New Report Finds 10 Early Lessons Learned From The H1N1 Outbreak

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, Ph.D., 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: 1. Investments in pandemic planning and stockpiling antiviral medications paid off; 2. Public health departments did not have enough resources to carry out plans; 3. Response plans must be adaptable and science-driven; 4. Providing clear, straightforward information to the public was essential for allaying fears and building trust; 5. School closings have major ramifications for students, parents and employers; 6. Sick leave and policies for limiting mass gatherings were also problematic; 7. Even with a mild outbreak, the health care delivery system was overwhelmed; 8. Communication between the public health system and health providers was not well coordinated;

9. WHO pandemic alert phases caused confusion; and 10. 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. 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. The Center for Biosecurity is an independent, non-profit organization of the University of Pittsburgh Medical Center. Their mission is to strengthen national security by reducing the risks posed by biological attacks, epidemics, and other destabilizing events and to improve the nation's resilience in the face of such incidents. The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need -- the Foundation expects to make a difference in our lifetime. Source: Trust for America's Health
Source Welsh Assembly Government

Swine Flu Media Bulletin Issued At: 11am Thursday 21 May 2009, Wales
- 1 confirmed case in Wales (a 31 year old male from the Caerphilly local authority area. He has had mild flu symptoms, has been offered antivirals and is recovering at home).

- 0 probable cases in Wales. - 98 people have been under investigation in Wales. Of these, swine flu has been confirmed in one case (see above) and ruled out in 89 cases, leaving eight still under investigation. All of these are displaying, or have displayed, mild symptoms. - Of the eight people under investigation, six were well when first identified, but reported recent flu-like symptoms following travel to affected areas. Blood tests are being undertaken on these individuals to see if they had the flu and to help the NPHS understand the pattern of the disease from the past. Their symptoms may or may not have been due to swine flu. Testing will be conducted in a number of weeks to check whether these people did have swine flu - scientifically it won't work before that. Investigations have shown that people they had close contact with did not catch flu from them when they were ill. - There are now 230 confirmed cases in the UK - one case in Wales, 17 cases in Scotland, 211 cases in England and one in Northern Ireland. - For the latest international figures for the spread of swine flu, visit the website of the World Health Organization at http://www.who.int Comment from Welsh Assembly Government and National Public Health Service for Wales - Chief Medical Officer for Wales, Dr Tony Jewell, said: "We have made it clear all along that there would be cases in Wales and everyone must continue to be vigilant and try to reduce the spread of the virus. "It is likely that further cases will continue to emerge and we are continuing to monitor the situation very closely. However, while numbers remain low, our focus continues to be on learning as much as we can about the virus and working to slow its spread. "Our advice to the public remains the same, people should follow good respiratory and hand hygiene to help prevent the spread of influenza - always using a tissue to catch sneezes, throwing away used tissues where germs can linger and regularly washing your hands, or cleaning them with a sanitising gel. "Although it is natural for people to feel apprehensive, we would like to reassure the public that we have been working to prepare for the arrival of the virus for many years and have robust procedures in place." - Dr Roland Salmon, Director of the Communicable Disease Surveillance Centre, National Public

Health Service for Wales, said: "We continue to advise that anyone who has flu-like symptoms and has travelled to one of the affected areas should stay at home and phone their GP or NHS Direct Wales on 0845 46 47. "People should not go to Accident and Emergency Departments or to their GP surgery without ringing first, as this may risk spreading the infection. It also places undue pressure on the emergency services. "Although there are indications that this flu is mild, we know that seasonal flu can be severe, particularly for elderly and vulnerable people, so there is still good reason for us all to take action to reduce its effects. Flu is often confused with a bad cold but is in fact far more serious and leads to many deaths each year in Wales. "The National Public Health Service for Wales will continue to assess any person with flu-like symptoms who has travelled to affected areas." Public health advice and messages - If you have returned from an affected area and have flu-like symptoms, stay at home, phone your GP or NHS Direct Wales and you will be assessed and receive treatment if necessary. Do not go into your GP surgery or Accident and Emergency department unless you are advised to do so or are seriously ill, as you may spread the illness to others. - Further information including health advice can be found at http://www.wales.gov.uk, http://www.nphs.wales.nhs.uk and http://www.hpa.org.uk. You can also call the Swine Flu Information line on 0800 1 513 513 for recorded information, or NHS Direct Wales on 0845 46 47 for health advice. -- It is always good practice to follow respiratory and hand hygiene such as: - Covering your nose and mouth when coughing or sneezing, using a tissue when possible. - Disposing of dirty tissues promptly and carefully. - Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people. - Cleaning hard surfaces (e.g. door handles) frequently using a normal cleaning product. - Helping your children follow this advice. Facemasks - Although we are aware that facemasks are being given out to the public in Mexico, the available

scientific evidence does not support the general wearing of facemasks by those who are not ill whilst going about their normal activities. We are, however, reviewing NHS supplies and stockpiles of facemasks for healthcare workers who are likely to come into regular contact with people who may have symptoms. The UK will receive an additional five million surgical facemasks and an extra 1.6 million respirators. Wales will receive 4.9% of this stock for its healthcare staff. Control measures - Agreements have been signed between the UK Government and vaccine manufacturers to secure supplies of up to 90 million doses of H1N1 vaccine before the autumn. This will not affect the usual seasonal flu vaccination and will be made available to frontline healthcare workers and vulnerable people. Advance purchase arrangements are also in place to buy enough vaccine for the whole population should a pandemic be declared. - The Welsh Assembly Government's Health Emergency Preparedness Unit has issued guidance to Local Health Boards on anti-viral distribution. The unit is co-ordinating work on identifying appropriate collection points and the necessary arrangements to support this process. - People who have travelled to affected areas and have flu-like symptoms have been advised to stay at home and call NHS Direct Wales on 0845 4647 or phone their GP for health advice. - The national Swine Flu Information line - 0800 1 513 513 - provides recorded information. People requiring health advice should contact NHS Direct Wales on 0845 4647. - The National Public Health Service for Wales has provided advice to port health authorities on arrangements for returning travellers. Features of the outbreak - Based on assessment of all available information and following several expert consultations, the World Health Organization (WHO) has declared the level of influenza pandemic alert at phase 5. - Phase 5 indicates that WHO considers a global pandemic to be imminent. This change is a signal to countries' governments to ramp up their pandemic preparations. - More investigations and testing are needed to determine the severity of the disease and the ease with which it can spread. These investigations are currently underway with the support of the WHO. - Testing has shown that the human swine influenza H1N1 can be treated with the antiviral

oseltamavir (Tamiflu) and zanamivir (Relenza). - Evidence of sustained person to person spread in Mexico and the USA. Person to person transmission of swine flu has also been confirmed in other countries across the world. - Further information on Swine Flu and Pandemic Flu is available bilingually from http://www.nphs.wales.nhs.uk - Further information from the Welsh Assembly Government response is available bilingually at http://www.wales.gov.uk