H1N1 Update: Regina Phelps on 'How Bad is It?'

The fall flu season has begun in the U.S., and the news each day is filled with stories about H1N1 (swine flu) outbreaks at schools and businesses. But how bad is the outbreak? Is it on a par with a typical flu season? Far better or far worse?

To help separate fact from fiction, noted pandemic expert Regina Phelps discusses:

Current realities of H1N1;
What organizations should be doing now - especially with Halloween approaching;
Lessons learned and what to expect next.

Phelps is an internationally recognized expert in the field of emergency management and continuity planning. With over 26 years of experience, she has provided consultation and educational speaking services to clients in four continents. She is founder of Emergency Management & Safety Solutions, a consulting company specializing in emergency management, continuity planning and safety.

TOM FIELD: Hi, this is Tom Field, Editorial Director with Information Security Media Group. We're talking today about the H1N1 virus. Where is it, how is it, and how are we coping? We're talking with Regina Phelps, foremost expert in pandemic preparation. Regina, it's a pleasure to talk to you again.

REGINA PHELPS: Thanks, Tom. It's great to be here.

FIELD: Well, here we are in the current pandemic. What's the key news right now for businesses and government organizations?

PHELPS: Well, we're actually in a week 40, and we are technically in week 10 of Wave 2 in the United States. We have a significant number of cases throughout the U.S. When the CDC reported cases last week, we actually had 41 states in the U.S. reporting widespread cases. So, 41 of the 50 states have widespread cases. That's fairly significant. Also, too, we have an increasing number of pediatric deaths that have been occurring. About 90 so far this year, which is double the amount that normally die during seasonal flu. And just to remind you, seasonal flu has not yet begun in the U.S. We also have a fair number of deaths that have been accounted for in the area of influenza-like illnesses and pneumonia. There're only about 300 deaths in the U.S. that have been attributed directly to H1N1 through lab-confirmed testing. However, there're about roughly 2,500 deaths that have occurred that are from influenza-like illnesses and pneumonia that were not sub-typed in the H1N1. So, the net net, is even though the disease remains very mild, there's still a significant number of illnesses, hospitalizations and deaths, and an increasingly an issue in young people.

FIELD: Regina, you mentioned that the fall flu season hasn't struck yet in the U.S., but give us some perspective on what we're seeing so far from H1N1 versus what we would see in a normal flu season.

PHELPS: That's a great question. So, first of all, we're much earlier with the number of flu illnesses that we are seeing. Normally, the flu season begins around the first part of October and really begins to escalate into November-December-January. We've already had major case activity in H1N1 without the seasonal flu yet beginning. So, we're probably going to see this year alone, when we add in the deaths and hospitalizations with seasonal flu, probably somewhere around the number of 90,000 or so deaths through this calendar year and probably at least 500,000 hospitalizations if we stay on the current level that we are, which is combining H1N1 and seasonal flu. To contrast that for you, seasonal flu every year normally produces 36,000 deaths and about 200,000 hospitalizations. So, we're looking at doubling all of that if not a little bit more than that.

FIELD: Now, we hear different accounts about how strong the virus has been in different generations of people. In your estimation, how sick have people been getting, and how quickly is the virus spreading?

PHELPS: Well, you know, the interesting thing about this virus, Tom, is it is highly contagious; it is more contagious than usual seasonal flu, so, it spreads like wildfire. Now, the majority of individuals have very traditional times of illness, like 5 to 10 days, which is typical for most flu. The disease presents some unusual characteristics: Between 10 and 30 percent of the victims of the H1N1 do not have a fever at all -- very unusual -- and about a third of them have gastrointestinal distress; diarrhea and vomiting in particular. So, the symptoms are somewhat different. From the perspective of the illness, it does affect young people substantially more than it does older folks. If you were born before 1957, your chances of having this illness and having a serious case of it are somewhat diminished. But for younger people, there has been an increasing number of cases of what's called Acute Respiratory Distress Syndrome, which is a really severe lung issue that requires immediate hospitalization, placed in an Intensive Care Unit, and being placed on mechanical ventilators, and some of those mechanical ventilators are like a heart-lung machine, and in those cases, about 40% of those young people have no pre-existing conditions, so no asthma, no cardiovascular disease, very healthy, young people who end up getting this illness, and it just really significantly impacts them.

FIELD: Now, Regina, I've had the chance to walk by a couple of televisions this week, and what struck me is, as I saw on CNN in fact, news anchors talking about myths of H1N1. And in a case of a school, I believe in Illinois, that was shut down because half of the students were reportedly ill, one of the anchors actually alleged that half of the students might be faking the illness. That struck me to wonder, are we taking this too seriously or not seriously enough?

PHELPS: You know, I find this so interesting that the news media has that kind of attitude. I think we are taking this very seriously. I think some news agencies are a little flippant in their coverage of this, as I've seen it, and I'm not sure what's driving that, but I think if you look at, for example, colleges and universities across the United States, many of them have been really hit hard, and they have taken this very seriously, which is good, of course. For any of your listeners that have kids off in college, they want to know that those colleges are taking this very seriously by setting up things such as isolation wards and special-care units for these sick kids. But this is really something that we need to take seriously. It is nothing that we should be flippant about; it's a disease that's never existed before; it's constantly shifting and changing, and just because it's producing mild illness in the vast majority of people that get it, I do want to remind your listeners that, there are people dying today from this illness that are young and healthy. Just in our client population alone globally, we've had three deaths, and I've had several people I know personally who've been admitted to ICU, so I would encourage people to take this seriously; it's nothing to dismiss.

FIELD: One thing that struck me is next week in the U.S. is Halloween. You've got lots of offices who are having parties, they're having children come in and parade around, people are going to be engaging in trick-or-treating. Should we change our behavior this year?

PHELPS: You know, I have thought about this long and hard. Personally, you know, what I would say to a person with children, first of all, is that it's one day out of a year. You're going to place your kid potentially in a lot of risk by having them go home-to-home, walking down the streets with lots of kids, especially in environments where the flu is present, and in environments where the weather is cool, and the flu happens to love cool, moist weather. So personally, if I was a parent, I'd be very inclined to do something very different. Maybe do something very special for your child, but not necessarily do something traditional, and certainly not take them to parties where they're hanging around lots of other kids and handling all kinds of things that everybody else's hands have already touched. If you're going to be doing any sort of Halloween or holiday-related parties during the flu season while the pandemic is still with us this fall and winter, I would think that you'd want to be thinking about the kinds of foods that you serve and the kind of things -- or how you organize the party. For example, you might want to be serving finger foods that are basically something that somebody could pick up off of a tray, and they're not touching or handling serving utensils, just minimizing the amount of touching and handling of different things that people are doing, so that we are not then touching those surfaces and then touching our face, our hands to our nose or mouth, and then potentially infecting yourself. So, I would just encourage people to think about this a little bit differently. Not to put a damper on people's enjoyment of the holidays, but just to be a little smarter.

FIELD: So, probably not the best time to be inviting all the families into the office this year?

PHELPS: I wouldn't -- especially children, because children really are germ factories, if you will, and you bring one kid in, even the slightly ill or does not know they're ill yet but incubating the disease and contagious, that's all it would take to really get a lot of folks ill in an office.

FIELD: What do we expect to see next in this pandemic, Regina?

PHELPS: Well, the good news is that the vaccine is now being distributed. The bad news about that is that it's very slow. They're having difficulty in manufacturing the numbers of vaccines that they need, and the vaccine that's out right now in the largest numbers is called Flu Mist, and this particular vaccine is the one that's the aerosol that's taken in through the nose. It has a live virus in it and cannot be given to individuals who have asthma, lung conditions or pregnancy, which are the highest risk individuals. So, until we get lots of more injectible vaccine available in the U.S., we're going to be in a position where it's going to be difficult for us to be protecting those most vulnerable, young children, infants, as well as pregnant women and those with underlying medical conditions. So, I would just think that as we go through this fall, until the vaccine becomes widely available, which frankly will probably take another two months, I think people are just going to have to exercise caution and especially if they are in a high-risk group, or they have young children in their household, and by that, I would define them under the age of 18. They should be really exercising caution, really being careful about hygiene, good hand washing, cough protection, not touching your face, avoiding a lot of large crowds if you can, just being smart until people are well vaccinated, and once we get to what's called herd immunity, which will be somewhere around 50 or 60 percent of the population either being vaccinated or have gotten the illness. We're still going to have a lot of wide-spread disease this fall and winter.

FIELD: Regina, one last question for you. You certainly have traveled far and wide this year. Of the businesses and the agencies you've visited with so far, what would you say are lessons learned by these organizations from the pandemic experience?

PHELPS: Well, you know, I've really noticed a lot of different changes within businesses in particular, Tom, and what I've noticed is, that employers are much more interested and concerned in promoting health in ways I really haven't seen before. For example, the annual seasonal flu shot -- many employers have had programs like that in the past. I have seen many more employers promoting seasonal flu shots, bringing contractors onto their sites to actually give out injections at very little or no cost, and also providing a great opportunity for employers to then educate employees on their overall pandemic program, health awareness. My theory about that, of course, this is from my nursing background, when you have a needle in somebody's arm, you have a great opportunity to educate them. So, I've really seen great seasonal flu programs and also really excellent educational opportunities. But also to that end, I've also seen just changes in posters, for example, in restrooms, where people are really encouraged to wash their hands. I've seen displays in lobbies and in break rooms and in cafeterias that I normally don't see. Brown-bag educational programs for employees promoting health and wellness and really educating folks about seasonal and pandemic influenza. I've also seen employers promoting stay-at-home-if-you're-sick, really encouraging people to stay home if they're ill, as the CDC has been encouraging folks to do over the last few months, and really just an overall heightened awareness. So, I think all of that is really good. I've also noticed that even when people start meetings, for example, they encourage people not to shake hands. Or, for example, see hand sanitizers widely used throughout an office environment. Or before a meeting even starts, somebody passing a bottle of hand sanitizer around. So, a lot of really good, smart changes in people's behavior that I've noticed in the work environment, and I'm really hopeful that these changes continue on after our pandemic has changed and evolved and concluded in the fall season.

FIELD: Regina, as always, I'm grateful for your update and for your insights.

PHELPS: Tom, as always, it's great talking to you.

FIELD: We've been talking about H1N1. We've been talking with Regina Phelps. For Information Security Media Group, I'm Tom Field. Thank you very much.




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