Still too early to declare swine flu pandemic over: WHO

It is too soon to decide whether to declare the H1N1 pandemic over, World Health Organization officials said Thursday.

While the number of infections and deaths are falling in Canada and the U.S., “that’s still not true for the entire Northern Hemisphere,” and it is impossible to know now whether the spring will bring a third wave of infection, Dr. Feiji Fukuda, special adviser to the WHO director-general on pandemic influenza said in a press briefing.

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“Overall, it’s too early to say whether activity is peaking in the Northern Hemisphere, and, at this point, it is also not possible to predict what we are going to be seeing in the spring time.”

And while new estimates suggest H1N1 is, overall, no more deadly than regular seasonal influenza, Dr. Fukuda warned that it is premature to declare how H1N1 will stack up against past pandemics.

The WHO says swine flu pandemic is milder than expected, may be nearing peak

Fukuda acknowledged that the virus has proved less lethal than authorities originally feared. “It is possible there could be unexpected events which occur as we go through” the pandemic, he said. But “it is quite possible to have a pandemic on the milder side and if we are experiencing that, and if the number of serious cases is kept down … this is something for which we should all be thankful.”

Fukuda said that more than 150 million doses of swine flu vaccine have now been distributed in about 40 countries. The United States, with at least 70 million doses, represents nearly half that total.

He also said that, so far, researchers have identified 96 patients with strains of the swine flu virus that are resistant to the most commonly used antiviral agent, Tamiflu, known generically as oseltamivir.

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New data from college campuses support the idea that swine flu may have passed its peak in the United States. For the week ending Nov. 27, there were only 1,076 new cases of influenza-like illnesses, generally presumed to be swine flu, among the nearly 3 million students covered in the survey, a 69% drop from the previous week.

Top doctor pleads for Canadians to get H1N1 vaccine

H1N1 may have hit its peak but the risk of transmission remains high and millions of Canadians could still be infected, Canada’s top doctor warned Wednesday in pleading for Canadians to get vaccinated.

“Even if you are not personally worried about getting H1N1, for the sake of others around you, as well as your loved ones, please get your H1N1 flu shot,” said Dr. David Butler-Jones, Canada’s chief public health officer.

Full Article: here.

International Study of the Prevalence and Outcomes of Infection in Intensive Care Units

The Journal of the American Medical Association (JAMA) has taken a one-day snapshot of the number of infected patients in ICUs worldwide — and the results are not good.

Of the tens of thousands of patients surveyed, at over a thousand hospitals, in over 75 countries, more than 50% were considered infected.

The patients who had been in the ICU the longest (prior to the study day) had higher rates of infection “especially infections due to resistant staphylococci, Acinetobacter, Pseudomonas species, and Candida species”.

“The ICU mortality rate of infected patients was more than twice that of noninfected patients… as was the hospital mortality rate”.

JAMA’s conclusions? “Infections are common in patients in contemporary ICUs, and risk of infection increases with duration of ICU stay. In this large cohort, infection was independently associated with an increased risk of hospital death.”

Abstract here.

CBC coverage here.

From the most recent issue of Strategic Change’s newsletter, Michael Schiel on “What the H1N1 Panic Can Teach Us“:

“As the public panic begins to subside over the H1N1 vaccination response by Federal and Provincial governments, there is a good chance that calmer heads will prevail. If one takes a systemic point of view, some important organizational, policy or process lessons can be garnered.

When you filter through the hype, some of the important aspects include:

• Challenges with Estimating Demand – Although much of the reporting in the media has been hyperbolic, it is clear that the provinces have had some trouble in figuring out in advance how much supply was required.
• Challenges with Supply Side – The Federal Government was somewhat hamstrung as there was only one supplier of the vaccine, and they had issues meeting the changing needs of the government and the populace.
• Supply Logistics – There were many indicators that public health organizations had some trouble determining the best approach to supplying the vaccine, as evidenced by mixed messages, the allowance of queue jumping at many places, and the inability of some clinics to realistically handle the crowds.

What does all of this mean?

• Leadership is Complex - In a recent report, the Auditor General found that “defining a leadership role when each department responds to its own ministerial direction, and coordinating that direction with other departments can be a challenge”. I have seen this before on other large multi-ministry or inter-jurisdictional projects too. From a change management perspective, it is important to determine clear leadership links in advance, or at least to widely declare them if they need to be created on the fly.
• Roles and Responsibility – Thee Auditor General also found that “…while Public Safety Canada played a coordination role in some emergencies it has yet to establish the policies and programs that would help define its leadership and coordination role for emergency management in an all-hazards environment”. More thought and effort will need to go into planning for coordination across different jurisdictions.
• Communication is Key - One of the biggest challenges has been conflicting and changing messages from the government. It would be wise in future events for a calm, strategic approach to communication to be used. People resist change naturally, and one of the best ways to overcome that resistance is a more effective communication strategy.
• Forecasting – A key lesson here is that when planning for future external events like pandemics, public sector organizations will need to continue to find better ways to estimate what the public response will be.
• Need for Engaged and Experienced Staff – The area of Public Safety Canada that was responsible for planning and responding to the pandemic had an employee vacancy rate of 39 percent in the 2008-09 fiscal year, and a vacancy rate of 50 percent the previous year. Numerous studies exist on the difficulties that the Federal Government has faced in engaging staff during the 1990s and 2000s, and several reform efforts during that time have only partially eased some of the issues. Clearly it is hard to expect top level service delivery with low levels of staff, and one can imagine the existing staff are also overworked and somewhat stressed.
• Flexibility – It must be remembered though, that no amount of planning would be able to accurately foretell what the public reaction would be. The public changed its mind dramatically as the pandemic unfolded, and the various levels of government did their best to adjust their vaccination program rollout accordingly. Patience, openness and flexibility are key characteristics to achieve success during events like this.”

CDC warns: Holiday could bring more swine flu

Swine flu pandemic peaks in Ukraine

After three weeks of panic, pandemonium and politics, the initial swine flu pandemic in Ukraine has peaked.

Today the government is expected to end a nationwide ban on public gatherings, lift travel restrictions and order the reopening of parliament, schools and universities in all but 11 regions.

But the country, with its anemic health-care system, is still reeling from having 1.6 million people fall sick with the flu, resulting in the hospitalization of 97,000 people and the deaths of 388 in three weeks.

Full Article: here.

Business Groups Oppose Emergency H1N1 Paid Sick Leave

Public health officials say the H1N1 flu pandemic is exacerbated by employees going into work sick because they don’t get paid time off. But a representative from the business community told Congress on Tuesday to stay out of it.

House Education and Labor Committee Chairman George Miller (D-Calif.) is pushing an emergency bill that would require employers with more than 15 workers to provide up to five days of paid sick leave.

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According to the U.S. Bureau of Labor Statistics, 39 percent of workers in the private sector do not receive paid sick leave.

Full Article: here.

As of yesterday, Ontario has expanded its H1N1 priority list to include frontline responders (e.g. police, firefighters, correctional workers) as well as seniors over the age 65 who have chronic conditions and live in long-term care institutions. This shortly after Montreal’s The Gazette ran a story wondering why seniors weren’t considered a priority group for the vaccine (see excerpt below).

Why aren’t seniors an H1N1 priority? critics ask

Senior citizens left off the government’s swine-flu vaccination priority list say they are victims of discrimination.

With the average age of those dying from H1N1 complication in Quebec being 63.9, many seniors have called The Gazette to say the vaccine priorities are “criminal” and one person suggested it was “Canada’s new pension plan.”

Most of those who have succumbed to swine flu have had underlying health issues, yet seniors over 65 – a group known to have multiple health problems – have been left off the roster until the end of the campaign.

Full Article: here.

A closer look at how the virus works

The Globe & Mail breaks down the different stages of the H1N1 virus, including warning signs that require special medical attention.

Full Article: here.

WHO calls for ‘close’ watch on flu in farmers, animals

The World Health Organisation on Friday called for closer monitoring of farm workers and animals for influenza A viruses, following recent cases in a wider range of creatures than pigs

Although the WHO stressed that the cases were isolated and had no impact on the way the A(H1N1) swine flu pandemic evolved in humans, the UN health agency said recent findings may indicate broader potential for flu viruses to mix and mutate.

Pigs have traditionally acted as virtual mixing vessels for different flu viruses, allowing them to mutate into new forms that could be passed to humans.

Full Article: here