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H1N1

Preparing for the Flu Season

Elisabeth WhitneyProgram CoordinatorSan Francisco CARD

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1.We’re not sure how severe this flu season will be• Mild – 1957 Type of Pandemic• Severe – 1918 Spanish Flu

2.There are no guaranteed medical means to avoid the virus• Vaccines will be available this fall / winter

• For both seasonal flu and H1N1• Antivirals are options for treatment

3. What is H1N1 or Swine Flu?

1.We’re not sure how severe this flu season will be• Mild – 1957 Type of Pandemic• Severe – 1918 Spanish Flu

2.There are no guaranteed medical means to avoid the virus• Vaccines will be available this fall / winter

• For both seasonal flu and H1N1• Antivirals are options for treatment

3. What is H1N1 or Swine Flu?

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Influenza – A Little FYI•Influenza is a highly contagious respiratory disease spread by tiny, wet droplets produced when a person

•Coughs, sneezes or talks•Touching your face •Poor Cough Hygiene Swine Flu or

•When are we contagious? H1N1

•Every year 10 – 20% of the world’s population gets influenza causing associated deaths of from 500,000 – 1 million deaths•In Epidemic years 25% of the population get it•In the U.S, annual seasonal flu results in approx. 36,000 deaths and 114,000 hospitalizations•Some 90% of people who die during a regular flu season are over 65 years old. By contrast, Swine flu (H1N1) disproportionally affects younger people

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Influenza – A Little FYI

• Who is more likely to get very sick with the flu?– People with lung disease like asthma

– People with other medical conditions like diabetes, heart disease, kidney or liver disease, blood cell disease including sickle cell, or neurological disease that affects swallowing or breathing

– Pregnant women and women who have given birth within 2 weeks

– Children age 2 years and under

– Adults age 65 years and over

– People with weak immune systems (due to disease or medicines)

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Underlying Conditions

Pandemic Hospitalizations Reported to CDC Underlying Conditions as of June 19, 2009

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Influenza – A Little FYI

• Is it a cold or the flu?Symptom Flu Cold

Fever Usually 102 degrees F, but can go up to 104 degrees F and usually lasts 3 to 4 days.

Rare in adults and older children, but can be as high as 102 degrees F in infants and small children.

Headache Sudden onset and can be severe Rare

Muscle Aches Usually, and often severe None or mild

Tiredness and Weakness Can last 2 or more weeks Mild

Extreme Exhaustion Sudden onset and can be severe Never

Runny Nose Sometimes Often

Sneezing Sometimes Often

Sore Throat Sometimes Often

Cough Usually, and can become severe Mild to moderate

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Clinical Characteristics

Epidemiological/Surveillance Pandemic H1N1 Hospitalizations Reported to CDC as of June 19, 2009

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Course of Influenza in Adults

0 1 2 3 4 5 6 7 8 9

Day 0 Become infectedDay 1 – 4 Disease Incubation (average 2 days)Day 1 – 6 Contagious (one day before symptoms

to 5 days after symptom onset)Day 2 – 9 Symptomatic (usually 2 – 5 days)Day 4 to ? Decreased energy (one week or more)

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Percent of Visits for Influenza-like Illness

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Influenza – Statistics

Data by Epidemiologic Week 43:

United States

New cases 6834

Total cases 57,602

Deaths 1123

California cases ~5000

Source: http://new.paho.org/hg/images/atlas/en/atlas.html

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Current Conditions

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Novel H1N1 Confirmed & Probable Case Rate in the U.S.

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Novel H1N1 U.S. Hospitalization Rate per 100,000 Population by Age

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CDC Summary•Uncertain how serious or severe H1N1 will be in terms of:

•How many infected people will develop serious complications or die•How the virus may affect the U.S. during the flu season in fall and winter

•Because this is a new virus (for the given population), there will be little or no immunity, resulting in more severe and widespread illness•Vaccines will be available, but may be in limited supply•With this new virus, CDC speculates:

•More cases•More hospitalizations•More deaths

for this season . . .

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Most Recent Guidance

•H1N1 Vaccine will not protect against seasonal flu

•The FDA has approved the use of one dose of H1N1 (swine) flu vaccine for persons age 10 years and older

•Children 6 months old to 10 years need two doses separated by 3-4 weeks, and it is best to use the same type of vaccine for the first and second dose.

•You may get seasonal and H1N1 vaccinations at the same time.

•If your child got a dose of the recalled vaccine (ages: 6 months to 35 months), you do not need to revaccinate them.

•It was recalled for potency not safety reasons!

•H1N1 vaccines are being made available to all persons over 3 at the DPH Travel Clinic (101 Grove Street) by appointment. Call (415) 554-2625 and press 5 to make an appointment.

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H1N1 Vaccination Priorities:

•Pregnant women•Caregivers for children younger than 6 months•Healthcare and EMS personnel•People ages 6 months – 24 years•People with underlying medical conditions associated with higher-risk of complications associated with flu (ages 25 – 64 years)

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Global doses to be manufactured and distributed ~ 3 billion.

2009 H1N1 Influenza Vaccine Supply StatusNovember 6, 2009, 1:30 PM ET

Doses Allocated as of 11/05/09 35,618,800Doses allocated to project areas for ordering are those that are at the distribution depots and ready for project areas to order.Vaccine is allocated to each project area in proportion to its population (pro rata). Doses Ordered as of 11/04/09 28,036,300Doses Shipped as of 11/04/09 26,248,100There is a lag time between allocation, ordering, and shipment of doses as project areas place orders and those orders are processed and shipped.Vaccine Shipment Status by Project AreaProject Areas Total Doses Shipped as of 11/04/09California 2,953,000

Source: http://www.cdc.gov/h1n1flu/vaccination/vaccinesupply.htm

Latest on Vaccines

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Vaccines

• Types of influenza vaccines available this flu season

• LAIV• Inactivated shot• H1N1 LAIV and seasonal LAIV should not

be given together • 2009 H1N1 LAIV may be given at the

same time as most other vaccines• people who are allergic to eggs should not

get the vaccine

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Flu Antiviral Drugs

• There are two commonly used antivirals in the US

1. Tamiflu ® (oseltamivir)

Do not confuse with Theraflu ® an over the counter cold medication. It is not an antiviral medication!

2. Relenza ® (zanamivir)• Can children take antiviral drugs?

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10 Lessons from the Frontlines1. Investments in pandemic planning and stockpiling

antiviral medications paid off

2. Public health departments did not have enough resources to carry out plans

3. Response plans must be adaptable and science-driven

4. Providing clear, straightforward information to the public was essential for allaying fears and building trust

5. School closings have major ramifications for students, parents and employers

Trust for America’s Health, June 5 2009

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10 Lessons from the Frontlines6. Sick leave and policies for limiting mass gatherings

were problematic

7. Even with a mild outbreak, the health care delivery system was overwhelmed

8. Communication between the public health system and health providers was not well coordinated

9. WHO pandemic alert phases caused confusion

10. International coordination was more complicated than expected

Trust for America’s Health, June 5 2009

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So, What Might be Next?•H1N1 Could disappear (unlikely)•H1N1 didn’t cause worst case scenarios in So. Hemisphere•H1N1 Could:

•Be our next pandemic (it already is)•Continue to be mild-to-moderate (1957 or ’68-like)•Increase virility to 1918 pandemic levels

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What Does That Mean to You?

• For a bad flu season (1957 or ‘68-like)– Many sick employees, volunteers and clients

• From 25 – 40%

– Higher levels of absenteeism• Comes in waves

– Possibility of some deaths in the ‘family’– Adverse impact on your organizations’

operations

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Action Agenda

• Prepare your organization– COOP works, once sick it is too late

• Identify your mission critical functions– Those operations that must continue – without

them your organization will not function• It can be integral to a device or system that makes

that function possible

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Questions to ask:

• How is demand for your product or service likely to be affected during and between each pandemic wave?

• What are your requirements and commitments with suppliers and customers? How might these be affected when the pandemic is at its peak?

• What circumstances could precipitate a shutdown of your workplace?

• What trigger will you use to re-open the workplace?• Are alternative work arrangements available for

employees who are not ill but still able to come in?• How will you communicate with your employees at

different points in the pandemic wave? What message will you broadcast?

Source: http://www.ems-solutionsinc.com/pdfs/Lessons-from-H1N1-FirstWave.pdf

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Considerations for Human Resources

• Review and update sick leave policies– Flu absences may be a long-term issue– Staff may be absent due to:

• Family members that are sick• Schools and childcare facilities closed

• Most important consideration– Please stress “don’t come to work sick!”

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Guidelines for Managers: Communicating with Staff about Influenza A (H1N1)

1. Consider including medical staff, counselors, and peer helpers in group meetings on the topic, to respond to questions about health risks and protection.

2. It is important for staff and families to be given facts about the situation and have their immediate concerns addressed in order to dispel rumors.

3. Note that action is an antidote for feelings of helplessness.

4. Regular briefings in all offices are essential to contain staff anxiety as well as rumor circulation. Efforts should be made to keep the discussion supportive and do not attempt to deny or minimize the potential impact on staff.

5. Also, pay attention to what is unspoken and to staff who may be withdrawn.

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Is Working Off-Site Realistic?

• Needs a robust work-from-home program

• High Speed Internet

• Organization provides equipment

• Work from home at least once a month– Confirms that person can

work from home

• Alternate plans if working remotely fails

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• Volunteer Management– How do we make it safe for our volunteers to

continue helping?

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Summary of Education

• Influenza basics

• Workplace strategies & cleaning

• Hand washing techniques

• Cover your cough campaign

• Polite social distancing

• Stay home if sick policy

• Virtual meeting strategies

• Strategies to minimize face to face contact with clients

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Education Con’t.

Hand Maintenance•Hand-washing is most effective •Hand Sanitizers

•Nearly as effective as hand-washing but not quite. However, it is a good alternative

•Must be at least 60% alcohol

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Organization Education Campaign

•Potty Posters•Desk and wall postings•Staff briefings

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Social Distancing

•Develop guidelines for social distancing

•Floor plans for spreading staff out at least six feet from each other•Investigate shift work and weekend work•Avoid shared equipment

•Clean often if you must share

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Impact of Social Distancing

1. Delay outbreak peak

2. Decompress peak burden on hospitals and infrastructure

3. Diminish overall cases and health impacts

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Cleaning

•Use disinfectants that match the surface needs

•Virus Survival•Virus lives on hard non-porous surfaces > 24 hours•On porous surfaces 24 – 48 hours•Swiss banknotes up to 17 days!

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Cleaning•High touch Areas and Surfaces require increased frequent and more intense cleaning

•Doorbells•Intercoms•Handrails•Door handles•Elevator buttons•Steering wheels•Common controls (levers, buttons)

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Cleaning – Infection Control at Work

•Top four germy office work areas

•Telephone•Keyboard/mouse•Desk surface•Doorknob

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PPE – Personal Protective Equipment

•Should you wear PPE?

•When & Why

•Masks•N95•Surgical masks

•Gloves•Latex•Nitrile

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PPE Recommendations

•Surgical masks for most organizations

•N95 masks for most health care providers

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It’s Time to Prepare!

•Evaluate your preparedness•HR Dept should create or evaluate plans•Adapt to different issues and situations•Communicate effectively (to staff, volunteers and clients)

•Keep Informed•No one knows what will happen•Different recommendations will surface and conflicting information may go viral

•Follow your local Dept. of Public Health Guidance

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Keep Current• 211 – good source of information and it is in multiple languages

http://www.211.org/

• For the most current local information:http://www.sfcdcp.org/flu

• For email answers to your specific questions:http://www.Fluinfo.dph@sfdph.org

• For questions: 415-554-2905

• California Department of Public Health (CDPH) H1N1 Flu Hotline: 1-888-865-0564

• The Centers for Disease Control (CDC) website:http://www.cdc.gov/swineflu/

• World Health Organization (WHO) website:http://www.WHO.int/csr/disease/swineflu/en/

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Questions?

However, I stress again, that any specific medical or legal questions are best answered by the appropriate specialist.

Thank you!