New Report Finds 10 Early Lessons Learned from the H1N1 Outbreak

Washington, D.C. - Trust for America's Health (TFAH), the Center for Biosecurity, and the Robert Wood Johnson Foundation (RWJF) issued a new analysis today, Pandemic Flu: Lessons From the Frontlines, which found that the initial response to the H1N1 outbreak showed strong coordination and communication and an ability to adapt to changing circumstances from U.S. officials, but it also showed how quickly the nation's core public health capacity would be overwhelmed if an outbreak were more severe or widespread.
"H1N1 is a real-world test of our initial emergency response capabilities -- all of the planning and preparations have paid off. The country is significantly ahead of where we were a few years ago," said Jeff Levi, PhD, Executive Director of TFAH. "However, the outbreak also revealed serious gaps in our nation's preparedness for pandemic flu and other public health emergencies."
The Pandemic Flu: Lessons from the Frontlines report reviews 10 early lessons learned from the response to the H1N1 (swine) flu outbreak, 10 ongoing core vulnerabilities in U.S. pandemic flu preparedness, and case studies of challenges communities around the country faced when responding to the outbreak. The 10 early lessons learned from the 2009 H1N1 outbreak in the report were that:
Investments in pandemic planning and stockpiling antiviral medications paid off;
Public health departments did not have enough resources to carry out plans;
Response plans must be adaptable and science-driven;
Providing clear, straightforward information to the public was essential for allaying fears and building trust;
School closings have major ramifications for students, parents and employers;
Sick leave and policies for limiting mass gatherings were also problematic;
Even with a mild outbreak, the health care delivery system was overwhelmed;
Communication between the public health system and health providers was not well coordinated;
WHO pandemic alert phases caused confusion; and
International coordination was more complicated than expected.
"Its critical to understand what worked as planned in the H1N1 response, as well as to look at what needs to be strengthened, fixed, or better funded. This report is a contribution to that effort," said Thomas Inglesby, MD, Deputy Director, Center for Biosecurity of UPMC.
The report also identified some surprises encountered during the H1N1 outbreak, including that much of the world's pandemic planning had revolved around the potential threat of the H5N1 (bird) flu virus, which had been circulating in Asia and elsewhere for nearly a decade. It also reveals that planners anticipated there would be six weeks of lead time between the time a novel flu virus was identified and its spread to the United States.
In addition, according to the analysis in Pandemic Flu: Lessons from the Frontlines, there are a number of systemic gaps in the nation's ability to respond to a pandemic flu outbreak. To further strengthen U.S. preparedness, the following 10 core areas must be addressed:

1. Maintaining the Strategic National Stockpile -- making sure enough antiviral medications, vaccinations, and equipment are available to protect Americans, which includes replenishing the stockpile when medications and supplies are used;

2. Vaccine development and production -- enhancing the biomedical research and development abilities of the United States to rapidly develop and produce a vaccine;

3. Vaccinating all Americans -- ensuring that all Americans would be able to be inoculated in a short period of time;

4. Planning and Coordination -- improving coordination among federal, state, and local governments and the private sector preparedness and planning activities on an ongoing basis, including taking into account how the nature of flu threats change over time;

5. School closings, sick leave, and community mitigation strategies -- improving strategies to limit the spread of disease ensuring all working Americans have sick leave benefits and that communities are prepared to limit public gatherings and close schools as necessary;

6. Global coordination -- building trust, technologies, and policies internationally to encourage science-based, consistent decision making across borders during an outbreak;

7. Resources -- providing enough funding for the on-the-ground response, which is currently under funded and overextended;

8. Workforce -- stopping layoffs at state and local health departments and recruiting the next generation of public health professionals;

9. Surge capacity -- improving the ability for health providers to manage a massive influx of patients; and

10. Caring for the uninsured and underinsured -- ensuring that all Americans will receive care during an emergency, which limits the spread of the contagious disease to others, and making sure hospitals and health care providers are compensated for providing care.

The full analysis is available on TFAH's Web site at www.healthyamericans.org. The report was supported by a grant from RWJF.
Trust for America's Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. www.healthyamericans.org

Global Testing Shows No Variation in Swine Flu Virus

Experts worry that it could mutate and become more dangerous as it travels from country to country

THURSDAY, June 4 (HealthDay News) -- In what would seem to be some encouraging news in the ongoing H1N1 swine flu outbreak, a leading federal health official said Thursday that samples of the virus from points around the globe are genetically identical to the strain found in the United States.

"We have tested isolates from a wide geographic area, from the Americas, Europe, from Asia and New Zealand and we are not seeing variations in isolates from the genetic testing we do here," Dr. Anne Schuchat, the Centers for Disease Control and Prevention's interim deputy director for science and public health program, said during a press conference.

While infections caused by the virus continue to be relatively mild and patients recover quickly, health officials have warned that the virus could mutate into a more virulent form, putting greater numbers of people at risk.

The World Health Organization said Tuesday that it was weighing whether to declare a global pandemic, with more cases of the H1N1 swine flu surfacing in the Southern Hemisphere -- where flu season is just beginning -- and outside North America.

The vast majority of infections and deaths have occurred in Mexico -- the source of the outbreak -- and the United States. But person-to-person transmission in now being reported in countries such as Australia (501 cases) and Chile (313 cases), as well as Great Britain, Spain and Japan, according to published reports.

"We still are waiting for evidence of really widespread community activity in these countries, and so it's fair to say that they are in transition and are not quite there yet, which is why we are not in phase 6 yet," WHO flu chief Dr. Keiji Fukuda said during a press conference at the agency's headquarters in Geneva, Switzerland.

Phase 6 is the highest alert on WHO's scale, representing a global epidemic. In terms of the geographic spread of swine flu, the world is "at phase 5 but getting closer to phase 6," Fukuda said, the Associated Press reported.

The WHO also was debating whether to add a second measure that indicates how dangerous the H1N1 swine flu virus is -- rather than just how widespread -- after several countries expressed concerns that declaring a global pandemic could cause mass confusion and panic even though it's still not clear how dangerous the virus will be, the news service said.

To date, the virus has caused 19,273 cases of infection in 66 countries, but just 117 deaths, 97 of them in Mexico, the WHO reported Wednesday.

Since the outbreak started in April, health officials in the United States have said that infections have been mild for the most part. Testing has found that the H1N1 virus remains susceptible to two common antiviral drugs, Tamiflu and Relenza.

The U.S. Centers for Disease Control and Prevention was reporting Wednesday a total of 11,054 cases in all 50 states and the District of Columbia and Puerto Rico, including 17 deaths. The agency said that confirmed cases of H1N1 swine flu represent about one in 20 of actual cases, bringing the total probable number of cases in the United States to about 200,000.

During the next few months, CDC scientists will be looking to see if the virus mutates or becomes resistant to antiviral medications, or is more easily spread among people. The flu season is winding down in the Northern Hemisphere but is just beginning in the Southern Hemisphere.
Some older people may have partial immunity to the H1N1 swine flu virus because of possible exposure to another H1N1 flu strain that circulated prior to 1957, according to the CDC.
A vaccine for the swine flu virus could be ready by October, if research and testing proceed as planned this summer, agency officials said.

U.S. Human Cases of H1N1 Flu Infection(As of June 3, 2009, 11:00 AM ET)
States & Territories* # confrm'd & pr'bable cases Deaths
Alabama 94
Alaska 1
Arkansas 9
Arizona 547 4 deaths
California 804
Colorado 68
Connecticut 196
Delaware 135
Florida 194
Georgia 32
Hawaii 94
Idaho 16
Illinois 1151 3 deaths
Indiana 146
Iowa 92
Kansas 87
Kentucky 90
Louisiana 122
Maine 12
Maryland 63
Massachusetts 566
Michigan 287
Minnesota 66
Mississippi 34
Missouri 41 1 death
Montana 15
Nebraska 43
Nevada 113
New Hampshire 50
New Jersey 74
New Mexico 108
New York 646 4 deaths
North Carolina 21
North Dakota 18
Ohio 29
Oklahoma 87
Oregon 159
Pennsylvania 226
Rhode Island 16
South Carolina 49
South Dakota 9
Tennessee 103
Texas 1403 3 deaths
Utah 369 1 death
Vermont 7
Virginia 36
Washington 574 1 death
Washington, D.C. 20
West Virginia 3
Wisconsin 1905
Wyoming 18

Territories
Puerto Rico 6

TOTAL*(52)
11,054 cases
17 deaths
*includes the District of Columbia and Puerto Rico

Source: U.S. Centers for Disease Control and Prevention

SOURCES: June 4, 2009, teleconference with Anne Schuchat, M.D., U.S. Centers for Disease Control and Prevention's interim deputy director for science and public health program; Associated PressHealthDay