Sep 22, 2009 (CIDRAP News) – With so much uncertainty over how broad and severe the next wave of H1N1 influenza could be, now is the time to focus on the two top goals of saving and sustaining lives, Dr. Julie Gerberding, former director of the US Centers for Disease Control and Prevention (CDC), told business groups today.
Like the federal government, businesses sometimes face a difficult balance between taking measures that save lives and choosing ones that preserve families, communities, and the economy, said Gerberding, who is now a clinical professor of medicine at Emory University in Atlanta and adjunct professor of medicine at the University of California, San Francisco. She made the comments at the opening session of a pandemic planning conference hosted by the CIDRAP Business Source, part of the University of Minnesota Center for Infectious Disease Research and Policy. It was attended by about 300 people.
Complicated messages about the pandemic H1N1 vaccine and disease severity create a difficult platform for practical planning, she told the audience.
Unfortunately, viruses and pandemics are unpredictable, Gerberding said. "When I oversaw the nation's strategic national stockpile, one of the most needed items that we didn’t stock was a crystal ball."
Age pattern of cases unexplained
So far it's not clear why the pandemic virus is hitting young people the hardest and largely sparing seniors, she said. Theories include some level of preexisting immunity in people older than 52 and the initial introduction of the virus into schools in the spring, when children were returning from spring break. Gerberding added that during the 1918 pandemic, children were primarily affected first, but the virus hit older groups harder after the virus penetrated into the community.
"It's very premature to relax," she said, noting that the case-fatality rate calculations for the pandemic virus are unreliable.
She suggested that business pandemic planners focus on what experts do know about pandemic H1N1 flu. For example, she said that although the strain causes mainly mild illnesses in many patients, it has the capacity in some patients to cause severe pneumonia with hemorrhagic damage to the lungs. "This is not what we see with regular seasonal flu pneumonia, typically," she said.
The public is getting mixed messages about the pandemic H1N1 vaccine, which could be sowing confusion, she said. Though the nation has the technical capability to deliver the vaccine, it's not clear how beneficial it will be and how readily people will accept it.
Gerberding said businesses can help public health officials by getting clear, consistent messages out to the workforce about the H1N1 vaccine.
More tools are needed to respond to the pandemic, she said. For example, clinicians desperately need more antiviral treatment options. She predicted that new data will be published in the months ahead that will show benefits of nonpharmaceutical measures to reduce the spread of the flu.
She likened the pandemic flu developments to the evils that spilled out of Pandora's box in Greek mythology, but observed that not all of the box's contents were bad. "Pandora didn't just have evil, she had hope," Gerberding said. "Even if there are challenges, there's still a reason to hope—to take action to empower our organizations to solve these problems."
The fundamental unpredictability of influenza was the theme of Michael T. Osterholm, PhD, MPH, who followed Gerberding at the conference lectern today. He stressed that no one can predict the course of the current pandemic, and businesses must be prepared to make quick decisions as it evolves.
"I can't find any two pandemics in history that are alike," said Osterholm, director of the Center for Infectious Disease Research and Policy, sponsor of the conference. "We can surely learn from the past, we can anticipate from the past, but we can't predict from the past."
He noted that pandemic planning in recent years has been shaped largely by the threat from the H5N1 avian influenza virus. "Now will we have people asking us, 'Did you scare the hell out of me needlessly?'" he said, but added, " Id rather be prepared for something that doesn't happen than be unprepared for something that does."
Describing the complex and confusing nature of the H1N1 pandemic, Osterholm pointed out two news reports that appeared the same day, one reporting that people in poor countries are more likely to die of the infection than those in wealthier countries, another saying that the death rate in H1N1 cases is about the same as that for seasonal flu.
"For about 99% of people this [H1N1] is a pretty mild situation," he said. "But for the other 1% this is not a good illness. . . . People really die."
With the pandemic's second wave now rising in the Northern Hemisphere, one big question is whether there will be a third wave, Osterholm said. Some previous pandemics occurred in three waves, and the third was the most severe in some cases.
He summed up the situation by quoting a point made by a group of experts convened by the World Health Organization last May: "The only thing that's certain about influenza viruses is that nothing is certain."
With most of the current H1N1 cases breaking out in school children and college students, the "zillion dollar question" is when the virus will start spreading more widely among adults, he said.
Global vaccine supply poor
He advised his listeners not to overestimate the impact of H1N1 vaccines on the pandemic. The United States' top 15 trading partners have a combined population of 3.2 billion, but they have ordered only 443 million doses of H1N1 vaccine, enough to cover about 14% of the population. Countries like Canada and Germany have ordered enough to protect most of their people, but in India and China the doses on order will cover less than 0.5% of the population, he said.
Osterholm also warned that the pandemic could pose a severe challenge to critical care resources. "We tapped that intensive care capacity to the max in the spring," he said. "If we see a 20% to 30% increase in intensive care activity [this fall and winter], we are going to see a big increase in deaths."
In this complex and confusing situation, "balancing our messages and our responses is going to be difficult," he said. He urged business people to pay attention to flu developments not only at home but also abroad.
While deaths are important, "this pandemic may be even more about absenteeism—about how long you can operate without people who are sick themselves or are caring for sick people," he said.
Osterholm urged his audience to adopt a "battlefield mentality."
"We're going to have to make quick decisions. If we lose our lieutenants, how do we replace them with sergeants?" he said.
Quoting Churchill, he added, "Plans are useless, but planning is invaluable."