Sunday, September 16, 2018

#NatlPrep : Because Pandemics Happen

Note: September is National Preparedness Month . Follow this year’s campaign on Twitter by searching for the #NatlPrep hash tag.
This month, I’ll be rerunning some edited and updated older preparedness essays, along with some new ones.

During this 100th Anniversary of the deadliest flu pandemic in history, it is worth noting that there have been 3 legitimate pandemics, and a couple of pseudo-pandemics in my lifetime.  As I’m only 64, there is a pretty good chance I’ll see another one before I exit stage left.

Over the past 60 years we’ve seen:
  • The 1957 H2N2 Pandemic 
  • The 1968 H3N2 Pandemic
  • The 1977 H1N1 `Russian Flu’ pseudo-pandemic
  • The 2003 SARS pseudo-pandemic
  • The 2009 H1N1 Pandemic

If we expand that timeline by just a few years, we could add in the brief, but virulent, flu outbreak of 1951: The Year Seasonal Flu Went Rogue. It started in December of 1950 when a new (and still unidentified) strain of virulent influenza appeared in Liverpool, England, and by late spring, had spread across much of England, Wales, and Canada.

A 2006 EID Journal article by Viboud C, Tam T, Fleming D, Miller MA, Simonsen L. 1951 influenza epidemic, England and Wales, Canada, and the United States describes its impact.
The 1951 influenza epidemic (A/H1N1) caused an unusually high death toll in England; in particular, weekly deaths in Liverpool even surpassed those of the 1918 pandemic. . . . . Why this epidemic was so severe in some areas but not others remains unknown and highlights major gaps in our understanding of interpandemic influenza.
As it started relatively late in the flu season, this new strain never managed to spread much beyond UK and Eastern Canada. Nor did it reappear the following flu season. 
It simply vanished as mysteriously as it appeared, leaving behind an enduring medical mystery.
We are also in the midst of a slow-rolling HIV pandemic, which nonetheless has claimed the tens of millions of lives, and the 7th Cholera Pandemic (which ran between 1961-1975) still claims tens of thousands of lives each year.
While a lot of pathogens can potentially cause a pandemic, it is novel influenza that has historically wreaked the most havoc, and keeps most epidemiologists up at night.
A decade ago - when the H5N1 bird flu virus first threatened - we saw a massive global push for pandemic preparedness. Many groups selected a CPO; a Chief Pandemic Officer.  Someone in their business, organization, or family - whose job it was to coordinate their pandemic plan  (see Quick! Who's Your CPO?). 
Unfortunately, since the 2009 H1N1 pandemic was perceived by many as being mild and the next event thought years away, many corporate, organizational, or agency pandemic plans haven’t been updated – or in some cases even looked at – in years.
While a pandemic may not strike with the suddenness of an earthquake or a Hurricane, a pandemic virus can still spread around the globe in a matter of days or weeks, leaving precious little time to prepare. 

The CDC, and FEMA continue to urge pandemic preparedness, and early last year the CDC updated their CDC/HHS Community Pandemic Mitigation Plan - 2017, which recognizes a vaccine could be months in coming, and focuses on reducing the spread of a pandemic virus through non-pharmaceutical interventions (see Community Pandemic Mitigation's Primary Goal : Flattening The Curve)

The CDC’s Nonpharmaceutical Interventions (NPIs) webpage defines NPIs as:
Nonpharmaceutical interventions (NPIs) are actions, apart from getting vaccinated and taking medicine, that people and communities can take to help slow the spread of illnesses like influenza (flu). NPIs are also known as community mitigation strategies.
Social distancing, staying home when sick, avoiding crowds, even the closure of schools or other public venues are all potential NPIs.

Although there may be other pharmaceutical options - like antivirals - available at the start of a pandemic, those will be in finite supply and are not a panacea for infection.  Prevention is always better than treatment, but never more so than during a pandemic, when treatment options may quickly become limited (see Pandemic Realities: Ventilator Shortages).

Hospital beds, antiviral drugs, even hospital staff - may all be in short supply during a pandemic (doctors and nurses get sick, too) - which makes it all the more imperative we flatten the curve - even if it means extending the duration of a pandemic wave.

While telling people to wash their hands, cover their coughs, avoid crowds, and stay home while sick may seem like a weak response to a pandemic - in truth, they (and other more disruptive measures like school closures, cancellation of public events, etc.) may be our most powerful weapons in any pandemic.
But they must be properly applied, else they could do more harm than good.
It's neither practical or desirable to simply shut everything down at the first sneeze, and try to wait out what could be a year (or longer) pandemic. Very few are equipped to do so, and besides, someone has to keep the lights on, deliver the food, refine the fuel, police the streets,  take care of the sick and injured . . . and do the thousands of other things that hold civilization together.
We'll have to find ways to live and work as safely as possible during a pandemic. Else the virus could quickly become the least of our problems.
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.

And if you follow only one link from this blog post, I’d highly recommend the following 20 minute video produced by Public Health - Seattle & King County -  called Business Not As Usual .
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.  For more information on how to prepare, you may want to revisit:

Pandemic Planning For Business
NPM13: Pandemic Planning Assumptions
The Pandemic Preparedness Messaging Dilemma

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