Monday, October 23, 2017

Pandemic Unpreparedness Revisited


As we head once more into an uncertain avian flu season - with three different H7N9 threats growing in China, and HPAI H5N8 and H5N6 expected to make new inroads across Asia, Europe, Africa and potentially North America this winter- the number of pandemic threats is greater than at any time I can recall.
Four days ago, in Cell Host & Microbe: HPAI H7N9 Lethality & Transmission In Ferrets, we looked at a somber assessment of the evolution (and pandemic potential) of the recently emerged HPAI H7N9 virus. 
Since then we've seen dozens of media reports on this growing threat, with perhaps CIDRAP's report by Lisa Schnirring (see Study details pandemic potential of latest H7N9 flu strains) my favorite.

While others (excluding the usual tabloid press) presented the facts well enough, Lisa's coverage ended with this all too familiar cautionary note from Dr. Michael Osterholm.  

World not prepared for H7N9 threat

Michael Osterholm, PhD, MPH, director of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP) said the study's findings bolster concerns that experts already have about H7N9. "The study is another very stark reminder that we could be sitting on top of a global time bomb with H7N9," he said. CIDRAP is the publisher of CIDRAP News.

Large gaps in pandemic preparedness still remain, and if H7N9 triggers a pandemic, the vaccine would likely play a limited role, he said.

Osterholm added that little work has been done to create strong global supply chains of the critical supplies and services that would be needed to battle pandemic flu, and he predicted critical shortages of drugs and equipment such as respirators if the next global flu threat is even close to the severity of the 1918 pandemic virus.

Despite decades of forewarning and the near inevitability of seeing another 1918-style pandemic, the world remains woefully unprepared.  And this isn't just one person's opinion. This is a message that has been repeated nearly every year by governments and organizations since I began blogging about pandemic flu 12 years ago.
While there was a decided international push for pandemic preparedness at all levels (public, private, community and individual) in the middle of the last decade - much of the momentum was lost after the H1N1 pandemic proved less severe than first feared.
Last May, in World Bank: World Ill-Prepared For A Pandemic, we looked at a 131-page working paper from The World Bank, that warned that far too many nations have let pandemic preparedness slide, and that the world remains unprepared to face even a moderately severe pandemic.

A conclusion not unlike that reached in 2015 by a World Bank Poll: Majority Believe World Is Not Ready For A Pandemic, and by a 2011 WHO Panel: World Ill-Prepared To Deal With A Pandemic.

In 2015, we looked at an 84-page Bipartisan Report of The Blue Ribbon Study Panel On Biodefense that looked at our nation’s vulnerability to the triple threat of a biological attack, an accidental release, or naturally occurring pandemic with a highly pathogenic biological agent.   
Their conclusion?  We aren't anywhere near ready.
None of this is to suggest that some progress hasn't been made. The WHO continues to expand their library of Candidate Vaccines For Pandemic Preparedness, surveillance - at least in some areas of the world - has improved, and newer antivirals are in the pipeline.

But the number, and variety of global disease threats continues to expand.  While novel influenza is at the top of that list, it is far from the only threat on our radar. MERS-CoV and SARS, Nipah and Hendra, Monkeypox, and a short list of hemorrhagic viruses all make the list.
And of course, there's always Virus X - the one we don't know about yet.
I can't tell you what will spark the next severe pandemic, or when it will happen. Only that each day that passes brings us closer to that day.  And when it comes, it will likely happen swiftly, with scant warning and little time to prepare.

A little over a decade ago, in Quotable Quotes, we looked at some statements by government officials on what an H5N1 pandemic might look like.  A small sampling includes:
[A pandemic] is an absolute certainty. When it comes to a pandemic we are overdue and we're under-prepared. -- Mike Leavitt, former Secretary, US Health and Human Services

Short of thermonuclear war, I have a hard time imagining anything in my lifetime that would be as horrible. -- Laurie Garrett, US Council on Foreign Relations Senior Fellow for Global Health

There would be no mutual aid, we'd have to take care of this ourselves. --Former Florida Governor Jeb Bush February 15, 2006
Although the threat today is more centered on H7N9 than H5n1 - like with earthquakes, hurricanes, blizzards and tornadoes - we ignore the inevitability of another severe pandemic at our own peril.

All of which makes this a very good time for local and state governments, businesses, organizations and even individuals to drag out, dust off, and take a hard look at their old pandemic plans (or create a new one if need be).

The HHS/CDC has recently done just that, with the release last April of a revised CDC/HHS Community Pandemic Mitigation Plan - 2017 followed in June with the release of their HHS Pandemic Influenza Plan - 2017 Update.
Although a welcomed update to the US government's pandemic plan, as in politics - all pandemics are local
While the federal government deals with a pandemic on the macro level (coordinating the development of a vaccine, the release of antiviral stockpiles, among other things), it will fall largely upon local communities, hospitals, school districts, businesses, and individuals to deal with the brunt of an outbreak. 

One of the nation’s leaders in pandemic and disaster planning is Public Health - Seattle & King County.  In 2008 they produced a 20 minute film called Business Not As Usual, designed to help introduce businesses to the core concepts of pandemic planning.

Frankly, this video should be required viewing for every businesses owner, manager, and employee.

You’ll also find a long list of preparedness resources available on this page as well:
 General resources:
Business and government preparedness:
Community Based Organization (CBO) preparedness:
Personal preparedness:

 Another excellent resources comes from TFAH (Trust for America’s Health)


Credit TFAH It's Not Flu As Usual Brochure

If you are an employer, you should know that OSHA considers it your responsibility to provide a safe workplace – even during a pandemic - and has produced specific guidance on preparing workplaces for an Influenza Pandemic  along with Guidance for Protecting Employees Against Avian Flu.

Frankly, few businesses could survive a prolonged shutdown due to a pandemic. Which is why pandemic planning should be part of their overall business continuity and recovery plan. A couple of good resources worth checking out are The Business Continuity Daily and Cambridge Risk Perspectives, both of which provide daily reviews of current threats and advice on preparedness.
urges that individuals and families take the following steps before a pandemic as well.
Before a Pandemic
  • Store a two week supply of water and food.
  • Periodically check your regular prescription drugs to ensure a continuous supply in your home.
  • Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.
  • Get copies and maintain electronic versions of health records from doctors, hospitals, pharmacies and other sources and store them, for personal reference. Get help accessing electronic help records.
  • Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home.

Having the supplies to treat flu at home will be essential during a pandemic, as most hospitals will be clogged, with only the `sickest of the sick' likely to be admitted. As with flashlights, batteries, and ice before a hurricane, the store shelves will be quickly wiped clean of flu supplies in the opening days of a pandemic.
As an aside, I would add a box of vinyl exam gloves, hand sanitizer, and a small supply of surgical (or N95) masks to any home flu kit. 
And now is an excellent time to discuss with family and friends who will act as your Flu Buddies people you can call on if you get sick, who will then check on you every day, make sure you have the medicines you need, help care for you if needed, and who can call for medical help if your condition deteriorates.
Frankly, these are individual and family preparations that would hold you in good stead during any flu season - not just during a pandemic.
Admittedly we could easily go years, or even decades, before the next pandemic strikes. Or, it could begin somewhere in the world tomorrow. Like earthquakes along fault lines, and tornadoes in Tornado Alley, pandemics are inevitable. The timing is really the only question.
For a family or an individual - if you are well prepared for a flood, an earthquake, or a hurricane - you are probably in pretty good shape to deal with a pandemic.  Unfortunately, fewer than half of all American households are so prepared.
Businesses, health care facilities, and government agencies will find that their disaster plans will need to consider pandemics a bit more specifically. I could go on, but I'll simply close with one more quotable quote from 2006, one that sums up the pandemic preparedness dilemma in a nut shell.

“Everything you say in advance of a pandemic seems alarmist.  Anything you’ve done after it starts is inadequate."- Michael Leavitt,  Former Secretary of HHS

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