Sunday, October 06, 2013

Pandemic Preparedness: Taking Our Cue From The Experts


Credit CDC 



# 7839



Actuaries with better math skills than I have calculated the odds at about 3-4% that during any given year, we could see a pandemic. This is based on seeing 3 full-fledged influenza pandemics in the last century (not to mention several  Pseudo Pandemics And Viral Interlopers). Now, just 13 years into this new century, and we’ve already seen one pandemic (2009) and one near miss (SARS in 2003).


While 3-4% may seem pretty small odds, it’s greater than the chance of seeing a direct hit with a CAT 5 hurricane on Miami or an 8.0 magnitude earthquake in Los Angeles during any given year.  And those are high risk areas.

With two emerging viruses in the wings (H7N9 and MERS-CoV), the continued threat of H5N1, plus a poke full of swine variant viruses, it certainly feels as if our odds of seeing some kind of global public health emergency over the next year or two are  higher than normal.


But how much higher?  I’ve no idea.


But one can certainly understand why public health officials are urging an enhanced level of vigilance during the upcoming flu season (see PAHO: Dr Keiji Fukuda Briefs Delegates On H7N9 & MERS-CoV). The messaging from public health agencies ranging from the World Health Organization, to the ECDC, to Hong Kong’s HPC, to our own CDC runs pretty much the same: 


No one knows if any of these viruses will pose a pandemic threat, but given the stakes, no one is willing to ignore the possibility. 


Which should be motivating every family, business, organization and community to dust off their pandemic plans (you DO have a pandemic plan, right?) and make sure that it is adequate, up-to-date, and tested


If you don’t already have a plan, now is the time to appoint a CPO (Chief Pandemic Officer), and to give that person the green-light and resources to develop a workable plan.


To help get you started, one of the nation’s leaders in pandemic and disaster planning - Public Health - Seattle & King County - produced a 20 minute film called Business Not As Usual back in 2008, 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:

In 2009 OSHA created this fact sheet on protecting employees during a pandemic.


    During an influenza pandemic, transmission of the pandemic virus can be anticipated in the workplace, not only from patients to workers in healthcare settings, but also from customers and coworkers in general work settings. Employers can use a set of occupational safety and health controls referred to as the "hierarchy of controls" to reduce exposures to pandemic influenza in their workplaces. The types of control measures, listed from most effective to least effective, that may be used to protect yourself, your workers and your customers are:

    • Engineering controls;
    • Administrative controls;
    • Work practices; and
    • Personal protective equipment (PPE).

    Next a 46-page PDF file from the Department of Labor and the HHS on preparing workplaces for an influenza pandemic.


    The CDC provides the following links for Community Mitigation of Pandemic Flu on their website.

    Mitigation Guide

    Community Strategy for Pandemic Influenza Mitigation (PDF - 10.3 MB)
    CDC guidelines on actions, designed primarily to reduce contact between people, that community government and health officials can take to try to limit the spread of infection should a pandemic flu develop. Appendixes 5, 6, and 7 contain information for childcare programs, elementary schools, and colleges and universities.


    Plan Now to Be Ready for the Next Flu Pandemic (PDF - 213.55 KB); (DOC - 51 KB)


    The Next Flu Pandemic: What to Expect (PDF - 226.83 KB); (DOC - 47 KB)


    While work is ongoing on both an H7N9 and a MERS vaccine, prospects for seeing either in the next year (or longer) are slim.  The reasons for this are discussed in depth in several of my earlier blogs:


    Challenges To Developing A Coronavirus Vaccine

    JAMA: Challenges Of Producing An Effective & Timely H7N9 Vaccine

    Branswell On The Challenges Of Producing An H7N9 Vaccine


    Our first line of defense against either of these viruses is not going to be a shot or a pill, but a range of steps collectively called NPIs, or Non Pharmaceutical Interventions. 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.


    NPIs are geared to the virulence and spread of the virus, and may range from simple advice to `wash your hands and cover your coughs’ to mandatory school and business closings.




    Businesses, organizations, schools, and others should be considering how they can implement NPIs like these into their daily operations, steps that can not only reduce disease transmission, but may also allow them to continue to operate during a pandemic.


    Should the novel coronavirus, H7N9, or any other novel virus threaten, we’ll be talking a lot about NPIs, and their efficacy, impact, and practicality in the blog.


    No one can predict when the next pandemic will arrive, or how bad it will be.  It may not happen for years. History only tells us that pandemics happen, and they have the potential to be very disruptive.


    We can’t prevent pandemics from happening anymore than we can stop earthquakes, floods, or tornadoes. 


    But we can prepare for these eventualities, knowing that the advantage in any emergency always goes to those who are the best prepared.