International SOS

Swine Flu Briefing

Dr Armid Azadeh
Pandemic Specialist
Agenda for today…

•Evolution of the Threat

•Swine Flu – How it all Started
•Is this a PANDEMIC?
•What can you do now?
Evolution of the Threat

Thursday,
April 23rd
Mexico: 120 / 20
Mexico City – 115 / 20
3 other regions – 5

USA: 2
2 California
Evolution of the Threat

Friday,
April 24th
Mexico: 850 / 59
• Schools Close
• Airport Screening

USA: 6
4 California, 2 Texas
Evolution of the Threat

Saturday,
April 25th
Mexico: 1324 / 59
• No public gatherings
• Closed libraries

USA: 8 - add 2 Kansas

Suspect NYC (8)
Evolution of the Threat

A Fast Moving Target: Where We are Now

Evolution of the Threat
Country Cases What Else?
Mexico Many Most severely impacted (33 confirmed)
Suspect 1,600+ cases and 150 deaths
US 91 New York, Texas, California, Kansas, Massachusetts,
Michigan, Arizona, Indiana, Nevada, Ohio.
Canada 13 Two provinces: Nova Scotia (4), British Columbia (2)
New Zealand 3 Another 11 likely to be confirmed from group of 25 students
Israel 2 Both traveled to Mexico
UK 5 Scottish honeymooners
Spain 10 Travel partners
Germany 3 Bavaria, Hamburg
Costa Rica 2 San Jose, Heredia
Austria 1 Vienna
Peru 1 Lima

As of April 30th
Evolution of the Threat
S-OIV (Swine-Origin Influenza Virus) flu:

ƒ Symptoms similar to seasonal human influenza.

o Mild to severe.
o 1-4 days after exposure to get sick on AVERAGE
o EARLY: Sore throat, Runny nose (clear) and Itchy eyes
o PROGRESSION: Fever, Muscle Aches, Fatigue, Joint Aches, Cough
ƒ S-OIV Outside Mexico
¾ Most cases presented as mild.
¾ Few cases required hospitalization
¾ Only one death to date in Texas, so far, low % death
ƒ S-OIV in Mexico
¾ Mild to severe
¾ Some resulting in death but likely a much higher
number of infections, so % deaths unknown
Evolution of the Threat
Influenza: How it is spread

ƒ Mainly by ‘droplet’ spread – “drops” to ground

o Droplets containing the virus produced when coughing, sneezing and talking
o Deposited in mouth, nose, eyes, or via common surfaces

ƒ Possible by ‘Aerosol’ spread – “floats” in air (1 meter rule)

o Unusual
o Possible in very crowded conditions
o Subways, Planes

Why Influenzas can spread quickly:

¾ May be contagious BEFORE developing symptoms (1 to 2 days)
¾ Contagious for 7-10 days AFTER symptoms develop; children can be longer
¾ Some cases are mild and undetectable
¾ Virus can survive on hard surfaces for many hours (i.e. door handles, etc.)

According to the CDC and WHO this virus is unlikely to be contained

Evolution of the Threat
WHO
Inter-pandemic phase Low risk of human cases 1
New virus in animals,
Higher risk of human cases 2
no human cases
No or very limited human-to-human
Pandemic alert 3
transmission
Evidence of increased
4
New virus causes human-to-human transmission
human cases Evidence of significant
5
human-to-human transmission

Efficient and sustained significant

Pandemic 6
human-to-human transmission
Evolution of the Threat
WHO
Inter-pandemic phase Low risk of human cases 1
New virus in animals,
Higher risk of human cases 2
no human cases
No or very limited human-to-human
Pandemic alert 3
transmission
Evidence of increased
4
New virus causes human-to-human transmission
human cases Evidence of significant
5
human-to-human transmission

Efficient and sustained significant

Pandemic 6
human-to-human transmission
Swine Flu – How it all Started

Usually infects pigs

Infections in Humans uncommon
2005-2009: 12 cases in the USA
1988 (Sept.): 1 fatal case in Wisconsin
1976: 200 cases (1 fatal) in an outbreak in New Jersey

S-OIV is a new strain

Swine Flu – How it all Started

Pig farm and Mexican child?

Probably started end of March
April 22nd – CDC and WHO find cases in California
and Texas to be linked to Mexico, days before further
cases in North America, EU, and Middle East.

Prior to S-OIV: Close pig contact

This virus: Human to Human spread
Swine Flu – How it all Started

•S-OIV (Swine-origin
Influenza Virus)

•H1N1

Source: http://www.sciencemag.org/cgi/content/full/299/5612/1502
Is this a PANDEMIC ?

The Pandemic Clock is

ticking…we just don’t know what
time it is.

Edgar Marcus
University of Washington School of Medicine
Is this a PANDEMIC ?

Credit: US National Museum of Health and Medicine

1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”

50 million deaths 1-4 million 1-4 million

deaths deaths
Is this a PANDEMIC ?

Pandemic Severity Index (PSI)

“The substantial difference in

the severity of the illness
associated with infections from
the same virus, the relatively
low number of cases detected
in the United States, and
insufficient epidemiologic and
clinical data to ascribe a PSI”
•CDC Apr 09
Is this a PANDEMIC ?
• Number 1 threat to Business Continuity Today
• The threat is increasing
• Possibly 60-100 million dead (HIV has 40 million)
• Significant disruption to global economy (ADB
postulates a decrease in global GDP of 800
Billion $)
• Business is Darwinian “Survival of the Fittest”
What can you do NOW?

Protect yourself: Non Pharmaceutical Interventions

Hygiene, Hygiene, Hygiene
Hand washing can decrease respiratory infections by

35%
Hand sanitizers can kill 95% of germs on your hands
Stay away from crowded areas
What can you do NOW?

Protect yourself: Personal Protective Equipment

• Surgical masks can prevent droplet spread
• Ideal for crowded areas
• N95 masks, gloves, gowns?
• Avoid contact rather
What can you do NOW?

Protect yourself: Seasonal Vaccination

• Does not seem to protect against S-OIV
• Diagnostic benefits
• Continue normal best practice use
• 6 months before S-OIV specific vaccine
What can you do NOW?
Protect yourself: Antiviral medication
Tamiflu (oseltamivir) and Relenza (zanamivir)
Roche’s priorities
1) WHO
2) Pending Government and other orders
3) New Government orders
What can you do NOW?

Protect your business: Pandemic Consulting

• Implement existing Pandemic Preparedness
Plans (PPP) or
• Develop a customized PPP
• Provides a Crisis Management Tool
• Complements Business Continuity Initiatives
• Pre-emptive measure, development is not
suitable for Phases 4-6
What can you do NOW?

Stay Informed: Keeping your finger on the pulse

http://urgent.internationalsos.com
Pandemic Information Services (PIS)
What can you do NOW?
What can you do NOW?
What can you do NOW?
What can you do NOW?
 Take home message

1) Pandemic is a real risk (yesterday – birds,

today – pigs, tomorrow - ?)
2) Hygiene, Hygiene, Hygiene!
3) Secure, trusted information source
PIS screenshots