Upcoming NPM Webinars:

September 23 – Social Media - What Role Does it Play in Business Preparedness and Recovery?

September 30 – Creating a Culture of Preparedness

For audio, please call 773-945-1010 access code 682-141-850 or you may listen through your computer’s speakers

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Pandemic Planning - How to Prepare Your Business for the Upcoming Flu Season

Presented by: William L. Lang, MD, MHA

“We may see lots of flu activity in September and October…On the other hand, we may not.”

CDC Briefing, August 21, 2009

“While [the current flu outbreak] is within the range of what we’re expecting, we really don’t know what the trajectory will be”

CDC Briefing, September 8, 2009

KEY UPDATES

Bottom Line Up Front

H1N1 continues to show unusual characteristics– More easily transmitted than seasonal flu– Severity variable, but generally less severe than seasonal flu

Can rarely cause serious disease/death in healthy young adults Can cause serious disease/death in typical high-risk populations

– Predominant flu in southern hemisphere (in peak flu season)– Currently, essentially all flu in northern hemisphere is Swine– Occasional reports of anti-viral resistance

Issues for Northern Hemisphere flu season– H1N1 will circulate, and will likely be predominant – No reason to expect increased virulence

…but expect high attack rate

What is the current status?

The breadth of spread is unprecedented– World-wide pandemic in only 8 weeks; previous record 6 months– Virus still circulating in US; Widespread transmission in 3 states

But, virulence remains relatively low to moderate– No genetic markers of high virulence…but viruses can mutate– Southern Hemisphere season not as bad as feared

Parallels to 1918 pandemic (50M deaths):– Began with a non-virulent flu in spring; became deadly in fall– Some evidence that both have predilection for lung– There are important distinctions:

1918 virus was Avian origin. Avian viruses generally more virulent 2009 virus is Swine origin. Swine viruses generally less virulent

Next Step: Get Ready For Flu Season

Deal directly with “pandemic fatigue” – After hype of spring outbreak, but little impact, many people

are complacent, even cynical

Watch for new media emphasis thru fall– Fairly active S. hemisphere flu season; a harbinger? – Headlines to expect:

Parallels to 1918; Vaccine difficulties; Young person deaths– Even if much is media hype, it doesn’t mean risk is negligible

Take a lessons learned approach:– Use H1N1 as a reason to update business continuity plans– Emphasize importance of:

Solid information in a crisis; not just media. Media is often hype! Having good information allows good rumor control

– Review importance of hand and respiratory hygiene!

ADDITIONAL INFORMATION

And

BACKGROUND

What is this outbreak?

Basic virus type is “H1N1”– This is a common type of flu, but immunity is based on the

individual strain variants not virus type– Since this is new strain variant, there is little natural immunity– Not all H1N1 is H1N1-Swine!

Seasonal H1N1 is different; Some seasonal H1N1 is drug resistant

Current terminology is “2009 H1N1”– Initially called “Swine Flu” but that terminology dropped

“Swine” is correct nomenclature based on virus origin, but… …incorrectly implied that swine/pork is source of infection

Cases

Case counts now of little significance More important to watch flu surveillance data

– Routine flu screening systems track: Relative rates and types of flu in screening populations Changes in virulence: Pneumonia & Flu

deaths/hospitalization

– Current surveillance data related to H1N1-swine Only flu virus currently in significant circulation in US Peak transmission in June…but increasing since mid-August; Widespread flu in 11 states; also throughout Mexico Insufficient data to be sure H1N1-swine will dominate in

fall/winter…but all signs indicate that it will

Current Flu Curve

reported to CDC this week were 2009 influenza A (H1N1) viruses.

Current Extent in US

Official Status

WHO (Pandemic Phase)– As of June 11, Phase 6: “Community-level outbreaks in at

least two WHO regions; global pandemic is under way.” – “Public Health Emergency of International Concern” (4/26)– Focus has changed from spread to severity.

Current phase system based on spread; does not address severity

U.S. Government – HHS declared “Public Health Emergency” (4/26)– CDC is not using U.S. Response Staging – This has not merited full Pandemic Plan activation.

How is this “Flu” different than Usual?

Increased attack rates – Low general immunity– High attack rate, especially high in younger people

Severity is highly variable– Usually mild flu except those with underlying chronic disease – Genetic markers not associated with high virulence – But stories of severe disease in healthy young people

This flu is sensitive to oseltamivir or zanamivir – Most recent seasonal flu was 98% resistant to oseltamivir

Needs new vaccine; Under development– Mid-October: 50M; End of Year: 200M; doses per person???– Targets: High infection risk; high severity risk

How is this flu similar to usual flu?

Transmission:– Respiratory secretions: surfaces/airborne droplets

Incubation period / Infectivity period:– Incubation average 1½ days (90% within 3 days)– People can be infectious from about 24 hours before

symptoms start and up to 7 days after onset of symptoms– Usually ok to return to work/school when afebrile > 24 hours

Symptoms– Typical flu symptoms– Effects can be much worse in those with chronic disease

Treatment– Antivirals are effective

Is this THE “Pandemic Flu” we all fear?

Contrast “Reasonable Worst Case” with “Likely Scenario”

Former always gets top billing– The US Government has an obligation to set preparations

for “reasonable worst case” (consider Katrina lessons)– CDC very clearly acknowledges that worst case is not the

“likely scenario”

Likely scenario is still “significant” flu season– Think 2004 more than 1918– But 1918 is not totally out of the realm of reason!– A “two-wave” season is possible

What should organizations do?

Begin preparations for a significant flu season– Refresh training on controlling transmission risk…it makes

sense all the time, not just when flu fear comes up! Cover mouth when coughing/sneezing Use paper tissues and throw them away when done Wash hands frequently and/or use a hand sanitizer Encourage social distancing, especially if ill. 4 to 6 feet is enough.

– Encourage culture of prevention Anyone who develops a fever or respiratory illness within 7 days after

possible exposure should stay home. – Usually no need to seek medical care – those at high risk need early care– Don’t go to a clinic/hospital without contacting the facility first

Consider personnel policies that balance productivity with prevention

– For international travelers – don’t forget malaria!

Should we change travel/meeting plans?

Emphasize basic infection control– Use hand sanitizers frequently; provide for meetings– Avoid shared magazines / blankets / pillows / etc.– Don’t travel if you have respiratory illness symptoms

International travel– All international travelers should consider carrying single

stand-by treatment course of antiviral– Many nations are screening travelers to/from affected

countries; some screening all travelers – Some nations isolating /quarantining those with fever or

exposure risks– Some airlines refusing to accept travelers with fever or other

obvious symptoms without a medical clearance

Operations Considerations:

For all organizations:– Review and update pandemic plan

Do not base actions solely on WHO Phases Base actions on severity of disease and local factors

– Consider an organizational anti-viral plan Must consider supply, storage, distribution, administration Establish decision-process for who/when to use anti-virals Confirm availability/security of pre-arranged anti-virals Expect expiration date extensions

– Use event as a “teaching opportunity” Review respiratory/hand-hygiene for all personnel Breadth of spread means all locations at some risk

Operations Considerations:

For sites not in proximity to known cases:– No change in operations

– Management should choose a trusted source of information and continue to monitor closely

– Begin preparing employees for upcoming flu season; combat “Pandemic Fatigue”

– Ensure travelers are briefed on precautions to minimize risk of bringing disease “home”

Operations Considerations:

Sites in proximity to known cases– No change in operations– Minimize gatherings in close conditions

Social distancing - 1 to 2 meters (4 to 6 feet)

– Have plans for handling ill employees: Establish policy that employees should not to come to work

with fever and respiratory symptoms Practice very careful hygiene / social distancing if exposed

to someone with a respiratory illness at home Institute specific plans for handling personnel developing

symptoms while at work Follow local public health guidelines, including having plans

to screen employees if directed by local public health

Operations Considerations

Consider “worst case” scenario– Duties, obligations, and fiduciary responsibilities– What operations are “essential”– What resources are “essential” to operations

People Logistics and materials Utilities and communications

– Strategies for mitigating personnel impacts Examples: Telework or shiftwork

– Enhances social distancing– Decreases exposure via public transit

Key Points

We don’t know how bad this will be– Don’t listen to the hype and don’t react to every horror story– …but don’t ignore the possibilities

Combat Pandemic Fatigue thru preparedness– Good pandemic preparedness is good general preparedness

Good information is key– Trusted sources– Trusted and targeted analysis

Questions?

• If you have accessed audio through your computer speakers, enter your question in the Q&A pane on the right side of your screen. Hit submit to send.

• If you have accessed via telephone, you may submit your question online or raise your hand in the small tab on the right side of your screen, to ask your question live.

Reference Slides

Utility of Screening Tests

Screening only needed for hospitalized patients with influenza-like illnesses

Most screens are A+B tests– If positive, treat with antivirals;

Send sample to State lab unless H1N1 already known predominate in locality

– Rapid tests sensitivity 50-70%; negative test cannot rule out H1N1 Treatment decision based on local epidemiology and patient’s contacts

– If Screen can separately identify flu type B (not common): Positive B and negative A rules out current swine flu strain Positive A must be handled as above

Many governmental reference (e.g., state, national) labs now have diagnostic capability

Vaccine Issues

Little antigenic cross-protection from current flu vaccine Seasonal flu vaccine will not prevent H1N1-2009 Being vaccinated, however, can help rule out seasonal flu if ill Season flu still a risk, especially later on, so still need regular vaccine

H1N1 vaccine production underway Initial low vaccine yields but better with new strains Still waiting on final clinical studies to determine doses/dosages

– Early indications: One dase,15 micrograms is effective*– Expect add’l info late September and decision in early/mid October*– Initial clinical studies have shown “no red flags”

No licensed adjuvant in US; adjuvant would require EUA and add one month to the availability projections; trials are ongoing*

Domestic production typically 20% of need but increased this year*

– Early June: Novartis announced a H1N1 cell-based vaccine Unclear what production capacity will be; using “Optaflu” platform

Additional epidemiology information

Only 5% of cases older than 51 years of age– Cross-reactive antibody to H1N1 flu (swine flu) detected in

6-9% of adults aged 18-64 years and in 33% of those aged > 60 years

Study of California cases requiring hospital care:

– 2/3 have underlying risk factor– 2/3 had positive rapid antigen flu tests

Consistent with seasonal flu 50-70% sensitivity of rapid tests

– Median hospital stay 4 days– No cases of secondary bacterial infection– 27% had received seasonal flu vaccine

Anti-viral Resistance*

Small number of oseltamivir-resistant isolates– 21 as of September 10

14 of 21 cases given oseltamivir for prophylaxis 4 of 21 were in immunocompromised patients.

No secondary transmission has been confirmed to have occurred from these patients

Mutations do not appear due to drug pressure. Guidelines on fewer indications for prophylactic

use of oseltamivir may be coming. These cases have no implications for treatment

of H1N1-2009 cases

Agility Recovery Solutions

BUSINESS AS USUAL.

NO MATTER WHAT.

• Every Business Should Be Prepared

• 10 Steps to Prepare Your Business for a Pandemic

• Overview of Agility’s Recovery Solution

Presented by: Bob Boyd, CEO

Why Should You Have A Pandemic Plan?

  

Reputation – impacts customers and vendors

Revenue – losses and costs of an outage

Responsibility – to customers, shareholders, employees & community

Requirement – some audits require a plan

Regulation – some regulation requires a pandemic plan

Steps to Prepare for a Pandemic

1. Maintain a healthy work environment.

2. Be informed.

3. Communicate openly and proactively with employees.

4. Identify a pandemic team.

5. Identify essential job functions.

6. Cross-train employees.

7. Prepare for telecommuting needs.

8. Diversify your supply chain.

9. Update sick, family and medical leave policies.

10. Prepare financially.

Business Continuity Is About The Future.

BUSINESS AS USUAL.

NO MATTER WHAT.

The future of your family.The future of your business.The future of your community.

Agility Has A Simple Vision:

We imagine a day when every business will rest easier knowing its future is moresecure.

IMAGINE.

ReadySuite: A Simple Solution For A Complex World.

In exchange for a small monthly fee, you can have access to all of our knowledge, expertise and resources.

Our Promise: If you have a disaster, we’ll rescue your business. We will deliver any or all of the four key elements of recovery:

Power.Technology.Space.Connectivity.PASSION.

We have a passion for delivering hope in the face of overwhelming odds.

POWER

Statistics show that 70 percent of businesses will experience a power outage within the next 12 months.

With a ReadySuite membership, you won’t be powerless for long.

We have established priority relationships with generator providers throughout North America that enable us to get you up and running quickly.Emergency power generators

stationed across North America.

SPACE

We recognize that your business is rooted in a community, your community, where you live and work.

Our space options include the required office furniture for your employees to get back to work in a comfortable, functioning office space.

Agility is recognized as the premier provider of on-site mobile recovery, yet we provide our members with numerous space options, allowing you to recover where you need to be.

* - Agility leads the industry and can respond to regional disasters with greater inventory and resources then anyone in the industry.Source: Forrester Wave Vendor Summary 3/27/06

TECHNOLOGY

Access to information is the backbone of every industry.

ReadySuite membership provides you with replacement PCs, servers, networking equipment, printers, phones and fax machines delivered onsite

Our equipment is maintained in a state of permanent readiness in distribution centers across North America.

CONNECTIVITY

In today’s virtual society, connectivity is critical.

ReadySuite membership provides both telephone and Internet access via satellite connections, enabling your communication virtually anywhere.

To ensure communication regardless of local infrastructure, Agility has access to dedicated bandwidth on multiple communication satellites.

BELIEVE.We believe every business should have access to continuity services.

Our ReadySuite membership solution addresses the typical high-cost, high-frustration factor associated with business continuity planning.

Immediate Protection.The day you become a member, your business is covered.

Customized Recovery Plan.Access and edit your plan anytime on MyAgility, our online planning resource.

24-Hour Hotline.Our recovery specialists are available whenever you need Agility.

Simple and Easy To Use.

MyAgility

24/7 online access to your customized recovery plan.

Recent site refresh provides quick access to popular tools and resources.

Store critical documents.

Develop contact databases for easy communication via the Alert Notification System.

Maintain fixed-asset inventory database.

QUESTIONS?

866.364.9696Bob.Boyd@AgilityRecovery.com

• Type question in the question pane on the right side of your screen and then hit submit to send.

• If you have accessed via telephone, you may raise your hand in the small tab on the right side of your screen, to ask your question live.

REGISTER TODAY at www.agilityrecovery.com

Upcoming NPM Webinars:

September 23 – Social Media - What Role Does it Play in Business Preparedness and Recovery?; John P. Shea, Public Information Officer, FEMA

September 30 – Creating a Culture of Preparedness; R. David Paulison, Former Administrator of FEMA