Pandemic Planning — An H1N1 Update

July 04, 2011

Joe Ozorio, CBCP
Assistant Vice-President
Marsh Risk Consulting

Just 6 short months ago there was discussion about the possibility of an influenza pandemic occurring and that it was a matter of when, not if. As we all know, we are now steeped in the midst of global pandemic, and the only thing that’s different from what was last written, is the type of influenza — not avian as originally feared, but swine flu, or as it’s now properly known: Influenza Type A H1N1.

On June 11, 2009 the World Health Organization’s Dr. Margaret Chan, stating that “…the scientific criteria for an influenza pandemic have been met.”, officially raised the pandemic alert level from Phase 5 to Phase 6 (see previous article for the WHO phases and their descriptions). The world was at the start of a full influenza pandemic. Since then we’ve seen the number of cases rise dramatically all over the globe. As of the last available official update — July 6, 2009 — WHO reported over 94,000 confirmed cumulative cases of H1N1 and 429 deaths worldwide. However since then, they’ve stopped reporting the cumulative numbers. Public Health Agency of Canada has also stopped reporting cumulative cases and now reports only deaths.

Why? It was pointless for several reasons:
Further spread of the pandemic, within affected countries and to new countries, was considered inevitable

• The 2009 influenza pandemic is spreading internationally with unprecedented speed. In past pandemics, influenza viruses have needed more than six months to spread as widely as the new H1N1 virus had spread in less than six weeks
• The increasing number of cases in many countries with sustained community (human to human) transmission made it extremely difficult, if not altogether impossible, for countries to try and confirm them through laboratory testing
• The counting of individual cases was considered no longer essential in many countries for monitoring either the level or nature of the risk posed by the pandemic virus or for the implementation of the most appropriate response measuresAre we over the worst now that it’s summer?
  In the vast majority of cases, the virus appears to be mild in impact to victims, most of who recover without incident and without the need for hospitalization. Does this mean we can rest easy? Absolutely not! There is still cause for much concern. There are patterns of cluster cases where severity of the disease is great. Doctors and researchers do not yet understand why the disease severely impacts some and not the rest. Additionally, the current H1N1 situation has some disturbing similarities to the 1918 Spanish Influenza Pandemic (which caused an estimated 50 to 100 million deaths worldwide):
  • The initial outbreak was a relatively small surge starting in the spring, reducing its spread in the northern hemisphere throughout the summer months, and with a relatively mild severity
  • The virus spread rampantly through the southern hemisphere during its winter months (June to September). We see evidence of such a spread in Chile, Argentina and Australia.
  • Unlike seasonal flu which has severe impacts on very young children and the elderly, the Spanish Flu heavily affected healthy young adults. Again, we see evidence of this occurring with H1N1. The WHO has expressed concern about current patterns of serious cases and deaths that are occurring primarily among young persons, including the previously healthy and those with pre-existing medical conditions or pregnancy.

In 1918, during the fall season in the northern hemisphere, the Spanish Flu spread with far greater severity. Health officials are concerned that H1N1 will perform in a similar manner in our upcoming fall flu season. All indications are that the worst is yet to come.

What risk are we at of contracting the disease?

The Influenza Type A H1N1 influenza virus is classified as a “novel strain.” In a nutshell this means nobody, who has not yet contracted the disease (i.e. the vast majority of the world), is immune. Because we haven’t seen this particular strain before, our current seasonal flu vaccines are not effective against it.

Types of medications to combat H1N1

There are two kinds of medication that can help fight influenza and it’s important to know the differences.

Vaccines: A vaccine is a whole or part of a virus, which when injected, creates an immune system response that protects against infection. The challenge is that when a novel strain of a virus like the current H1N1, comes about, it takes months to develop and then manufacture enough vaccine to inoculate the majority of the population. We are still a few months away from having the H1N1 vaccine available for the general public. Early available doses will likely go first to emergency front line workers (doctors, nurses, paramedics, hospital staff, clinic workers, etc.). We cannot count on having an H1N1 vaccine available for the majority of people until probably late 2009.

Antivirals: Antiviral drugs may reduce the symptoms and duration of virus, just as they do for seasonal influenza, but they don’t prevent it. They may however, contribute to preventing severe disease impact and death. The types of antiviral drugs that are showing effectiveness against H1N1 are inhibitors of neuraminidase (the “N” in H1N1), such as oseltamivir (better known as Tamiflu) and zanamivir (Relenza).

There are several considerations to bear in mind with antiviral drugs:

• To be effective, antivirals have to be given very quickly after symptoms start.
• It would not be possible to give everybody antiviral drugs, and some will not need them (Canada has stockpiled antiviral drugs for treatment purposes only, not prevention).
• Given the current challenges in diagnosing H1N1 due to its spread, it is also difficult to identify those groups of people who will develop more serious illness and who need antivirals the most.
• The pandemic influenza virus may develop resistance to the antiviral drugs, although there are only very rare and isolated cases of resistance around the world so far.

A state of readiness

Given all of the above, we all need to do what we can to prepare for this very real threat to our businesses and our personal lives. Heed the instructions you’re hearing on radio, TV and poster ads about practicing good hygiene (wash hands frequently; use a hand sanitizer if hand washing is not available; cough into your sleeve not your hand; if sick, stay at home) — this is all very good advice! One of the most effective methods in 1918 of combating the spread of the Spanish Flu was simple hand washing.

From a business perspective, you should be fully engaged in planning and implementing the elements we spoke of in the last newsletter (developing corporate policies, assumptions, monitoring and sources of data, quality decision making, comprehensive communications, response plans). If you’ve already developed your plans, review them thoroughly using the current H1N1 state as an exercise opportunity and update them accordingly. For example, one important thing we’ve learned since the outbreak of H1N1 is that simply tying into the WHO phases is not enough in gauging impact to our businesses and workforce or developing effective triggers for our response plans. We also have to consider such things as:

• What’s the current rate of absenteeism?
• What is the situation in each location where our business is?
• What is the local ministry of health or public chief medical officer’s current directives?
• What is the local public transportation situation?

So if you haven’t started your planning, start now!

The bottom line is to take this threat and risk very seriously. Do not leave it to chance or to fate, because as Louis Pasteur once said:
“Fate favours the prepared…”

Article printed with permission. Joe Ozorio is an Assistant Vice-President in the Business Continuity Practice for Marsh Risk Consulting. He can be reached at 416-868-2930 or joe.ozorio@marsh.com.