Katherine M. Williams, RN Masters of Nursing & Health care Practices Slide Presentation on Pandemic Flu

1. Pandemic Influenza:
What YOU Need To Know
Katherine M. Williams, RN
Masters of Nursing and Healthcare Practices
Affiliated with:
The American Red Cross
Service Employees International Union, Local 199

2. What is Pandemic Influenza?
 Pandemic influenza in humans occurs
naturally several times a century, on average.
 Pandemic flu is usually more severe than
“seasonal” flu (the kind you get your annual
flu shot for), with a higher death rate.

3. What is Pandemic Influenza?
 Pandemic flu affects the entire world,
not just a country or a continent.

4. Where Does it Come From?
 Pandemic influenza is a virus to which humans have
no natural immunity.
 It originates in wild birds and then jumps to other
species, including pigs and humans.
 “Swine flu” has bird, pig and
human genes, a very
unusual occurrence.

5. Recent Pandemics
 1918-19 - H1N1, "Spanish flu”
Severe: Humans had no immunity to any of
the 8 gene sequences
 1957-58 “Asian flu”
Mild: We had immunity to 5 of 8
gene sequences
 1968-69 "Hong Kong flu”
Milder: We had immunity to 6 of 8
gene sequences
 1997- ? H5N1, “Bird Flu”
Severe: Humans have no immunity
 2009 - ? A/H1N1, “Swine Flu”
Moderate: We have no immunity to any of
the 8 gene sequences, but have modern
medicine to help us this time.

6. Why Should We Be Concerned?
 The 1918 “Spanish flu” had a mortality rate of
approximately 3% and caused widespread social
disruption.
 H1N1 currently has a mortality rate of around 0.5%,
or 5 times the death rate of seasonal influenza, with
prompt, first-rate medical care.
 It has spread rapidly around the globe.
 It is a new, unstable, unpredictable virus that has the
capability to mutate soon and often.

7. Where is it Now?
Blue: A/H1N1 Red: H5N1 Purple: Both A/H1N1 & H5N1

8. Current Situation
Reported deaths
3,969 deaths as of Sept 17, 2009:
 Brazil: 899
 United States: 694
 Argentina: 514
 India: 220
 Mexico: 217
 Australia: 172
 Thailand: 153
 Chile: 132
 Peru: 121
 Great Britain: 79
 Canada: 76
 Malaysia: 76
Cases have been confirmed on
all continents and in nearly
every country.
WORLD CUMULATIVEDEATHS
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5/1/2009
5/15/2009
5/29/2009
6/12/2009
6/26/2009
7/10/2009
7/24/2009
8/7/2009
8/21/2009
9/4/2009
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9. Deaths in the U.S.
First reported death:
April, 2009
Current total: 693
Last week alone: 102
United States Cumulative Deaths
0
100
200
300
400
500
600
700
800
4/1/2009
4/15/2009
4/29/2009
5/13/2009
5/27/2009
6/10/2009
6/24/2009
7/8/2009
7/22/2009
8/5/2009
8/19/2009
9/2/2009
9/16/2009
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10. Severity
 This is now considered a “moderate” pandemic by
the CDC (Category 2).
 Expect at least 100,000,000 Americans to become ill
at some point in the next 6-18 months.
 Category 2 = between 90,000 and 450,000 deaths,
mostly children and young adults.

11. A/H1N1 Fatalities
 Average age of death: 38 years old.
 Affecting children and young adults, very
different from seasonal flu.
 About 1/3 have NO pre-existing medical
conditions.
 Most on ventilators for at least 7 days.

12. Who’s Most at Risk?
 Ages 5-50
 Pre-existing conditions:
 Asthma
 Diabetes
 Pregnancy
 Heart disease
 Obesity

13. But I’m not hearing much
on the news!
 Complacency and Apathy: our two worst
enemies.
 Media censorship: don’t want to cause
“panic.”
 There’s more “important”
news out there!

14. What about that “36,000” number?
 Only around 1,300 people die
each year directly from
seasonal influenza, according
to the American Lung Assoc.
 The “36,000” number is an
estimated number from a 2003
study, based on pneumonia
death rates.
 Most at risk of death from
seasonal flu: >65 or <2 years
old

15. Under-reporting Issues:
 No longer testing all suspected
cases
 Only the severely ill and/or
hospitalized
 Shortage of testing kits
 Highly unreliable results
 Need specialized test for
definitive diagnosis (PCR)

16. What about a vaccine?
 Won’t be available until at least mid-October
 Just finishing first clinical trials
 First to receive vaccines:
 Healthcare workers
 Pregnant women
 Emergency services
 “High risk” people

17. Potential Problems with a vaccine
Major questions:
 Safety?
 Number of shots needed?
 How well will it work?
 How many available?
 How to distribute?
 80% of U.S. vaccines
are made overseas.

18. What does this flu look like?
 Fever (but up to 25% have no fever!)
 Respiratory symptoms: cough, congestion,
respiratory distress
 Nausea and vomiting
 Body aches and pains
 Severe headache & mental status changes
 Conjunctivitis

19. What if you catch it?
 Most cases are “mild,” requiring no medical
intervention.
 Some cases are NOT mild!
 If you have increased risk factors
DEMAND Tamiflu from your doctor.
 Pay careful attention to disease progression – if you
experience respiratory distress, high fever, gray skin,
or extreme lethargy:
GO TO THE EMERGENCY ROOM ASAP!

20. So What Can YOU Do?
 Be aware of the people around you – is anyone
coughing or looking sick?
 If you have increased risk factors,
consider avoiding crowded areas
like malls, airplanes, churches,
and movie theaters.
 BE AWARE: People can spread the flu for the first
24-48 hours they are infected and not show any
symptoms.

21. So What Can YOU Do?
 If you feel sick, STAY HOME until you have
been symptom-free for at least 48 hours.
 Relapse is common – watch for this.
 PREPARE for the
second wave
starting now.

22. Prepare? For What?
 Increased virulence in Second Wave?
 Vaccine production and distribution issues
 Tamiflu resistance?
 Possible shortages of food and fuel
 Combination with H5N1?

23. H1N1 + H5N1:
The Worst Case Scenario
 H5N1 (“bird flu”) has a 60% mortality rate.
 If the two combine, we may have a virus that
is easily transmissible and highly lethal.
 The World Health Organization is VERY
worried about this recombination.
 Widespread civilization collapse is possible.

24. Mike Leavitt
Former Secretary, U.S. Dept of Health and Human Services
 “Local preparedness is the foundation of
pandemic readiness. Any community that
fails to prepare with the expectation that
the federal government will, at the last
moment, be able to come to the rescue
will be tragically wrong.”
- Interview, March 21, 2006

25. Former Secretary Leavitt, again:
 "Anything we say in advance of a
pandemic seems alarmist. Anything
you've done to prepare after it
begins is inadequate."
- March 2006, California
Pandemic Planning Summit

26. Who Should Prepare?
 The U.S. Department of Health and Human Services
recommends the following entities should begin
preparations:
 Individuals
 Businesses
 Faith-Based Organizations
 Schools
 Healthcare Agencies
 Non-profit agencies
 State and local Governments

27. Thoughts on Preparedness
 We CANNOT depend on governmental help.
 Most states and local governments are
woefully behind on their pandemic
preparedness plans.
 Does your city have a plan?
 How do these top-down plans affect you?

28. Individual Preparations
“You are on your own.”
What does this mean
to the average family?
It means we must PREPARE.

29. Why Prepare?
 40-50% of the workforce will be absent:
 Some will be sick.
 Some will need to take care of
families.
 Some will be afraid to come to work.
 Most businesses do not have a
pandemic plan.

30. Why Prepare?
 Medical services will be overwhelmed:
 Our health care system has no real “surge capacity” to
deal with a huge increase in patients.
 Most hospitals do not have adequate supplies of
personal protective equipment on hand to protect
healthcare workers.

31. Why Prepare?
 Basic services may be interrupted:
 Utility workers will be affected, too, resulting in
electricity, water and natural gas outages.
 Most communities have only a week’s worth of
chlorine on hand to treat water supplies.
 Police and other
emergency services
may be overwhelmed.

32. Why Prepare?
 International commerce will be drastically
reduced:
 About 80% of the raw materials for our
medications come from overseas.

33. Why Prepare?
 “Just in time” thinking will backfire:
 Most businesses and services have very little
on hand for day-to-day operations.
 Think of what local grocery
stores look like the day
before a blizzard is predicted.

34. Why Prepare?
 Schools may be
closed:
 Schools are prime
locations for disease
transmission.
 Other places people
congregate may also
close, such as malls,
churches, etc.

35. Why Prepare?
 Interstate commerce may break down:
 The people who deliver our
food, supplies and fuel will be
vulnerable, too.
 Interstate travel may be restricted.

36. So Why Aren’t People
Preparing?

37. I’m not preparing because…
 I HAVEN’T HEARD OF IT
 There are some folks out of touch with
world events and the news -
they don’t want to know what’s
really going on around them.

38. I’m not preparing because…
 I BELIEVE THE WHOLE
THING IS JUST HYPE
 “News organizations produce
scary stories to get ratings.”
 “Politicians and leaders want to
cover their butts no matter how
small the threat.”
 “Big Pharmaceutical companies
are encouraging fear to get
business for their drugs.”

39. I’m not preparing because…
 I DON’T HAVE THE FUNDS TO PREPARE
 “It’s hard enough just paying the regular
bills and you want me to spend money on
something that probably won’t affect me?”

40. I’m not preparing because…
 MAGICAL THINKING
 “The threat is real but if I don’t prepare it
won’t happen. Preparation will just cause it
to happen.”

41. I’m not preparing because…
 I’LL WAIT AND SEE WHAT
HAPPENS
 “Yeah, I know bad things
could happen, but there will
be plenty of time to take
steps if it gets worse.”

42. I’m not preparing because…
 IT’S NOT HAPPENING IN MY TOWN
“Why should I be concerned
because a bunch of people
somewhere else are getting
sick?”

43. I’m not preparing because…
 I HAVE NO FEAR
 “So what if it happens,
I’ll just take my chances –
Nothing can hurt me!”

44. I’m not preparing because…
 THERE’S NO HOPE
 “Preparation is an illusion.
The pandemic will last so long
and be so bad that I can’t avoid it.
Everyone will die, so I might as
well give up hope now.”

45. So you feel the need to start preparing…
 What exactly do I need to do?
 And for how long?

46. Take the First Steps:
 Start THINKING about how you will react to a
disaster – ANY disaster.
 Stay INFORMED.
 TELL OTHERS what you
know and learn.
… AND THE BIG ONE:
 Be ready to “make it on your own” if things
take a turn for the worse.

47. How Do We Prepare?
 Begin to stockpile:
 Food and water supplies
 Medications
 Alternative heating and cooking
methods
 Emergency radio / communications
 Alternative sanitation / hygiene

48. A Kernel of Truth?

49. Things to Consider:
 Food
 For how long?
 How much per person?
 What to buy?
 How to store it?

50. Things to Consider:
 Water
 How much?
 How to store it?
 Alternative sources?

51. Things to Consider:
 Heating, lighting and cooking
 Wood
 Propane
 Solar
 Candles and lamps

52. Things to Consider:
 Sanitation
 Sewage waste
 Toilet paper!
 Feminine products
 Garbage disposal

53. Things to Consider:
 Medications and First Aid
 Talk to your doctor about prescriptions
 Buy a good first aid kit
 Basic OTC medications
 Take a First Aid course from your local
American Red Cross chapter
 Get the flu shot!

54. Also Consider:
 Home schooling for children
Security
Money
Providing for Pets
Entertainment

55. For How Long?
 U.S. Dept of Health and Human
Services recommends that
families have AT LEAST TWO
WEEKS of supplies ready.
 The U.S. State Dept. has
recommended that all U.S.
residents overseas stockpile up
to THREE MONTHS of
supplies.

56. THREE MONTHS?!?!?!
 The best models we have indicate that
pandemics will travel in waves.
 Each wave may be in your community for
several weeks to a month.
 The waves may contain slightly different
versions of the virus, so you might get it more
than once.

57. Plan Ahead
 What happens if you get sick or
get stuck at work?
 Who will take care of your
children?
 Who will take on the role of
“nurse?” or caregiver?
 Do you have family or
neighbors who need extra
help?

58. Some good advice:
 “In your pandemic flu prep plans, don’t
forget mental health. You’ll need a hefty
supply of strength, resolve and useful ways to
manage stress and maintain resilience as
much as you will need water and food.”
- excellent advice from the Fluwiki

59. Why I am Preparing:
“Prepare for the worst,
hope for the best.”

60. For More Information…
 U.S. Department of Health & Human Services
www.pandemicflu.gov
 Centers for Disease Control & Prevention
(CDC)
www.cdc.gov/flu/pandemic/
 World Health Organization
www.who.int/csr/disease/influenza/pandemic

61. For More Information…
 The Flu Wiki: the original site for preparation and up-
to-the-minute news forum.
www.fluwiki.info
 Pandemic Flu Information Forum: excellent source
for current news and preparation.
www.singtomeohmuse.com
 Get Pandemic Ready: all the basics on preparation
for families and individuals, easy to use.
http://66.236.6.202/

62. Any Questions?
Thank you for coming!