Pandemic Influenza: What YOU Need To Know

Katherine M. Williams, RNMasters of Nursing and Healthcare Practices

Affiliated with: The American Red Cross

Service Employees International Union, Local 199

What is Pandemic Influenza?

Pandemic influenza in humans occurs naturally several times a century, on average.

Pandemic flu is usually more severe than “seasonal” flu (the kind you get your annual flu shot for), with a higher death rate.

What is Pandemic Influenza?

Pandemic flu affects the entire world,

not just a country or a continent.

Where Does it Come From?

Pandemic influenza is a virus to which humans have no natural immunity.

It originates in wild birds and then jumps to other species, including pigs and humans.

“Swine flu” has bird, pig andhuman genes, a very unusual occurrence.

Recent Pandemics

1918-19 - H1N1, "Spanish flu” Severe: Humans had no immunity to any ofthe 8 gene sequences

1957-58 “Asian flu” Mild: We had immunity to 5 of 8 gene sequences

1968-69 "Hong Kong flu”Milder: We had immunity to 6 of 8 gene sequences

1997- ? H5N1, “Bird Flu”Severe: Humans have no immunity

2009 - ? A/H1N1, “Swine Flu” Moderate: We have no immunity to any of the 8 gene sequences, but have modernmedicine to help us this time.

Why Should We Be Concerned? The 1918 “Spanish flu” had a mortality rate of

approximately 3% and caused widespread social disruption.

H1N1 currently has a mortality rate of around 0.5%, or 5 times the death rate of seasonal influenza, with prompt, first-rate medical care.

It has spread rapidly around the globe.

It is a new, unstable, unpredictable virus that has the capability to mutate soon and often.

Where is it Now?

Blue: A/H1N1 Red: H5N1 Purple: Both A/H1N1 & H5N1

Current Situation Reported deaths

3,969 deaths as of Sept 17, 2009:

Brazil: 899 United States: 694 Argentina: 514 India: 220 Mexico: 217 Australia: 172 Thailand: 153 Chile: 132 Peru: 121 Great Britain: 79 Canada: 76 Malaysia: 76

Cases have been confirmed on all continents and in nearly every country.

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Deaths in the U.S.

First reported death: April, 2009

Current total: 693

Last week alone: 102

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Severity This is now considered a “moderate” pandemic by

the CDC (Category 2).

Expect at least 100,000,000 Americans to become ill at some point in the next 6-18 months.

Category 2 = between 90,000 and 450,000 deaths, mostly children and young adults.

A/H1N1 Fatalities

Average age of death: 38 years old.

Affecting children and young adults, very different from seasonal flu.

About 1/3 have NO pre-existing medical conditions.

Most on ventilators for at least 7 days.

Who’s Most at Risk?

Ages 5-50 Pre-existing conditions:

Asthma Diabetes Pregnancy Heart disease Obesity

But I’m not hearing much on the news!

Complacency and Apathy: our two worst enemies.

Media censorship: don’t want to cause “panic.”

There’s more “important” news out there!

What about that “36,000” number?

Only around 1,300 people die each year directly from seasonal influenza, according to the American Lung Assoc.

The “36,000” number is an estimated number from a 2003 study, based on pneumonia death rates.

Most at risk of death from seasonal flu: >65 or <2 years old

Under-reporting Issues:

No longer testing all suspected cases Only the severely ill and/or

hospitalized Shortage of testing kits Highly unreliable results Need specialized test for

definitive diagnosis (PCR)

What about a vaccine?

Won’t be available until at least mid-October

Just finishing first clinical trials

First to receive vaccines: Healthcare workers Pregnant women Emergency services “High risk” people

Potential Problems with a vaccine

Major questions: Safety? Number of shots needed? How well will it work? How many available? How to distribute?

80% of U.S. vaccines are made overseas.

What does this flu look like?

Fever (but up to 25% have no fever!)

Respiratory symptoms: cough, congestion,

respiratory distress

Nausea and vomiting

Body aches and pains

Severe headache & mental status changes

Conjunctivitis

What if you catch it? Most cases are “mild,” requiring no medical

intervention.

Some cases are NOT mild!

If you have increased risk factors DEMAND Tamiflu from your doctor.

Pay careful attention to disease progression – if you experience respiratory distress, high fever, gray skin, or extreme lethargy:

GO TO THE EMERGENCY ROOM ASAP!

So What Can YOU Do? Be aware of the people around you – is anyone

coughing or looking sick?

If you have increased risk factors, consider avoiding crowded areas like malls, airplanes, churches, and movie theaters.

BE AWARE: People can spread the flu for the first 24-48 hours they are infected and not show any symptoms.

So What Can YOU Do? If you feel sick, STAY HOME until you have

been symptom-free for at least 48 hours.

Relapse is common – watch for this.

PREPARE for the second wave starting now.

Prepare? For What?

Increased virulence in Second Wave?

Vaccine production and distribution issues

Tamiflu resistance?

Possible shortages of food and fuel

Combination with H5N1?

H1N1 + H5N1: The Worst Case Scenario

H5N1 (“bird flu”) has a 60% mortality rate.

If the two combine, we may have a virus that is easily transmissible and highly lethal.

The World Health Organization is VERY worried about this recombination.

Widespread civilization collapse is possible.

Mike Leavitt Former Secretary, U.S. Dept of Health and Human Services

“Local preparedness is the foundation of pandemic readiness. Any community that fails to prepare with the expectation that the federal government will, at the last moment, be able to come to the rescue will be tragically wrong.”

- Interview, March 21, 2006

Former Secretary Leavitt, again:

"Anything we say in advance of a pandemic seems alarmist. Anything you've done to prepare after it begins is inadequate."

- March 2006, California Pandemic Planning Summit

Who Should Prepare? The U.S. Department of Health and Human Services

recommends the following entities should begin preparations:

Individuals Businesses Faith-Based Organizations Schools Healthcare Agencies Non-profit agencies State and local Governments

Thoughts on Preparedness

We CANNOT depend on governmental help.

Most states and local governments are woefully behind on their pandemic preparedness plans.

Does your city have a plan?

How do these top-down plans affect you?

Individual Preparations

“You are on your own.”

What does this mean to the average family?

It means we must PREPARE.

Why Prepare?

40-50% of the workforce will be absent: Some will be sick.

Some will need to take care of

families.

Some will be afraid to come to work.

Most businesses do not have a

pandemic plan.

Why Prepare?

Medical services will be overwhelmed:

Our health care system has no real “surge capacity” to deal with a huge increase in patients.

Most hospitals do not have adequate supplies of personal protective equipment on hand to protect healthcare workers.

Why Prepare?

Basic services may be interrupted: Utility workers will be affected, too, resulting in

electricity, water and natural gas outages.

Most communities have only a week’s worth of chlorine on hand to treat water supplies.

Police and other emergency services

may be overwhelmed.

Why Prepare?

International commerce will be drastically reduced: About 80% of the raw materials for our

medications come from overseas.

Why Prepare?

“Just in time” thinking will backfire: Most businesses and services have very little

on hand for day-to-day operations.

Think of what local grocery

stores look like the day

before a blizzard is predicted.

Why Prepare?

Schools may be closed: Schools are prime

locations for disease transmission.

Other places people congregate may also close, such as malls, churches, etc.

Why Prepare?

Interstate commerce may break down: The people who deliver our

food, supplies and fuel will be

vulnerable, too.

Interstate travel may be restricted.

So Why Aren’t People Preparing?

I’m not preparing because…

I HAVEN’T HEARD OF IT

There are some folks out of touch with

world events and the news -

they don’t want to know

what’s really going on

around them.

I’m not preparing because…

I BELIEVE THE WHOLE THING IS JUST HYPE “News organizations produce

scary stories to get ratings.” “Politicians and leaders want to

cover their butts no matter how small the threat.”

“Big Pharmaceutical companies are encouraging fear to get business for their drugs.”

I’m not preparing because…

I DON’T HAVE THE FUNDS TO PREPARE

“It’s hard enough just paying the regular

bills and you want me to spend money on

something that probably won’t affect me?”

I’m not preparing because…

MAGICAL THINKING

“The threat is real but if I don’t prepare it

won’t happen. Preparation will just cause it

to happen.”

I’m not preparing because…

I’LL WAIT AND SEE WHAT HAPPENS

“Yeah, I know bad things

could happen, but there will

be plenty of time to take

steps if it gets worse.”

I’m not preparing because…

IT’S NOT HAPPENING IN MY TOWN

“Why should I be concerned

because a bunch of people

somewhere else are

getting sick?”

I’m not preparing because…

I HAVE NO FEAR

“So what if it happens,

I’ll just take my chances –

Nothing can hurt me!”

I’m not preparing because…

THERE’S NO HOPE “Preparation is an illusion.

The pandemic will last so long

and be so bad that I can’t avoid it.

Everyone will die, so I might as

well give up hope now.”

So you feel the need to start preparing…

What exactly do I need to do?

And for how long?

Take the First Steps:

Start THINKING about how you will react to a disaster – ANY disaster.

Stay INFORMED. TELL OTHERS what you know and learn.

… AND THE BIG ONE: Be ready to “make it on your own” if things

take a turn for the worse.

How Do We Prepare?

Begin to stockpile:

Food and water supplies

Medications

Alternative heating and cooking

methods

Emergency radio / communications

Alternative sanitation / hygiene

A Kernel of Truth?

Things to Consider:

Food For how long? How much per person? What to buy? How to store it?

Things to Consider:

Water How much?

How to store it?

Alternative sources?

Things to Consider:

Heating, lighting and cooking Wood Propane Solar Candles and lamps

Things to Consider:

Sanitation Sewage waste Toilet paper!

Feminine products

Garbage disposal

Things to Consider:

Medications and First Aid Talk to your doctor about prescriptions Buy a good first aid kit Basic OTC medications Take a First Aid course from your local

American Red Cross chapter Get the flu shot!

Also Consider:

Home schooling for childrenSecurityMoneyProviding for PetsEntertainment

For How Long?

U.S. Dept of Health and Human Services recommends that families have AT LEAST TWO WEEKS of supplies ready.

The U.S. State Dept. has recommended that all U.S. residents overseas stockpile up to THREE MONTHS of supplies.

THREE MONTHS?!?!?!

The best models we have indicate that pandemics will travel in waves.

Each wave may be in your community for several weeks to a month.

The waves may contain slightly different versions of the virus, so you might get it more than once.

Plan Ahead

What happens if you get sick or get stuck at work?

Who will take care of your

children?

Who will take on the role of

“nurse?” or caregiver?

Do you have family or

neighbors who need extra help?

Some good advice:

“In your pandemic flu prep plans, don’t

forget mental health. You’ll need a hefty

supply of strength, resolve and useful ways to

manage stress and maintain resilience as

much as you will need water and food.”

- excellent advice from the Fluwiki

Why I am Preparing:

“Prepare for the worst, hope for the best.”

For More Information…

U.S. Department of Health & Human Serviceswww.pandemicflu.gov

Centers for Disease Control & Prevention (CDC)

www.cdc.gov/flu/pandemic/

World Health Organization www.who.int/csr/disease/influenza/pandemic

For More Information…

The Flu Wiki: the original site for preparation and up-to-the-minute news forum.

www.fluwiki.info

Pandemic Flu Information Forum: excellent source for current news and preparation.

www.singtomeohmuse.com Get Pandemic Ready: all the basics on preparation

for families and individuals, easy to use.http://66.236.6.202/

Any Questions?

Thank you for coming!