Feb 8, 2007 (CIDRAP News) Predictions and observations at this week's conference on business preparedness for pandemic influenza ran the gamut from how fast a pandemic would circle the globe to how well the Internet would hold up, with many topics in between.
The meeting brought representatives from about 200 corporations and other organizations to Orlando, Fla., Feb 5 and 6 to hear a long list of flu and preparedness experts. The meeting was sponsored by the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News.
Dr. Margaret Chan, director-general of the World Health Organization, who videotaped a speech for the conference, said past pandemics took about 6 to 9 months to spread around the world, but the next one is likely to be much faster.
"Most experts predict the global spread of the next pandemic will take about 3 months," she said.
Conservative estimates are that about 20% of the global population will fall ill and worker absenteeism will reach about 35%, Chan added.
A recurring theme at the conference was the need for preparedness advocates to persevere and fight off "pandemic fatigue." Risk communication expert Peter Sandman, PhD, articulated the message in his lecture on Feb 5.
"Pandemic preparedness is a slog," he said. "It's not just climbing a mountain, it's climbing a mountain range. It takes time." By analogy, it took a generation to achieve the widespread use of auto seatbelts, he added.
Among other tips for communicating the importance of pandemic preparedness, Sandman said, "You need to involve your audience. It's much easier to get people to do something than to get them to care. Once they do something, it launches a process that may get them to care."
John M. Barry, author of The Great Influenza, a history of the 1918 pandemic, warned the audience that planning documents do not equal preparedness. He cited the impact of Hurricane Katrina on New Orleans as exhibit A: "If there was an event more planned for than a hurricane hitting New Orleans, I don't know what it is." Barry is a distinguished visiting scholar at Tulane University in New Orleans.
Barry commented on the recent recommendations from the Centers for Disease Control and Prevention (CDC) on nonpharmaceutical measures for battling a pandemicadvice shaped in part by research on the effects of social distancing, mask use, and the like in the 1918 episode.
Though he generally supports the CDC advice, he said, it pays little attention to the possibility that the next pandemic will come in multiple waves. In 1918, the pandemic began with a fairly mild wave in the spring, followed by a far more severe wave in the fall. People who were exposed to the disease in the spring were much less likely to get sick in the fall, he said.
"This greatly, enormously complicates all your planning," Barry asserted. "You can only pull the trigger so many times." (CIDRAP Director Michael T. Osterholm, PhD, MPH, discussed this same dilemma in his talk on the "fog of pandemic preparedness"; see link below.)
In other comments, Barry said the evidence from 1918 shows that quarantine "doesn't work, period." Researchers found that 99 of 120 military camps used quarantine during the pandemic, but it was effective only when rigidly enforced, which occurred in only three or four cases. And 11 of the 21 camps that didn't use quarantine fared better than average.
The question of Internet capacity came up in a discussion on the role of business and government in a pandemic, in which increased telecommuting and millions of homebound children could put heavy pressure on the system.
Rajeev Venkayya, MD, senior director for biodefense on the White House Homeland Security Council, said, "What I'm hearing is that there continues to be concerns about the last mile and also about the backbone," referring to the capillaries and main arteries of the Internet. He added that the Department of Homeland Security (DHS) is looking into the question.
Alfonso Martinez-Fonts, assistant secretary for the Private Sector Office at DHS, had a somewhat different message. "The backbone of the Internet is pretty sturdy," he said. "It's the last mile that's a concern."
A discussion on the role of the media brought a warning on the lack of hospital surge capacity from Greg Dworkin, MD, editor of the Flu Wiki and chief of pediatric pulmonology at Danbury Hospital in Danbury, Conn.
"The idea that if you just plan ahead you can handle the surge [of patients in a pandemic] just isn't so. You can't," said Dworkin. He said hospitals need to huddle with local officials about where to send seriously ill flu patients when hospitals are full. One option he mentioned: closed schools.
In a session on vaccines, antiviral drugs, masks, and respirators, Osterholm raised the possibility that governments would seize privately held supplies of such items in a pandemic emergency. He said he knows of two states where the attorneys-general have talked about that possibility.
"I don't know whether that's likely to hold up," he added.
In the same session, flu vaccine expert Gregory Poland, MD, of the Mayo Clinic in Rochester, Minn., stressed that the H5N1 avian influenza virusconsidered the leading candidate to spark a pandemicis not just one species.
"It's a teeming mass of constantly mutating viruses," Poland said. Noting that the virus has branched into different clades and more narrowly defined subgroups in the past few years, he added that there hasn't been a clade 1 human infection in almost a year, and yet the H5N1 vaccine currently being stockpiled by the US government is based on a clade 1 virus. Poland is director of the Mayo Vaccine Research Group.
In concluding the conference, Osterholm said it was clear that attendees at this year's meeting had a better grasp of the pandemic threat than those who attended the first CIDRAP business conference a year ago.
"We can't let pandemic fatigue get the best of us," though "there will be days when people look at you as if you were one brick short of a load," he said.
Feb 7 CIDRAP News story "Businesses must overcome 'fog' of pandemic preparedness"