So this is what a Level 5 pandemic alert feels like.
I walked home along Ottawa’s scenic Rideau Canal Wednesday afternoon, just hours after the World Health Organization (WHO) raised the global pandemic threat level to five on a six-point scale. In WHO parlance, Level 5 means a global pandemic is imminent.
For practical purposes, the message is: “Brace yourselves, folks. This thing could be coming soon, to a community near you. And it’s likely to get a whole lot bigger before we can get it under control.”
What struck me on my way home was that the day seemed so utterly normal. It was a gorgeous, sunny, spring afternoon, without a hint of the scramble that was under way to contain a brand new, fast-moving, widespread, sometimes deadly virus.
The magnitude was brought home to me later in the week, in an email from one of the calmest, most resourceful people I’ve ever met.
“The WHO plan was to throw a fire blanket on the part of the world where a pandemic erupted,” wrote Nelson Fabian, executive director of the U.S. National Environmental Health Association. That fire blanket was to involve saturating the affected population with anti-viral Tamiflu, “in the hope that we could stop the new flu dead in its tracks.”
Level 5 means that “we failed,” he said. “Now it’s a matter of mitigating its impact.”
Much of that responsibility falls to public health agencies that have already been stretched by multiple duties and decades of underfunding. But there are things that each of us can and must do—as meeting professionals, and as citizens—to respond to the pandemic. (My thanks to Nelson and to public health communicator Judy Redpath of JN Redpath & Associates for reviewing this advice for technical accuracy.)
The first layer of response, and the best inoculation against needless and unproductive panic, is to sweat the details and stay informed. Nelson Fabian talks about minor pandemics in 1957 and 1968 and notes that this one, too, might turn out to be “mild and inconsequential.” But it’s too soon to know how far it will spread, or whether an infection that seems mostly manageable outside Mexico will mutate into something even more deadly.
Most of what we hear about flu pandemics comes from the years after the First World War, when Spanish flu killed between 20 and 100 million people world-wide. From that experience, some practitioners suspect a mild wave now may be followed by a second, more serious outbreak in eight to 12 months.
Even that understanding is more than our ancestors had 90 years ago, and there’s more.
We have antibiotics to combat the secondary infections that can follow a serious viral flu. (Important note: Antibiotics work on bacteria, not viruses, so do not ask your doctor to prescribe them for a common cold or for flu itself.) We have a global health surveillance and research network that tracked and defined a previously unknown virus in less than a month, so that public health could mount a quicker response.
And we have the Internet to share accurate, timely information on the pandemic as it spreads and evolves. That’s a double-edged sword, since the Web can spread rumours and misinformation just as readily as facts. But reassuring and potentially life-saving knowledge is already out there for anyone who wants it: Knowing that I would be spending the next couple of days with several colleagues from an affected county in the U.S., I easily found a YouTube update from the region’s public health officer and signed up for further reports by email.
That kind of knowledge is the surest antidote to the confusion I saw in another colleague’s recent Facebook post, calling for closer media attention to the number of winter flu deaths in his country. We need to understand that this pandemic is different from regular, annual flu: it’s killing healthy youth and adults, not the very old and the very young, and it’s caused by a virus that researchers have never seen before. For public health practitioners, those anomalies signal a new health threat that could do just about anything, from the inconsequential to the calamitous. The uncertainty, in itself, is cause for serious and attentive concern.
Which means the second layer of response is to prepare our organizations to confront the pandemic before it reaches the front door of our homes or workplaces. In our office, we’ve always urged staff to stay home at the earliest sign of any health problems, both to speed their own recovery and to prevent transmission of anything contagious. On Monday, it became a firm company rule that anyone with the slightest cough or sniffle stays away until it clears—we’ll work from home if we can, but our health trumps any deadline. When the WHO declared Level 5, we extended the policy to any staff with a family member who isn’t well.
All of this underscores the value of telecommuting, virtual offices and, for that matter, virtual meetings in the event of a health crisis. But it also points to the business continuity issues that will emerge if we end up with a full-blown pandemic. Meetings industry leaders like Freeman, which published its pandemic preparedness policy in 2006, have some idea of how they’ll cope when 30% or more of their employees are sick, or taking care of family members who are infected. Do you?
There’s a third layer of response that will play out over a longer time span, but is still a crucial piece of the puzzle.
It’s clear that an extended bout of contagious disease will lead to a wave of cancellations, as our colleagues in Mexico can already attest. In the weeks and months ahead, we will see far too much evidence of our industry’s deep dependence on a public health infrastructure that is chronically underfunded and vulnerable, largely because its successes are invisible when disease is prevented.
The last time meetings were affected by a regional health crisis, there were bitter complaints that a group of cancer physicians had cancelled a convention in Toronto in the midst of the 2003 SARS outbreak. (Hint: SARS was a contagious disease, and cancer patients have compromised immune systems.)
The industry’s anger at the time was misdirected. SARS showed how important it is for meeting professionals to step up as passionate advocates for a smart, adequately funded public health system. We missed the signal in 2003. For better or worse, the next opportunity is now upon us.
From what I heard on various US news programs, Mexico’s health department is overburdened and understaffed. MORE, it is still not certain that this DID start in Mexico.
My greater fears are for the Fall – “flu season” – when this has mutated.
As former Minister of Health Marc Lalonde was quoted in the May 2, 2009 edition of “The Globe and Mail”:
“But that is the nature of these things. If you do too little, you are accused of negligence. If you do too much, you are wasting money and causing panic. These are very difficult calls.”
May we all be protected from the overzealous (and I’m being kind) nature of the 24/7 talking heads on TV and ill-informed politicians who warn their families to not take the subway (but seriously, does anyone think that the Biden’s actually take the subway?).
But most importantly, the old adage “an ounce of prevention is worth a pound of cure” will do us all well. Be prepared. Get your flu shot every year. Make sure all your routine vaccinations are up to date. Wash your hands regularly (using hot water and lots of soap for at least 20 seconds). And keep your hands away from your face (yes mom).
Now where’s my hanky….
An excellent review in depth of “epidemic proportions” of history and reaction times becoming more significant over the ages, and the importance of rapid and LUCID communication among health professionals and the media transmitting calmly and sanely with the population.
Incidently, since there is a lead time needed in preparing the specific form of serum needed in dealing with the flu viruses, this involves more than microbiology. Statistics, demography and a broad data base knowledge of similar known viruses (or should I say viri) all come into play. Then it’s still a person’s final judgement, hoping that the serum which is being produced now will be the right one to cope with the type of virus that will show up next season, months away.
Is it a highly scientific “crap shoot” after all?
It’s probably quite efficient, and if called on today to pick the winner of the Kentucky Derby, would easily have named the 50-1 longshot which won today.
I think you’re right on to situate the H1N1 virus as something that requires attention from a variety of sources outside of the biomedical/public health community.
Too often we miss opportunities like this to address the underlying socioeconomic gaps that lie at the heart of many of our “frontline” problems. While I know we have a take a more direct at this point, when are we going to learn it’s better to invest in stopping the bleeding than on a multitude of band-aids.
Mitchell,
Managing information quickly and effectively has become critical to how the world deals with the H1N1 flu pandemic. What strikes me is that much of what we read and hear about the pandemic comes from publicly funded health organizations, which makes sense.
However, are they well positioned to invest time and money in developing information management systems? This raises the question of the private sector’s role in helping these organizations manage information.
In the May 4, 2009 issue of Fortune magazine there is a very interesting article about ‘‘IBM’s Plan to Save the Planet’’. Their approach is to find problems, throw billions of dollars in R&D at them, add consultants and an earnest ad campaign – and watch the profits roll in. (By the way, ”profit” is a good word.)
H1N1 is a problem, and it is not likely to go away anytime soon. Maybe someone should ask IBM’s CEO, Sam Palmisano, about IBM’s plans to help public health organizations at all levels better manage health information in pandemic situations.
Mitchell – Suggest you give Sam a call.