As the start of school looms, vaccination plans, communication efforts and school closure contingencies dominate pandemic planning efforts by the Federal government and public health officials. And all that activity has the public's attention. From a survey of public attitudes about H1N1 from Harvard School of Public Health run in June:
"Approximately six in ten Americans(59%) believe it is very or somewhat likely that there will be widespread cases of Influenza A (H1N1) with people getting very sick this coming fall or winter. Parents are more likely than people without children to believe this will occur, with roughly two thirds of parents (65%) saying it is very or somewhat likely compared to 56% of people without children," HSPH informed.
"These results suggest Americans are likely to support public health officials in prioritizing preparations for the possibility of a serious H1N1 outbreak in the fall or winter," said Robert J. Blendon, Professor of Health Policy and Political Analysis at the Harvard School of Public Health.
A more recent set of questions from ABC/WaPo polling (Q 31-34) suggests around 40% of the public is concerned about swine flu, there's great confidence (whether it's justified is another story) in federal and local abilities to respond, and nearly 2/3 of respondents will get vaccinated if advised to by their doctor.
33. (HALF SAMPLE) Do you think you or someone in your household will get a swine flu vaccination when it becomes available, or not?
Will Will not No opinion
8/17/09 55 41 4
- (HALF SAMPLE) Assuming your doctor recommends it, do you think you or someone in your household will get a swine flu vaccination when it becomes available, or not?
Will Will not No opinion
8/17/09 65 32 3
There's certainly been a resurgence of news stories about H1N1. To cite a few examples, the WSJ is running an FAQ about swine flu, and the Washington Post has a prominent article quoting some of the leading experts in influenza and infectious disease research and practice, including Arnold Monto, Eric Toner, Joe Bresee and Marc Lipsitch (over the years, many including myself have turned to these folks for explanations of the finer points of pandemic lore):
While flu viruses are notoriously capricious, making any firm predictions impossible, a new round could hit the Northern Hemisphere within weeks and lead to major disruptions in schools, workplaces and hospitals, according to U.S. and international health officials.
"The virus is still around and ready to explode," said William Schaffner, an influenza expert at the Vanderbilt University School of Medicine who advises federal health officials. "We're potentially looking at a very big mess."
President Obama arrived in Mexico on Sunday for a two-day summit that will include discussions on swine flu, along with Mexico's drug wars, border security, immigration reform and economic recovery.
"Everyone recognizes that H1N1 is going to be a challenge for all of us, and there are people who are going to be getting sick in the fall and die," said John O. Brennan, the U.S. deputy national security adviser for counterterrorism and homeland security. "The strategy and the effort on the part of the governments is to make sure we . . . collaborate to minimize the impact."
The AP has more on what that collaboration means:
Sit for hours amid the sneezing in an emergency room this fall, and if you didn't arrive with swine flu you just might leave with it.
Fearing swamped ERs, the government is working with worried doctors to develop hot lines or interactive Web sites to help the flu-riddled decide when they really need a hospital - and when to stay home.
With flu season rapidly approaching, the plans aren't finished yet, and it's too soon to know how many people could access such programs.
But, "we are working on triage systems so people will have good information about, 'What will I need to do?'" Dr. Anne Schuchat of the Centers for Disease Control and Prevention told state health officials last week.
Current thinking is that this pandemic more resembles the one in 1957 than the one in 1918 (and that's a very good thing.) As it happens, many of the measures outlined above were used in 1957.
There is need for an understanding in national policy circles of the options for dealing with a pandemic, and time is short if states and local communities are going to be prepared," [DA] Henderson {University of Pittsburgh Medical Center] said...
The authors wrote that though no one can predict how a pandemic will unfold, "we would be ill-served if we did not consider past experience." The 1957 pandemic resembles the 2009 pandemic in that both viruses circulated in the summer months in the United States while the virus hit the southern hemisphere during its normal influenza season. Current disease patterns are also similar to the 1957 pandemic: illnesses are generally mild and the virus predominantly strikes younger people. The 2009 pandemic strain also appears to cause a similar case fatality rate to the 1957 strain, they add.
This is how the 1957 pandemic played out in Europe:
and this is how it played out in the US:
Peter Sandman has some very helpful communication advice, which also sums up the situation nicely:
- Pandemic H1N1 will almost certainly be pervasive.
- Pandemic H1N1 looks very mild so far. [unless you get it! See parallels to 1957 - DemFromCT]
- We must prepare for the possibility that pandemic H1N1 could become more severe.
So what does that last point mean? What preparations are we talking about? In regard to preparations, I had the opportunity along with other bloggers to ask John Brennan and CDC's Rich Besser (now on his way to ABC News) a few questions earlier this summer, and clearly the school preparedness issue was a paramount topic for both questioners and respondents (more below the fold.)
The suggested CDC two-tier school response (see Helpful reading, below)is covered here at Flu Wiki, and includes a less strict response if things stay the way they are now, and a more aggressive response if virulence worsens. The school summaries were provided by one of our regular posters, a teacher with grade school experience:
Current virulence:
Recommended responses under conditions with similar severity as in spring 2009
Stay home when sick
CDC recommends that individuals with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8° C] or greater), or signs of a fever, without the use of fever-reducing medications.
Separate ill students and staff
Hand hygiene
Respiratory etiquette
Routine cleaning
Early treatment for high-risk students and staff
Selective school dismissals
Increased virulence:
Recommended additional responses during times of increased influenza severity
"The strategies which follow use a variety of methods for increasing social distance, while attempting to maintain operability of most schools. Feasibility and acceptability of these strategies will vary considerably across communities. Except for school dismissals, the following strategies have not been scientifically tested. But CDC wants communities to have tools to use that may be the right measures for their community and circumstances."
Active screening for illness
Permit high-risk students and staff to stay home
Students with ill household members stay home
If influenza severity increases, school-aged children who live with people with influenza-like illness should remain home for 5 days from the day the first household member got sick.
Increase social distances within the school environment
If influenza severity increases, schools should explore innovative methods for increasing social distances within the school environment. The goal should be to keep distance between people at most times or to cluster students in small, consistent groups.
(Comment: suggestions include rotate teachers between classrooms while keeping the same group of students; canceling classes that bring students together from multiple classrooms; postpone class trips that bring students together from multiple classrooms or schools in large, densely-packed groups, and discouraging use of school buses and public transit among others listed.)
Extended exclusion period
If influenza severity increases, individuals with influenza-like illness should remain at home for at least 7 days, even if symptoms resolve sooner. Individuals who are still sick 7 days after they become ill should continue to stay home until at least 24 hours after symptoms have resolved.
School dismissals: reactive and preemptive
Resuming classes after a dismissal
The length of time students should be dismissed from school will vary depending on the type of school dismissal as well as the severity and extent of illness. When the decision is made to dismiss students, CDC recommends doing so for 5 to 7 calendar days.
(Comment -- closure for preemptive dismissal might be longer than closure for reactive dismissal).
Reducing adverse effects from school dismissal
The guidance is partly a result of requests from states for more federal direction, even though school closure remains a state and local issue. The thought is that the more practice and preparation that takes place now, the smoother it will be in the fall.
Regarding vaccination efforts, what's currently planned (subject to the result of safety and efficacy trials now ongoing) is 2 novel H1N1 shots at least 3 weeks apart, with 2 more weeks needed for the vaccine to "take" (so a total of five weeks from the initial jab for protection.) If you're getting the seasonal flu shot at the same time, rather than separately or earlier in the season, one jab is recommended in each arm. Since vaccine won't be available for everyone right away, certain high risk groups such as pregnant women, health care workers and school kids will be targeted first.
Vaccination program details are still being worked out state and locally. In fact, the WaPo today has a story about the extensive effort aimed a vaccinating the public:
Government health officials are mobilizing to launch a massive swine flu vaccination campaign this fall that is unprecedented in its scope -- and in the potential for complications.
The campaign aims to vaccinate at least half the country's population within months. Although more people have been inoculated against diseases such as smallpox and polio over a period of years, the United States has never tried to immunize so many so quickly.
But even as scientists rush to test the vaccine to ensure it is safe and effective, the campaign is lagging. Officials say only about a third as much vaccine as they had been expecting by mid-October is likely to arrive by then, when a new wave of infections could be peaking.
Among the unknowns: how many shots people will need, what the correct dosage should be, and how to avoid confusing the public with an overlapping effort to combat the regular seasonal flu.
Stay tuned for more on vaccines from your local public health department, obviously a work in progress. At the current time, there are no adjuvants ("immune boosters" like squalene or MF59) planned, nor do children's swine flu vaccine doses contain thimerosal, so concerns about those issues seem unwarranted. We're all interested in the "hot line and web site" approach covered in the AP article. And recognize that planning is going on for school activities, whether closure happens or not near you (and some schools will undoubtedly close for some period of time.)
Education Secretary Arne Duncan said that some schools "will have to close," and that administrators should be making plans to continue schooling at home, via telephones and the Internet.
Forewarned is better prepared. And news articles that simply say "schools won't close" are missing the bigger picture. This advice and guidance also very much includes businesses. Advice from CDC includes knowing what to do if you get sick, when to stay home and how to take care of yourself if ill.
Helpful reading: