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A Public Health Notice - H1N1 Influenza A – Swine Flu

by David Lukcso, MD 5 May 2009

Download a PDF version of this Medical Alert

"At the present time, I would still propose that a pandemic is imminent because we are seeing transmission to other countries," Dr. Michael J. Ryan, director of the World Health Organization (WHO) global alert and response team, said in a teleconference from Geneva on Sunday [May 3, 2009]. "We have to expect that Phase 6 will be reached. We have to hope that it is not."

David Lukcso, M.D., M.P.H., Chief Medical Officer of National Medical Advisory warns that influenza pandemics must be taken seriously because of their capacity to spread rapidly throughout the world. Preparation is critical: the catastrophic social and economic impacts of a pandemic are likely to exceed vastly what most individuals, corporations, and government leaders have imagined, or are prepared for.

We are writing to discuss a currently high-profile public health topic – the H1N1 Flu. As part of our continuing commitment to provide our clients with the best advice and action to ensure the health of their people and their buildings, all of us at The National Medical Advisory Services Group (The NMAS Group) have become increasingly involved in emergency preparedness.

Since this public health issue is on the national radar screen and in our current repertoire of consulting activities, we would like to share some observations. We will try not to duplicate what you have already read, but to answer questions which may be of concern to you and to offer some suggestions for potential future responses, as well as to provide links to authoritative websites where you can monitor this issue.

David Lukcso, MD, MPH, was at the American College of Occupational and Environmental Medicine (ACOEM) annual meeting last week where Swine Flu was discussed extensively. H1N1 Influenza A, a triple hybrid human/bird/pig flu virus, is believed to have originated in Veracruz, Mexico, a community where “a Smithfield subsidiary called Granjas Carrol raises 950,000 hogs per year in intensive conditions,” according to the Mexico City daily La Jornada and the Veracruz-based newspaper La Marcha. The migration from Mexico to 21 countries, with a reported 1124 confirmed cases of H1N1 flu, (as of May 5, 2009, according to WHO) has intensified the media coverage and public concern about this issue. The capability of transmission from person to person increases the likelihood of a worldwide pandemic. It is this transmission capability, along with the many uncertainties of H1N1 influenza A that has attracted the intense attention of the public health community worldwide.

Risk communication in these critical situations is crucial. For example, the WHO says it will stop using the term "swine flu," to avoid confusion over the any risk from pigs and will, instead, refer to the virus by its scientific name: "H1N1 influenza A." This is consistent with our guidance noted below regarding the development of a corporate communication strategy.

To mitigate the spread of H1N1 influenza A, some of the actions being taken are as follows:

  • Airlines have reduced or canceled service to Mexico
  • Schools “should send students home if campus has one or more cases and the shutdown should last up to 14 days," according to the Center for Disease Control (CDC)
  • A voluntary four-day home quarantine for recent travelers to Mexico
  • Federal guidance for offices and factories is "in the works," according to the CDC, but they have not said when it would be ready
  • Persons with a fever or symptoms of influenza (fever, headache, tiredness, cough, sore throat, runny nose, body aches, diarrhea, and vomiting) are encourage to stay home and avoid contact with other persons, except to seek medical care. If you leave the house to seek medical care, wear a mask or cover your coughs and sneezes with a tissue. In general you should avoid contact with other people as much as possible to keep from spreading your illness

Even absent a pandemic, simple preparedness measures are in order.

Our staff of medical doctors and public health experts recommends that you have a general prevention and preparedness plan for both home and work. Early, coordinated application of multiple interventions has been shown to be more effective in reducing transmission than the use of a single intervention.

Develop rational, comprehensive preparedness and response measures to mitigate the social and economic impact of a pandemic.

  1. Pay attention to news reports and the movement of the H1N1 Flu virus.  
  2. Minimize unnecessary travel
  3. Follow basic public health hygiene advice:
    • Practice “social distancing” at a distance of six-feet
    • Wash hands with soap and water and use hand sanitizers
    • Cover your nose and mouth with a tissue when you cough or sneeze.
    • Avoid touching your eyes, nose or mouth. Germs spread this way.
    • Try to avoid close contact with sick people.
  4. If you are sick with a flu-like illness, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. Keep away from other household members as much as possible. This is to keep you from infecting others and spreading the virus further.
  5. Follow public health advice regarding school and other public event closures.

Some guidance on pandemic preparedness items that should be considered

  • Develop a comprehensive all-hazards preparedness plan that considers the spectrum of response, recovery, restoration, and resumption activities; including pandemics,
  • Treat a pandemic as a catastrophic event, not as a “manageable disruption,”
  • Establish pandemic planning committees, supported by an actual budget;
  • Develop a human resource focused, communications strategy to keep workers informed,
  • Estimate and plan for post-pandemic changes,
  • Develop a telecommuting plan to encourage ill employees to stay home and prevent transmission of illnesses to the remainder of the workforce,
  • Acquire properly fitting N-95 filtering face piece respirators for necessary tasks, e.g., travel, care of sick family members, etc.
  • Acquire and store an adequate supply of food and water.

If you are interested in additional information, please feel free to contact us.

Our physician-led, medically-based enterprise risk management team can assist you by:

  • Managing your corporate response to serious health-related issues, such as travel to areas with elevated health risks,
  • Providing rapid investigation of suspicious outbreaks of disease,
  • Evaluating workplace exposures to potential hazards, and
  • Determining when re-entry and re-occupancy is possible in contaminated facilities.

Recommended Links to Authoritative Pandemic Web Sites

Regards,

David G. Lukcso, MD, MPH – info@nmas.com

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