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Dear Friends –

Novel H1N1 is increasing its impact in the northern hemisphere (now considered widespread in most places). The illness rates are already higher than any of the last 3 year’s winters.

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Neither CDC nor WHO have a crystal clear picture about how hard the infection is hitting people. A decision to stop requiring laboratory confirmation, except for hospitalized cases, leaves both agencies slightly handicapped on the statistical side.

An automated system for self-assessment regarding flu, is now available on the web at www.H1N1responsecenter.com — this was developed by Emory University.

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A report by HHS indicates that at least 15 states could exceed ICU capacity. They are currently evaluating a system to share case loads across state lines.

At this point, it’s impossible to predict who is most at risk. While 99% of people who get the swine flu have a relatively mild case (3 or 4 days of discomfort, then back to normal), 1% get very ill, requiring hospitalization. For severe cases, their symptoms change rapidly [when symptoms change rapidly or there are underlying health conditions of concern, early use of antiviral medication is critical]. About 30 to 50% of those go to the ICU and some die. Those who recover from ICU treatments (upwards of 12 days in ICU) frequently have longer term complications. The major target of the virus continues to be the young (50% are children & teens). Death rates due to flu are at unprecedented levels for this time of the year.

Two good articles in NEJM report on the study of H1N1 impact on patients & hospitals: http://content.nejm.org/cgi/content/full/NEJMoa0908481?query=TOC   and http://content.nejm.org/cgi/content/full/NEJMoa0906695?query=TOC

The continuing good news is that the virus has not mutated and while it continues to spread, severity is not increasing. But there are a lot of sick people out there.

The CDC has updated its recommendations for international travelers: http://wwwnc.cdc.gov/travel/content/news-announcements/delays-H1N1-screening.aspx

Minnesota is now proceeding with the same tactic that the UK implemented earlier. A “hot line” phone system is in place to screen patients and prescribe antiviral medication.

President Obama has declared the H1N1 pandemic flu to be a national emergency. The flu is widespread and appears to be growing in intensity. So far, the CDC has indicated over 1,000 deaths (including more than 100 children). The death rate attributed to pneumonia and influenza is above the epidemic threshold. The emergency declaration will sweep away many bureaucratic procedures that tend to slow response.

In the ICU, ventilators become very important. Most success is coming with an advanced ventilator called ECMO, because patients present with low levels of oxygen in their blood. The ExtraCorporeal Membrane Oxygenation is a special procedure that uses an artificial heart-lung machine to take over the work of the lungs.

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– Novel H1N1

This is probably one of the most tested influenza vaccines. All indications are that side effects are minimal, no greater than the typical seasonal flu vaccination.

While many states have received some swine flu vaccine, the local supply is spotty at best – lower output from manufacturing & glitches in distribution are the main culprits – this is expected to smooth out as additional vaccine arrives


– China

WHO has indicated that seasonal H3N2 is responsible for half the flu in China. This is different from the U.S., where over 99% is pandemic H1n1.

– UK

The UK, along with Germany, and others in the EU have begun to roll-out H1N1 vaccinations.

– Japan

Japanese scientists have found the antiviral drug Tamiflu (oseltamivir) in two rivers. The main concern about antiviral drugs in surface water is that wild birds are a natural reservoir for flu viruses. Exposing birds to this medication may lead the virus to evolve into a drug resistant strain.

            Over 6,400 schools have been closed due to H1N1.


If you want to review some flu myths, and why they’re wrong: http://www.nytimes.com/2009/10/12/opinion/12offit.html


If you live alone, consider teaming up with a flu pal (someone who will bring you food & medication and call a few times a day to check on you).

Employers should review their pandemic preparedness plans to ensure that their actions are appropriate in light of what we are learning about this pandemic and that all actions are being implemented (e.g. cleaning common surfaces, practicing social distancing & good hygiene, making hand sanitizers available, etc.). With the delays in the H1N1 vaccine and widespread outbreaks in most states, actions are critical to ensure business continuity.

As the H1N1 pandemic vaccine becomes available in your area, for your priority group, I urge you to get it – for yourself, your family & your community.

Stay safe

Best regards


Dennis Osmer
Environment, Health, Safety,
& Emergency Management