Ten Things I Think I Think about H1N1

I haven’t posted on H1N1 in a bit; honestly, I haven’t known what to think.  So, in homage to Peter King, here’s ten things I think I think about H1N1 today:

1.  Still, don’t panic.  Be Living Prepared for H1N1.  Read on.

2. Veratect on 5/15/09 announced the end of a valuable public service:

Due to the transition of surveillance and reporting on influenza A (H1N1) towards routine seasonal influenza tracking, Veratect will cease providing Twitter posts for this event as of 8:00p EST, May 15, 2009.

This is a shame.  I’m not certain that we have reached the end of this outbreak; nor whether routine seasonal influenza surveillance is sufficient, but I do understand that this was costing Veratect quite a bit to stand up two command centers and provide 24×7 coverage.

Also, note that a record blog posting by InSTEDD refers to this outbreak as the “Influenza A (H1N1) Media Hype”

3.  I’ve aggregated those official twitter feeds on H1N1 that I find most useful into my own H1N1 feed, @LP_H1N1.  This pulls from the @whonews, three CDC feeds, @birdflugov, and I think @healthmap.  I’ll add others if the situation warrants it, but for now, I think it’s good.  You can follow @LP_H1N1 directly or you’ll find the feed running in the column on the left or subscribe to the RSS for that feed directly.

4.  There are now 12 fatalities in the US out of 6500+ cases.  That’s a mortality rate of about .18%, really nothing to worry about.  The mortality rate of the cases in Mexico, where this virus originated, is about 1.9%, which would be something to worry about if the virus continued to spread exponentially throughout the world’s population.  However, according to the latest WHO figures, the global mortality rate (outside of Mexico) is about .17%.

Now, I am not an epidemiologist, but to me this suggests that as the H1N1 virus has spread, it has become less lethal as it has mutated.

5.  I’ve been trying to determine whether the spread of H1N1 infection is growing exponentially or linearly.  Obviously, if exponential, the infection rate is high enough to warrant concern.   And it appears that with the best public health infrastructure in the world, the growth of H1N1 in the US continues to be exponential while in the rest of the world, not so much – especially in Mexico, where this strain all started and has clearly now leveled off.  There’s a number of charts out there that show this.  Here is one.

6.  In doing this research, I came across a disturbing blog posting that, because I am unsure of the source’s credentials, I will not cite here.  However, the math is somewhat frightening. Based on confirmed data (cases and deaths) through early May, a mortality rate of close to 3% was being measured.  With an infection rate of 1.47% (again, measured average based on confirmed data), the spread of H1N1 and resulting deaths would look like this:

  • By 5/22/09 – almost 1 million infected globally; # of deaths assuming 3% mortality rate = 28,000; assuming .5% = 4,700
  • By 5/29/09 – 13 million infected, 250K+ dead at 3% mortality rate; 66K dead at .5% mortality rate
  • By 6/13/09 – over 3.8 billion infected, 116 million dead at 3% mortality rate; and almost 20 million dead at .5% mortality rate

However, according to the latest WHO figures, as of 5/25/09, there are only 12,515 cases globally with 91 deaths (and 80 of those in Mexico).

So, obviously, this scenario is not coming to pass, as clearly the calculated infection rate is not what we are observing.  And note that the .5% mortality rate I believe is the figure from the 1918 Spanish flu.  The .17% mortality rate measured globally (excluding the Mexican figures) is about the same as seasonal influenza; from that perspective, maybe Veratect was justified.

But essentially, what this means is, don’t panic.

7.  I am highly satisfied (make that thrilled) with the President’s choice of NYC Health Commissioner Thomas Friedan to head the CDC.  Dr. Friedan has done a great job at leading the City’s Department of Health and Mental Hygiene, overseeing the largest and best public health infrastructure of any City in the world.  I had the opportunity to consult with their Bureau of Emergency Management on a project to review the City’s bio-incident response plan and briefed the Commissioner personally on our findings just about a year ago.  I found him to be focused, strategic in his thinking, and a calm, motivating and highly effective leader.  He has the energy and the track record to head up the CDC and I’m confident will do a great job with the H1N1 and future challenges.

8.  I’m attending the Long-Island – New York City Emergency Management Conference this week and I am anxious to hear what the State, City, and surrounding counties have to say about how their pandemic response plans may need to change given the H1N1 experience.  I am also looking forward to sections about logistics (my specialty) and the weather, as I also worked on a project supporting the City’s Coastal Storm Plan.  Expect some blog posts live from the event!

9.  Current WHO Map of H1N1 influenza cases:

GlobalSubnationalMaster_20090525_1000

WHO has a timeline of influenza A (H1N1) that provides a really cool flash application that lets you scroll through these maps on a daily basis to monitor the spread of H1N1, starting with the latest map.  It’s my click of the day!

10.  These are my non-H1N1 thoughts of the day, and again, in homage of Peter King, they will be all-sports related:

  • I can’t believe the Red Sox lose 2/3 to the Mets, and 5/10, with Big Papi not hitting anything, and still ending up in first place.
  • I got cheated out of watching the Coca-Cola 600 on Sunday by rain; then by sun on Monday afternoon (we took the kids to the park), and again by rain in Charlotte on Monday evening.  Good for you David Reutimann for being the first to figure out to stay out during the last caution when rain was threatening!  But I think NASCAR has to change the rule that if rain ends an event that was running under caution, the final standings should go back to the last green flag lap – and not the order after pit stops run under yellow.
  • Go Magic!  Any team that barely beats the Celtics (without KG) has to go all the way…. though I have a feeling this is Denver’s year.  (Did I really say that?)
  • So if BB can’t sign Jason Taylor, trade for Julius Peppers, draft an OLB, while losing ILB rookie Tyrone McKenzie for the season I think it is time to mess up everyone else’s preparation for the Pats D and switch to the 4-3 as the primary set and have Mayo and Thomas play outside with Bruschi in the middle.

That’s it for now.  Keep Living Prepared for H1N1!

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Get Ready for Unnecessary Panic

The World Health Organization is considering to raise the Pandemic Alert level to 6 – the highest level – indicating a global pandemic.

Don’t Panic.

According to WHO:

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

WHO Pandemic Influenza Phases

Click to zoom

The amount of human-to-human and community-level outbreaks in several countries in different WHO regions clearly makes this decision reasonable.  After all, Phase 5 requires the spread of the disease to only two countries in one WHO region.

H1N1 Number of Laboratory Confirmed Cases - May 3, 2009

Click to zoom

Are we panicking yet?

Heck no!

Just last night, Mexico was reporting that the spread of H1N1 was beginning to decline.  There is still no evidence of community spread outside of the United States and Mexico, only cases related to travel, and the morbidity and mortality rates are reasonable for seasonal influenza.  This may hold back WHO’s decision to move to alert level 6.

The latest WHO Press Briefing that addresses these issues is available here:

4 May 2009 Press Briefing by WHO’s Dr Keiji Fukuda, Assistant Director-General ai, Health Security and Environment

I predict this signals the beginning of the end.

Living Prepared for H1N1

Ok, I admit it.  I believe it is important to be Living Prepared™ for the Influenza A H1N1 virus, and that means I’ve had to stock up on some items that I haven’t had on hand.  I still believe in Don’t Panic first and foremost, but given the warnings of the planet’s leading health authorities, it would be foolish to not take this seriously.

Now, I haven’t gotten the chance yet to blog about recommended household emergency supplies yet, so will do a lot of that on the fly and we’ll reconvene on those issues in coming posts.  And we should also review the list of things that one should never leave home without, as during a declared pandemic (alert level 5), which we are now facing, there are one or two additions to this list that come to mind – i.e. hand sanitizer and tissues.

Sanity Check

But to return to a sanity check -I wanted to comment on the most recent facts about the H1N1 / Swine Flu outbreak.

This morning, I received a notice from my daughter’s school, explaining how the school was responding to the Swine Influenza outbreak.  I sent the following note back to school parents in response:

As an emergency management professional, I consulted just over a year ago with the City’s Department of Health & Mental Hygiene to review the City’s bio-incident response plan and found an extremely high skill level of individuals at the agency, which is well-prepared and fully capable of protecting the health of the residents of this City through its biosurveillance program, health lab and relationship with CDC.

There is no need to panic.  Flu spreads around the world in seasonal epidemics annually, infecting millions and resulting in the deaths of hundreds of thousands annually.  According to the CDC:

Every year in the United States, on average:

  • 5% to 20% of the population gets the flu;
  • more than 200,000 people are hospitalized from flu-related complications; and
  • about 36,000 people die from flu-related causes.

Despite the attention and concern over the H1N1 virus, I don’t feel that there is any evidence yet that this strain is particularly dangerous or spreading throughout the general population.  The latest global statistics (as compiled by the World Health Organization on April 30, 2009) are this:  There are 11 countries that have officially reported 257 cases of influenza A (H1N1) infection.  There are only 97 confirmed cases in Mexico, with 7 deaths, and 109 confirmed cases in the US, with 1 death.  CDC and WHO expect the virus to continue to spread and for more confirmed cases to become known as lab results are completed, but in the context of seasonal flu, again, there is no need to panic.

According to a May 1 AP article, Mexico has now raised the confirmed swine flu death toll from 15 to 16, with a total confirmed number of cases of 397.

There are now more than 400 schools closed in the USThe U.S. Department of Education has said that 433 schools are closed, affecting 245,000 children in 17 states.  All this precaution for 140 confirmed U.S. cases as of today.  Really?  Are we panicking now?

H1N1 Info from NYC.gov

Two more excellent source of information about protecting yourself from Influenza came out today from the City of New York.  (I tweeted on this earlier today).  First, the City’s Department of Health and Mental Hygiene (DoHMH) released the following document for employers: Guidance for Preventing Transmission of H1N1 Influenza in the Workplace.  Also, the City’s Office of Emergency Management (OEM) has posted PDF versions of the recently released Ready New York Pandemic Flu guide (available in 14 languages) on its website.

H1N1 Preparedness

Back to the main topic, that is Living Prepared™ for the Influenza A H1N1 virus.

I’ve recently done some online and in store procurement of items I did not have in stock.  As mentioned in previous posts, we’re currently undergoing a renovation of our brownstone and my household emergency stocks are seriously depleted or in storage.  So I am somewhat having to start from scratch in building my household emergency supplies.  This is not good.

Anyway, I decided to order from LifeSecure Emergency Solutions the following:

  • N95 Respirator Facemasks (though I’ve become convinced that these are fairly useless; I’ll get to that in a coming post)
  • Hand & Surface Sanitizer (you can never have enough of this)
  • Eye Shield Protection Pack (2 frames, a bunch of clear lenses; I have clear glasses but wanted an extra and for spouse)
  • Antimicrobial Wipes (you can never have enough of these either)
  • Food bars

By the way, LifeSecure’s David Scott has recently blogged a fine article on H1N1 preparedness that everyone should read.

At local pharmacies and grocery stores, I have picked up:

  • Additional hand sanitizer (Purell or any equivalent of over 60% alcohol content) in various bottle sizes
  • Foaming hand wash (Method)
  • Lysol spray (mostly for my smelly cat’s litter box, but also for surface and general disinfecting)
  • Disinfecting surface wipes

I’m still short on bottled water – though I haven’t quite figured out how H1N1 is going to affect adversely the public water supply… but I need to get enough for my family of four for three days at least.  A trip to Costco is on order for the next few days.

So am I Living Prepared™ for the Influenza A H1N1 virus now?

More updates to follow.

UPDATE: Twitter Feeds on H1N1 / Swine Flu

Last month, I blogged about the use of twitter to push out information about emergency alerts and general preparedness information by a number of official (governmental and non-governmental organization) sources such as FEMA, CDC, the Red Cross and others.

Today, the utility of twitter to push out current and accurate information about emergencies has been proven in my mind, by the excellent coverage of the H1N1 / Swine Flu outbreak on twitter.

So much so that it prompted me to apply a new theme to this blog to add a third column, such that I could post twitter feeds from some of the best sources of information about the H1N1 / Swine Flu pandemic on this site.  Check them out on the left.  The latest five tweets from government sources, non-governmental organizations and a couple of the better media sources listed below will be posted on this site.

I also set up a twitter account called LP_SwineFlu to follow the feeds I’ve found to be reputable and reliable sources of information about the H1N1 / Swine Flu outbreak, but have yet to find a way to combine those into a single public feed I could post on this site (twitter requires login authorization to view the RSS feed of an accounts tweets plus tweets of those it is following).  I would appreciate any solutions others have found to this.  If there was an auto-retweet bot (discussed by seemingly unavailable) – that would solve 95% of the problem.

Until then, I’ve selected some of the best feeds to put on this site.

Essential Sources of H1N1 Information:

Government Sources:

whonews – from the World Health Organization.  WHO news releases related to H1N1 / Swine Flu as well as general public health information news and information are being tweeted here.

BirdFluGov – feed from official US government pan-agency pandemic flu site – http://www.pandemic flu.gov  – one-stop access to U.S. Government swine, avian and pandemic fly information.

CDCemergency – from the Centers for Disease Control Emergency Preparedness and Response division – this feed is providing the most regular updates from CDC.

H1N1Info – this may be a private effort – but is pulling all emergency updates exclusively from CDC Swine Flu page.

CDC_eHealth – from the Centers for Disease Control interactive media group – provides links to videos and podcasts related to H1N1 / Swine Flu as well as general public health information.

CDCFlu – from the Centers for Disease Control -general flu public information feed on prevention & vaccination; supposed to be providing updates from CDC Swine Flu RSS feed but is not yet actively posting H1N1 updates.

Non-Governmental Organization Sources:

Veratect – A private company that is providing the earliest detection of new information on H1N1 / Swine flu. This feed provides real-time output on the swine flu situation translated by their two operations centers from 37 languages globally.  This feed is providing some of the best, most accurate and up-to-date information about confirmed and suspected cases of H1N1 globally.

Healthmap – a public website bringing together disparate data sources (these are the tweets) to achieve a unified view of the current global state of infectious disease.  Check out their swine flu map – it’s better than the google mashup I posted earlier.

News Organizations Sources:

BreakingNews – the best source on twitter period for accurate global breaking news events coverage.  Anazingly accurate and always minutes, hours and sometimes days ahead of other news organizations on breaking news.

sanjayguptaCNN – CNN Chief Medical Correspondent Dr. Sanjay Gupta

cbshealth – the latest health news from CBSNews.com

msnbc_health – health, diet and nutrition news from msnbc.com

I would appreciate referrals to any other good sources of H1N1 information on twitter from similar sources.  I’m leaving out the private efforts of individuals as it is hard to verify their qualifications; most are reposting news stories from these and other sources.

Don’t Panic – Swine Flu in US and NYC

A colleague wrote today that he has “literally nothing to add to the swine flu discussion,” but blogged on it anyway.  I’m not sure that I have anything original to add either, but the public and media hysteria is reaching a fever (no pun intended) pitch over something that is not yet deserving of it, and it seems required that every preparedness practitioner comment on it.

So here’s my current take on the swine flu outbreak:  Don’t Panic


The Facts about Swine Flu in NYC

Swine flu outbreak in NYC is not spreading – according to NYC Department of Health and Mental Hygiene press release as of 1:30 PM today:

April 27, 2009 – The Health Department today announced that four days of close monitoring has yet to show any increase in reports of severe respiratory illness in New York City. The agency is investigating a cluster of illness at the St. Francis Preparatory School in Queens, where 100 students missed classes because of flu-like illness last week. Daily calls with hospitals and monitoring of admissions have yet to suggest a wider or more severe outbreak.

The virulent form of Swine Flu that has killed almost 200 in Mexico is not exactly the one that has shown up in the United States, including in the City of New York, where 100s of students at a private school in Queens have come down with a related form of influenza.  Virtually all of the St. Francis Preparatory School students who have come down with the flu recover within a day or two, and those who have not yet recovered are not reporting a worsening of the symptoms.  And there are no confirmed cases of the swine flu that originated in Mexico outside of this student population cluster in the City (though there are scattered cases elsewhere in the United States).  And although the confirmed cases of swine flu in the City is expected to go over 100, to match the number of St. Francis Prep students who have come down with flu-like symptoms but have yet to have tests confirm the diagnosis, there is no need to panic or fear a broader outbreak in the City at this time.

This information is according to a press conference and briefing just concluded held by the City of New York’s Mayor Michael Bloomberg, along with the City’s Health Commissioner Dr. Thomas Friedan, and a representative from the Centers from Disease Control.  Archived video will be available shortly on the http://www.nyc.gov homepage.

Don’t Panic


The Facts about Swine Flu

The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. (source: CDC)

If you are feeling sick, have a fever, coughing and sneezing, you should stay home.  Don’t run off to the emergency room, which are often crowded with people you may easily infect.

Take these everyday steps to protect your health:

  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
  • Avoid touching your eyes, nose or mouth. Germs spread this way.
  • Try to avoid close contact with sick people.
  • If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Don’t Panic


More Information About Swine Flu

There is lots of additional good information on the web from reputable public health information sources – the World Health Organization, the Centers for Disease Control, and the City of New York’s Department of Health and Mental Hygiene.  (But not the EU Health Commissioner, whose issuance of a travel advisory for Europeans to postpone nonessential travel to the US is just nonsense at this time.)

If you want to read up – here’s some of these reputable sources:

World Health Organization:

World Health Organization Epidemic and Pandemic Alert & Response Disease Outbreak News

U.S. Government / Centers for Disease Control:

One-stop access to U.S. government swine, avian and pandemic flu information

CDC Swine Flu Homepage

Fact Sheet – Q & A: Swine Influenza & You

FactSheet – Q & A: Key Facts about Swine Influenza (Swine Flu)

Fact Sheet: Preventing the Flu: Good Health Habits Can Help Stop Germs

Brochure: Swine Influeza (Flu) in Pigs and People

Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home

CDC Podcast on Swine Flu

City of New York:

The City of New York’s Department of Health and Mental Hygiene (DOHMH) has a lot of great information posted about the swine flu outbreak in the City and generally.

NYC DOHMH homepage

Fact Sheet: Swine Flu: What New Yorkers Need to Know

NYC DOHMH Bureau of Communicable Diseases Swine Flu information

NYC Office of Emergency Management Pandemic Flu Guide

So, Don’t Panic… if you don’t panic about the swine flu you will be Living Prepared™.