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States told to prepare for worst-case swine flu scenario

Shiloh

Editor, Senior Moderator
Source: http://www.cnn.com/2009/HEALTH/07/09/obama.swine.flu/


States told to prepare for worst-case swine flu scenario


WASHINGTON (CNN) -- The nation's secretary of health and human services told government leaders at a swine-flu preparedness summit Thursday that a vaccine to fight the H1N1 virus should be ready for distribution in mid-October.

HHS Secretary Kathleen Sebelius says researchers warn the impact of the H1N1 virus may worsen this fall.

Kathleen Sebelius also advised 500 government, health and education leaders to plan for the worst-case scenario: that the virus will reappear with renewed strength this fall.

"What we need to assume is that it will come back in a much more severe form," she said at the conference in Washington.


Commonly called swine flu, the virus is also known as influenza A(H1N1). The World Health Organization declared the virus a global pandemic on June 11.

Sebelius emphasized that extensive forward planning to combat the spread of the virus could always be scaled back later, but that officials could not delay starting work on those preparations.

"We can step back from our planning. What we can't do is wait until October," she explained.


The fight against H1N1 will be federally funded, the secretary said. She said the government will announce $350 million in preparedness grants on Friday: $260 million will go to state health departments and $90 million to hospitals preparing for a possible surge of patients.

The summit was requested by President Obama. He spoke to the group via video link from Italy, where he is attending the G-8 meeting of industrialized nations.
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"We want to make sure we aren't promoting panic, but we are promoting vigilance and preparation," Obama said.

Obama urged state and local officials, including school districts, to prepare for a vaccination campaign in the fall and to anticipate that schools could be significantly affected by the virus.

Health care workers hope to evaluate a candidate vaccine against H1N1 in early August, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who also spoke at the meeting.

Sebelius said medical experts are testing virus strains, preparing the production lines and beginning clinical trials.

She said the initial target group for the vaccine will be pregnant women, children ages 5 to 17, health care workers, the elderly, and anyone with chronic health conditions such as asthma.

A new Web site has been set up for H1N1, http://www.flu.gov/, which has information on the virus and helpful tips.


Swine flu continues to circulate in the United States and more than 120 other countries -- especially in the southern hemisphere, where flu season is under way. The virus could hit the United States as children are returning to school, which is only a few weeks away, Sebelius told CNN earlier in the day.

Thursday's symposium is an opportunity to look ahead and begin to put things in place, Sebelius explained on CNN's "American Morning."

There are more than 33,900 confirmed and probable cases of the H1N1 virus in the United States, with 170 deaths, according to the Centers for Disease Control and Prevention. More than 98,000 cases have been documented worldwide, with 440 deaths, according to the World Health Organization.

The virus has bucked traditional flu outbreak patterns. Influenza is typically more active during winter and then slows when the weather turns hot.

"Now, in the UK, as in many of the North American countries -- Canada, Mexico and the United States -- there has been quite widespread activity, or a lot of activity of this pandemic influenza virus. And right now, it is at a typical point of the year where the activity should be pretty low, but the activity is quite high because it is a pandemic situation for these countries," Keiji Fukuda, WHO assistant director-general, said this week.

Regular seasonal flu kills about 36,000 Americans annually. Sebelius said the vaccine for seasonal flu is ready for use
 
Re: States told to prepare for worst-case swine flu scenario

HHS Secretary Kathleen Sebelius says researchers warn the impact of the H1N1 virus may worsen this fall.

Kathleen Sebelius also advised 500 government, health and education leaders to plan for the worst-case scenario: that the virus will reappear with renewed strength this fall.

"What we need to assume is that it will come back in a much more severe form," she said at the conference in Washington.

If it hasn't mutated, there shouldn't be anything for .Gov to worry about, right?

Or does .Gov know more than they're telling us?
 
Re: States told to prepare for worst-case swine flu scenario

She said the initial target group for the vaccine will be pregnant women, children ages 5 to 17, health care workers, the elderly, and anyone with chronic health conditions such as asthma.
That's interesting, since the "official" priority list clearly says the military and homeland security people would be first, followed by health care workers and anyone supporting infrastructure. Pregnant women, children and anyone with chronic health conditions were in the third group, IIRC.
 
Re: States told to prepare for worst-case swine flu scenario

Liz, I too am now wondering who will get the first jabs???? Have they actually changed the guidelines or, are they being disingenuous?
 
Re: States told to prepare for worst-case swine flu scenario

Here are the family preparedness sections from http://www.flu.gov/. Absolute bare minimum, but if everyone did at least this much, it would help, no doubt about it.

You can prepare for an influenza pandemic now. You should know both the magnitude of what can happen during a pandemic outbreak and what actions you can take to help lessen the impact of an influenza pandemic on you and your family. This checklist will help you gather the information and resources you may need in case of a flu pandemic.

1. To plan for a pandemic:
  • Store a two week supply of water and food. During a pandemic, if you cannot get to a store, or if stores are out of supplies, it will be important for you to have extra supplies on hand. This can be useful in other types of emergencies, such as power outages and disasters.
  • Periodically check your regular prescription drugs to ensure a continuous supply in your home.
  • Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.
  • Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home.
  • Volunteer with local groups to prepare and assist with emergency response.
  • Get involved in your community as it works to prepare for an influenza pandemic.

2. To limit the spread of germs and prevent infection:
  • Teach your children to wash hands frequently with soap and water, and model the correct behavior.
  • Teach your children to cover coughs and sneezes with tissues, and be sure to model that behavior.
  • Teach your children to stay away from others as much as possible if they are sick. Stay home from work and school if sick.

3. Items to have on hand for an extended stay at home:

Examples of food and non-perishables
  • Ready-to-eat canned meats, fish, fruits, vegetables, beans, and soups
  • Protein or fruit bars
  • Dry cereal or granola
  • Peanut butter or nuts
  • Dried fruit
  • Crackers
  • Canned juices
  • Bottled water
  • Canned or jarred baby food and formula
  • Pet food
  • Other non-perishable items

Examples of medical, health, and emergency supplies
  • Prescribed medical supplies such as glucose and blood-pressure monitoring equipment
  • Soap and water, or alcohol-based (60-95%) hand wash
  • Medicines for fever, such as acetaminophen or ibuprofen
  • Thermometer
  • Anti-diarrheal medication
  • Vitamins
  • Fluids with electrolytes
  • Cleansing agent/soap
  • Flashlight
  • Batteries
  • Portable radio
  • Manual can opener
  • Garbage bags
  • Tissues, toilet paper, disposable diapers
 
Last edited:
Re: States told to prepare for worst-case swine flu scenario

Liz, I too am now wondering who will get the first jabs???? Have they actually changed the guidelines or, are they being disingenuous?
I went back to both the quote on FluTrackers and the original draft that I think it was taken from. The FluTrackers priority list is at http://www.flutrackers.com/forum/showpost.php?p=260052&postcount=2 Here is what it says, and in fact, that is what the pandemic.gov page shows.
<table cellpading="2" class="MyTable" width="700" border="0" cellspacing="2"><tbody><tr><th>
LEVEL
</th><th valign="top">
Homeland & National Security (HNS)
</th></tr><tr class="color1"><td>
A
</td><td valign="top">
  • Deployed and mission critical personnel
</td></tr><tr class="color2"><td>
B
</td><td valign="top">
  • Essential support and sustainment personnel
  • Intelligence services
  • Border protection personnel
  • National Guard personnel (who are not already included in Level A)
  • Other domestic national security personnel
</td></tr><tr class="color1"><td>
C
</td><td valign="top">
  • Remaining active duty military and essential support personnel
</td></tr></tbody></table>
<table cellpading="2" class="MyTable" width="700" border="0" cellspacing="2"><tbody><tr><th>
LEVEL
</th><th valign="top">Health Care & Community Support Services (HC/CSS)
</th></tr><tr class="color1"><td>
A
</td><td valign="top">
  • Public health personnel
  • Inpatient health care providers
  • Outpatient and home health care providers
  • Health care providers in long-term care facilities (LTCFs)
</td></tr><tr class="color2"><td>
B
</td><td valign="top">
  • Community support services and emergency management personnel
</td></tr><tr class="color1"><td>
C
</td><td valign="top">
  • Other important health care personnel
</td></tr></tbody></table>
<table cellpading="2" class="MyTable" width="700" border="0" cellspacing="2"><tbody><tr><th>
LEVEL
</th><th valign="top">
Critical Infrastructure (CI)
</th></tr><tr class="color1"><td>
A
</td><td valign="top">
  • Emergency Medical Services personnel
  • Law enforcement personnel
  • Fire services personnel
  • Manufacturers of pandemic vaccine, antiviral drugs, and other key pandemic response materials
  • Key government leaders
</td></tr><tr class="color2"><td>
B
</td><td valign="top">
  • Energy sector personnel (electricity and natural gas)
  • Communications personnel (telephony and IT)
  • Water sector personnel (potable and waste water)
  • Government personnel
</td></tr><tr class="color1"><td>
C
</td><td valign="top">
  • Transportation sector personnel
  • Food and agriculture sector personnel
  • Banking and finance sector personnel
  • Pharmaceutical sector personnel
  • Chemical sector personnel
  • Oil sector personnel
  • Postal and shipping sector personnel
  • Other important government personnel
</td></tr></tbody></table>
<table cellpading="2" class="MyTable" width="700" border="0" cellspacing="2"><tbody><tr><th>
LEVEL
</th><th valign="top">General Population (GP)
</th></tr><tr class="color1"><td>
A
</td><td valign="top">
  • Pregnant women
  • Infants and toddlers, 6 ? 35 months old
</td></tr><tr class="color2"><td>
B
</td><td valign="top">
  • Household contacts of infants under 6 months old
  • Children 3 ? 18 years old with high-risk medical conditions
  • Children 3 ? 18 years old without high-risk medical conditions
</td></tr><tr class="color1"><td>
C
</td><td valign="top">
  • High risk persons 19 ? 64 years old
  • Persons 65 years and older
</td></tr><tr class="color2"><td>
D
</td><td valign="top">
  • Healthy adults, 19 ? 64 years old, not included in other categories
</td></tr></tbody></table>

However, if you read their draft at http://www.pandemicflu.gov/vaccine/prioritization.pdf, particularly page 8, it appears that this list is not meant to prioritize from beginning to end, but as a way to designate groups that will be prioritized within the group.
Integrating Priorities for Pandemic Vaccination in Pandemics of Different Severity

Recognizing the need to address several important objectives for a pandemic vaccination
program, vaccine should be allocated simultaneously to target groups across categories. To do
so, target groups from different categories are integrated into tiers for vaccination.

The order in which target groups in Table 1 are vaccinated is defined separately for severe,
moderate, and less severe pandemics (see Table 2). All groups designated for vaccination within
a tier have equal priority for vaccination (see Figure 1 as an example of vaccination tiers for a
severe pandemic). In general, vaccine allocation within a tier will be proportional to the
populations of the targeted groups, though changes in this allocation scheme at the time of the
pandemic may occur based on the impacts of the pandemic and the specific needs identified at
that time.

Defining vaccination tiers differently by pandemic severity reflects differences in the threats
more or less severe pandemics pose to society and individuals. Pandemics with higher case
fatality rates are more likely to disrupt essential services, increase workplace absenteeism (due to
illness, caring for family members, or to decrease risk of exposure), threaten public order and
homeland security, and disrupt international and domestic supply chains compared with less
severe pandemics. Thus, tailoring strategies to pandemic severity will best achieve national
pandemic response goals and objectives. Pandemics are defined as ?severe? (PSI categories 4 or
5), ?moderate? (PSI category 3), and ?less severe? (PSI categories 1 and 2).

It should be noted that members of occupational target groups are defined by the functions
individuals within that target group are anticipated to perform over an extended period of time
during the pandemic outbreak; it does not distinguish among staff performing these duties as part
of their usual functions, those being reassigned to perform the function as a new response role, or
those performing the function as a volunteer. It should also be noted that vaccine does not
replace, but adds to other measures taken to protect the workforce and general population.

Pages 9 and 10 show graphically how high-risk populations would be integrated into the four primary groups.

So I think the answer is that nothing has really changed and that the officials in the interview were giving a technically correct answer (though not a complete answer).
 
Re: States told to prepare for worst-case swine flu scenario

deleted...I really should read the whole thread before posting...
 
Re: States told to prepare for worst-case swine flu scenario

Morningperson, welcome to ft. The DOD and Homeland security have been at the top of the vaccine list for years. This isn't something new. It really doesn't mean they expect mayhem in the streets.
 
Re: States told to prepare for worst-case swine flu scenario

Morningperson, welcome to ft. The DOD and Homeland security have been at the top of the vaccine list for years. This isn't something new. It really doesn't mean they expect mayhem in the streets.

Hello Shannon. I read the entire thread and realized that. Will read entire thread before posting...
 
Re: States told to prepare for worst-case swine flu scenario

LOL, no problem Morningperson. It is a bit of a shock the first time anyone reads the manual. Keeping America safe is and always will be at the top of the priority list. It just isn't something the average American thinks about.
 
Re: States told to prepare for worst-case swine flu scenario

New recommendations for vaccine targeting were published July 8, 2009. http://www.cdc.gov/h1n1flu/vaccination/statelocal/planning.htm/?breaknews

Here's what they call best-case scenario planning recommended with limited initial vaccine availability
1. Students and staff (all ages) associated with schools (K-12th grade) and children (age ≥6 months) and staff (all ages) in child care centers
2. Pregnant women, children 6 months – 4 years of age, new parents and household contacts of children <6 months of age.
3. Non-elderly adults (age <65 years) with medical conditions that increase the risk of complications of influenza.
4. Health care workers and emergency services sector personnel (regardless of age).
5. Note: Immunization of military (e.g., deployed forces) may be appropriate given the current circumstances; however, this memo focuses on vaccination of civilian populations under the authority of CDC and state and local health departments.
 
Re: States told to prepare for worst-case swine flu scenario

Welcome Morningperson - I had an off day yesterday! Must have been sunspots! Lol!
 
Re: States told to prepare for worst-case swine flu scenario

Hi LizW and Shannon,

It's difficult to keep up the official updates. I send out flu news to a distribution list daily, so I look for the new and meaningful information. The new recommendations for prioritizing vaccine is quite a departure. I found it interesting that children, who are seen as superspreaders by some, due to hygiene and physical boundary differences (sharing food, utensils, straws, cups, lack of concern about snot, not covering coughs and sneezes) , and who stay infectious longer, are first on the list along with vulnerables under age 65. A new sensibility is apparent.

Even better, HHS came out with strong preparedness recommendations today, including a new website and public service announcement contest.
 
Re: States told to prepare for worst-case swine flu scenario

That list is interesting for those of us who are not on it. :rolleyes:

My primary concern is whether egg-based vaccinations will be available to those who prefer them.

.
 
Re: States told to prepare for worst-case swine flu scenario

Even better, HHS came out with strong preparedness recommendations today, including a new website and public service announcement contest.

I'm not sure I think two weeks is a "strong preparedness" recommendation, but making any preparedness recommendation at all is a huge step in the right direction. :)

Welcome to FT, by the way. I've been hugely impressed by the numbers of competent and well-informed people who have turned up just when they were most needed.
 
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