Friday, September 20, 2019

#NatlPrep: Personal Pandemic Preparedness

Credit CDC

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.


A couple of days ago, in WHO/World Bank GPMB Pandemic Report : `A World At Risk', we looked at a readiness assessment that found the world still woefully unprepared to deal with a severe `1918-like' pandemic.

A snippet from the GPMB press release:
The report highlights that an outbreak equivalent to the 1918 influenza pandemic could kill an estimated 50 to 80 million people, spreading around the world in less than 36 hours and wiping out nearly five percent of the global economy. In the case of a pandemic, many national health systems would collapse, with low-resourced communities hit the hardest
Somehow this was mangled by a number of headline writers to read `80 million deaths in the 1st 36 hours' but even if it took weeks or months, the toll would be horrific. And of course, there is no guarantee that the next pandemic won't be worse than 1918. 
Last year Johns Hopkins presented a day-long pandemic table top exercise (see CLADE X: Archived Video & Recap), which envisioned an even greater death rate; 150 million or more. 
If you don't have the time to watch the (highly recommended) entire 8 hour exercise, I would urge you to at least view the 5 minute wrap up video. It will give you some idea of the possible impact of a severe - but not necessarily`worst case' - pandemic.

Recap Video

While we can debate the possible scenarios, what is almost certain is most individuals, communities, organizations, businesses, and governments (state, local, & Federal) are going to be caught flat-footed when the next pandemic arrives. 
Even if we discount a rapidly spreading `blitz-flu' , and assume it will take a few weeks for a novel flu to spread globally, it will still likely be  months before the first vaccines roll out.
And even then, vaccines will probably only be available in limited quantities (see CDC: 2018 Interim Guidance On Allocating & Targeting Pandemic Influenza Vaccine). Unless you are deemed an `essential worker', you may not be offered a vaccine for at least six months.  Maybe longer.
While I'm sure there are some survivalists who plan to head to their bunker for the duration - for the vast majority of us -  we are all going to have to figure out how we can live and work during a pandemic.  
The good news is, during the 1918 pandemic the vast majority of those infected recovered.  In the United States, about 98%. In places like India, and Asia, the death toll was far higher. 
And absent a vaccine, most of us are probably going to be exposed, and likely infected, by a novel flu. The goal is not so much to prevent infection, but to slow the spread through non-pharmaceutical interventions (see Community Pandemic Mitigation's Primary Goal : Flattening The Curve).

Even though the number of infections and deaths would likely be the same, a sharp, steep epi curve (shaded purple above) would be far worse for society than a longer, albeit less intense pandemic wave (grey hatched).
Our hospitals are more likely to be able to cope with 100,000 flu cases a week, than with a million.  Our infrastructure is more likely to remain operating with 10% of the workforce out sick (or caring for loved ones) than with 50%. 
While most people will fear the virus, a bigger threat could come if the medical system collapses under the weight of pandemic patients. A pandemic virus that directly claimed 2% of the population could kill several times more from collateral damage.

In 2018's Supply Chain Of Fools (Revisited), we looked at some of the ways that a severe pandemic could causes shortages in everything from essential medications, to surgical masks & N95s, to IV solutions and medical oxygen.
The US government does maintain a strategic national stockpile of PPEs, and many essential meds, including antivirals and antibiotics, but those supplies are finite, and might only last a few weeks in a severe pandemic (see Webinar: The Strategic National Stockpile).
For simplicity's sake, I've dealt only with the medical supply chain thus far, we could see similar shortages across a wide spectrum of goods and services; everything from food deliveries to local markets, to delivery of public utilities (water & electricity), to replacement parts for your car or computer.
In 2005 Dr. Michael Osterholm, director of CIDRAP, likened a severe pandemic to an 18-month global blizzard, where nearly everything is shut down. Many will be without a paycheck, either due to their refusal to work and risk exposure, or because their jobs are simply no longer available (see Baby, it's Cold Outside).
More recently, in his 2017 book Deadliest Enemy (see my Review: Deadliest Enemy: Our War Against Killer Germs), Dr. Osterholm revisited the idea of our JIT (just in time) economy, and wrote:
Ironically, the ways we have organized the modern world for efficiency, economic development, and for enhanced lifestyle -- the largely successful attempts to transform the planet into a global village -- have made us more susceptible to the effects of infectious disease than we were in 1918.  
And the more sophisticated, complex, and technologically integrated the world becomes, the more vulnerable we will be to one disastrous element devastating the entire system.

The $64 question then is; How then, do we cope with a severe pandemic?

While you and I can't do much about the readiness of our local, state, or federal government - much less that of other countries - we can take steps to prepare our homes, our businesses and our communities. 
The CDC,, and all have advice for what people should do before, and during, a pandemic. 
And if - as this week's WHO report suggests - the next pandemic could spread globally in a matter of days, you might want to address any preparedness deficits before a threat looms large.

This  advice from
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.
The last item is one we've discussed often (see Yes, We Have No Pandemic . . . But Line Up A Flu Buddy Anyway). I first fleshed out the idea in a 2008 blog called Lifelines In A Pandemic.
A `Flu Buddy’ is simply someone you can call if you get sick, who will then check on you every day (by phone, social media, or in person), make sure you have the food and medicines you need (including fetching prescriptions if appropriate), help care for you if needed, and who can call for medical help if your condition deteriorates.
Those people who care for others, like single parents, also need to consider who will take care of their dependents if they are sick.
In 2017, the CDC released a 16-page Household Pandemic Planning guide, which emphasizes the use of NPIs - or Non-Pharmaceutical Interventions - during a pandemic.
Get Your Household Ready for Pandemic Flu [PDF – 16 pages]
The CDC’s Nonpharmaceutical Interventions (NPIs) web page 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.
Measures like social distancing, hand hygiene, staying home when sick, avoiding crowds, wearing a mask if you are sick, even the closure of schools or other public venues are all potential NPIs.
Additionally, the CDC has prepared guidance for a number of other venues:
The good news is, much of what you need to do now to prepare for a pandemic would hold you in good stead for any prolonged emergency or disaster.  

While no obvious pandemic virus threatens us today, we need to be using this time wisely.   The following quote is more than a dozen years old, but it is just as true today as it was in 2006:
“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