight against this virus, but won’t be a panacea.   And even those who are lucky enough to receive the vaccine will have to continue to take precautions because the vaccine isn’t going to offer 100% protection.


Many of us are likely to develop immunity the old fashioned way; through exposure to the virus.   


But like a vaccination, the protection that affords will be temporary, as the virus will probably mutate over time and return next year, and probably in the years after that.  

For now, and for the next few months, it will be the basic things – like hand washing, staying home if we’re sick, avoiding crowds, and covering our coughs that will have the biggest effect on limiting the spread of this virus. 


A vaccine, when it arrives, will no doubt help to protect those at greatest risk.  But rolling out a vaccination program of this size is a huge task, and will take time.


The arrival of the novel H1N1 virus should be a wakeup call to our species.  A new, potentially deadly virus can show up on our doorstep at anytime, and without warning.   This time it was swine flu, and thus far, it is relatively mild.

Next time, it could be something worse.


The personal hygiene habits we are urged to adopt now are habits we should embrace all the time.  And where our preparedness for this pandemic is shown to be inadequate or incomplete, we should rectify those problems now.


And lastly, we need to reevaluate our priorities, and give more thought (and funding) to public health in our country, and around the world.   Preventing disease outbreaks is, in the long run, a lot less expensive than trying to deal with a pandemic.


While humanity is nearly 7 billion strong, we are still badly outnumbered by pathogens.  We either get smarter about dealing with them, or we can expect to pay the price for our ignorance.

Wednesday, August 26, 2009

CDC Webcast Tomorrow: Pregnancy, New Moms & Flu



# 3675





Join us 1-2 p.m. EDT Thursday, August 27, as we talk with experts about what pregnant women and new moms should do about the flu. Join the discussion by sending questions or comments to

 See more details about the Webcast (PDF – 1.9 MB)

The Outrage Factor




# 3674



Peter Sandman Website logo


When it comes to Risk Communication, you can’t do much better than the works of  Dr. Peter Sandman and Dr. Jody Lanard.   Both are well established experts, and together have provided a long and valuable stream of essays and books on the subject.


Dr. Sandman is the creator of   Risk= Hazard + Outrage meme.   A shorthand way of expressing that risk is more than just the hazard, it is the hazard plus the outrage people feel about it.


There are some hazards that are relatively major, but that we are used to, and so our outrage is small.    The annual death toll from influenza -  estimated at 36,000 Americans – is a good example.


Since 90% of the deaths occur in the the elderly – often among nursing home patients or others that are weak or infirmed – we tend not to be terribly outraged over that risk.  


Pneumonia, for centuries, has been called `The Old Man’s Friend’, because it tends to take the elderly quickly and quietly.  This yearly viral `harvesting’ of those close to the end of their life is accepted, or at least largely ignored, by the public.


When children, or young adults die from influenza, it is another matter entirely.  


It makes the newspapers, and sometimes the evening news.  It jolts the public, because we think it isn’t supposed to happen. And so, when it does, the outrage is high.


In truth, between 50 and 100 children die each year from influenza.  A horrible number, but still small in a nation of 300 million people. 


Now . . . imagine the outrage if 1,000 children should die this winter from pandemic flu.  Or 5,000.    Or more . . .


We would rightfully view it as a national tragedy.  


The only thing that might temper it, and cause it to have a smaller emotional impact than say – the 9/11 tragedy – would be that it would occur over a period of months, not all at once and on live TV.


In order to meet this challenge the CDC and the HHS have put together numerous guidance documents on everything from ways to keep school open to the best way for HCWs (Health Care Workers) to protect themselves when caring for flu patients.


Most of the guidelines, and recommendations being promoted by the HHS and the CDC are perfectly reasonable given the circumstances. They are based on a combination of the available science, practicality, and the fact that thus far, the novel H1N1 virus has shown a low level of lethality.


And in a perfect world, that would be enough. 


People would recognize the limitations that any government or society has in dealing with a pandemic, accept that certain losses cannot be avoided, and acquiesce to the policies promulgated by pandemic planners (sorry, I am unfortunately functionally alliterate).


Of course, we don’t live in a perfect world.  And what may seem reasonable from one perspective isn’t always reasonable to another. Following policies that make sense on a macro, or population-wide basis, may not always seem attractive or reasonable to individuals and families.


Some hazards may be statistically small, but nonetheless carry a lot of outrage.  


Officials who base their planning decisions solely on the science, and fail to take into account the `outrage factor’ that their plans and guidance may foster, are likely to find an irate and uncooperative public response.


Keeping schools open is a good example. 


There is a lot to be said for that.   Schools are the ideal place to teach kids good flu hygiene, and probably the best venue to deliver vaccinations to large groups of children.  


Closing schools won’t stop the spread of the virus in a community, and it would constitute a burden to a great many families where the parents both work.    There are also millions of students who depend upon the school nutrition program.

All valid reasons to keep schools open, and operational if possible.


It is arguably good for kids, it’s good for the community, and it’s good for the economy.


That is . . until a healthy kid - who follows the government’s advice and goes to school - comes home with the virus and ends up in the hospital . . . or worse, dies.   


And we know that is almost certainly going to happen.  Hundreds, probably thousands of times over the next few months. 


And when it does, parents – who instinctively think of schools as a `safe place’ to send their kids – are going to be outraged.  


Count on it.


Disinfecting school rooms, fever checks each morning, encouraging hand washing, and sending kids home with flu-like symptoms all make sense, but they won’t prevent kids from catching the virus at school – and bringing it home.


At best, these things may slow down the spread of the virus.   But parents aren’t going to want to hear that. 


They want their children safe and protected.


I’m already hearing a lot of outrage from parents who can’t believe that the plan is to keep schools open, even if students are falling ill from the virus. No matter how `reasonable’  from a public health standpoint the argument is for keeping schools open, for a parent, the health and wellbeing of their child comes first. 


Parents of children with asthma, or where there are at-risk individuals in the home, are particularly concerned over the risks of sending their kids to school, and what they might bring home.


My fear is that officials aren’t taking the inevitable outrage into account.    Or perhaps they are, which is why the decision to close schools has been left to local officials.


Closing schools is going to be a damned-if-you-do, damned-if-you-don’t  decision.   And no, I don’t have a good solution.  I suspect there isn’t one.  


Just as many people are likely to be outraged if you close the schools as those who will be outraged if you don’t.

But public officials need to understand that for parents there is no trauma greater than the loss of a child, and no instinct stronger than that of protecting their children from harm. 


If parents are afraid to send their kids to school in a pandemic – even if, in the eyes of authorities, it is an unreasonable fear -  they need to be able to keep their kids home without punitive actions taken against them, or their kids.


If officials try forcing kids to attend school during a pandemic, and those kids start getting sick, or dying, they are just asking for outrage.  


Regardless of how reasonable their arguments might be.


      *             *              *               *                *              *


In 1976, the Swine Flu vaccine ended up being blamed for about 25 deaths, and hundreds of cases of paralysis.  The outrage over the damage caused by that vaccination program probably cost Gerald Ford the presidential election. 

While the vaccine killed only 1 person out of every 1.6 million who got the shot  - and was blamed for neurological problems (GBS) in about 1 in 80,000 -  the nation was horrified.  


The actual risk was very low, but the outrage was very high.


Why?   I suspect because the vaccine was supposed to save lives.  And it didn’t.   It claimed more lives than the swine flu that year.  More people died in auto accidents in one day in the US than were killed by the vaccine, but that didn’t matter.


Deaths in car accidents are expected.  Deaths from vaccines are not.


Thirty years later, and millions of people still don’t trust vaccines.  While the hazard was apparently fixed decades ago (we’ve not seen a recurrence of the GBS neurological side-effects since then) the outrage, and the damage, remains to this day.


We are now about to embark on another huge vaccination program, and even if this H1N1 vaccine turns out to be among the safest ever devised, we will almost certainly be bombarded by reports and claims of side effects – and perhaps even deaths – linked to the shot.


These may turn out to be coincidental events, unconnected to the vaccine, but that won’t matter.  The media has harped on the dangers of a `rushed and untested’ vaccine for months. 


People are primed to expect another vaccine debacle. 


Already there is outrage about the fast tracking of vaccines, about the possibility of using untested adjuvants, and some people even fear that the vaccine will be forced on them.


While public health officials may find these fears ridiculous, unfounded, or just plain nuts . . . they would do well to take them seriously.  These concerns . . . and the outrage they inspire . . .  are powerful and potentially destructive forces.  


They must be addressed publicly, and often.  Otherwise, they have the potential to derail any national vaccination program.


No matter how safe or effective the vaccine might be.



       *             *              *               *                *              *

Another area of outrage, again with the potential for real damage, comes from health care workers who believe that their safety will be compromised during a pandemic, particularly if surgical masks are deemed `good enough protection when caring for flu patients. 


(See Nursing Survey Shows Hospital Deficiencies)


For decades they’ve been told that surgical masks are not PPE’s (Personal protective equipment).  That you needed N95 respirators or better to protect the wearer from an airborne virus. 


Surgical masks protect the patient from the doctor or nurse treating them . . . not the other way around.


Now , with a pandemic on our doorstep and a severe shortage of N95 masks likely,  surgical masks are suddenly being promoted as being `good enough’.  And many HCWs are outraged.


Most HCWs understand that our supply of N95's is very limited.  That, for a variety of reasons, hospitals and the government decided they had more pressing priorities than to stockpile PPEs for a pandemic.  


They understand it, but they are outraged over it. 


And many feel that rather than admitting to a general failure to prepare, the `rules’ are being changed instead. 


While it may be reasonable to recommend surgical masks when there are insufficient quantities of N95s available, the root of the problem is the lack of planning that put us in this situation; The failure to stockpile adequate PPEs. 


It is only pure luck that we are facing a less lethal swine flu pandemic, and not a highly fatal H5N1 virus.   Our PPE stockpile would have been no better had we been struck by the latter.   HCWs know that, and also know that this virus could become more virulent over the winter.



And you can bet that just about every nurse or HCW who is issued surgical masks instead of N95s, and ends up getting sick, is going to blame their hospital or workplace for not adequately protecting them.

Count on it.  


And it won’t matter whether or not having N95s would have made a difference.   HCWs will assume they would have.


  Because that’s what they have been told for the past 30 years.


       *             *              *               *                *              *

These were three examples of predictable outrage, but there are dozens more.  And public officials, hospital administrators, and others in a position of power need to be cognizant of their likelihood, and their potential for damage.


And it isn’t just the considerable political hit that public officials may take that should worry them. Businesses (including those in health care) could see lawsuits over perceived lapses in employee safety or patient care.  


The ultimate success or failure of the national vaccination program will depend, in large part, on how effectively officials communicate the risks and rewards of vaccination to the public. 


The percentage of HCWs and first responders that agree to work during a pandemic may well hinge on how well they believe they are being protected on the job.


In other words, there is a lot riding on how well officials handle the public outrage that pandemic policy decisions are almost sure to generate. 


To all of those, in the public or private sector, who are either involved in policy making, or in communicating a pandemic policy to employees or the public  . . . I urge you to proceed directly to the Peter Sandman Risk Communication website.



From It’s The Outrage, Stupid by Dwight Holing we get the Sandman philosophy in a nutshell. 


When it comes to communicating environmental risk, business needs to recognize that outrage is as important as hazard. “When people are outraged, they tend to think the hazard is more serious than it is,” says Dr Peter Sandman, the preeminent expert on risk communication. “Trying to convince them that it’s not is unlikely to do much good until you reduce the outrage.”


Business can accomplish that by being open, honest, accountable and sharing control with the public.


The same could be said about any government agency, as well. 


It isn’t going to be enough to formulate `reasonable plans and guidance’ and expect everyone to accept them.   The public has to be brought on board, made a part of the discussion (and that’s a 2-way conversation), and told honestly what can, and can’t be done during a pandemic.  


Since the Sandman website has so much information, a good place to start is the Crisis Communication (High Hazard, High Outrage) page along with  Sandman’s Swine Flu Pandemic Communication Update


But pack a lunch, there’s a lot to glean from their website.