Pandemic Flu Information Brief and FAQ
Authors: Stephen S. Morse and Gregory A. Thomas
Many health care experts have expressed concern that it will be only a matter of time before an influenza pandemic occurs somewhere in the world. Because of the huge impact that a pandemic outbreak would have on the United States health care system, federal, state and local public health officials have been working to develop preparedness and response plans designed to address the challenges that would arise from such a large scale health emergency.
Researchers cannot accurately predict the severity of the next pandemic, but we are certain that it would present myriad issues for the public health infrastructures of our local communities. Health care workers in hospitals and clinics for example would be forced to deal with increased calls for patient care, treatment and hospitalizations. And because of the wide ranging effects that such an outbreak could have on our pediatric and adolescent communities, as school officials, you may be asked to take steps to plan for the proper safeguarding of your students, staff and school community.
Expert researchers in school safety and infectious diseases from the National Center for Disaster Preparedness at the Columbia University Mailman School of Public Health have begun to look at the many consequences that may arise for communities and schools in particular if a pandemic flu outbreak were to occur. To help you in your planning for such a health care emergency, we have developed this informational brief that will help you as you and your colleagues begin to create your school based preparedness plan. We strongly suggest that you consult with your local government partners in public health and emergency management to ensure that your plans fit well with their intended response to a pandemic flu outbreak.
What Is “Pandemic Flu”?
Influenza – “flu” – is familiar to all of us, and causes epidemics every year. As most of us know from personal experience, these familiar influenza viruses spread very well from person to person. Sometimes a pandemic can occur. This is an influenza epidemic so large that essentially the entire world is affected. It occurs when a new influenza virus strain appears that is different from strains in the recent past (so that most of us don’t have any immunity from previous influenza infections) AND can also spread well from person to person.
In the 20th century, there have been at least 3 influenza pandemics: 1918-1919 (“Spanish flu”); 1957 (“Asian flu”), and 1968 (“Hong Kong flu”). The 1918-1919 influenza was very serious, infecting a large proportion of the world’s population and causing an estimated 20-50 million deaths worldwide. The 1957 and 1968 pandemics, while severe, caused far fewer deaths, estimated at about 2-3 million worldwide.
How Likely Is a Flu Pandemic?
Influenza pandemics have occurred several times in the twentieth century and earlier. For this reason, scientists believe that influenza pandemics are inevitable, like earthquakes or hurricanes. However, scientists cannot predict exactly when a new influenza pandemic will occur, or what influenza strain will be responsible. This means that public health authorities, like the people who track earthquakes or hurricanes, must be on the alert to try to spot pandemics as early as possible.
“Bird flu” and “pandemic flu” are NOT synonyms. If the “bird flu” evolves to spread efficiently from person to person, it could become the next pandemic. But so far it hasn’t done that, and we don’t know when or if it will.
Two conditions are required for an influenza pandemic: The influenza strain must be able to spread efficiently from person to person, and it must be different from regularly circulating human strains so that most of the population does not already have some immunity to it. There are many possible influenza strains that are novel to the human population, and influenza viruses are also constantly evolving. The greatest variety of influenza viruses is in wild waterfowl, which can harbor many different kinds. Luckily for us, many of these influenza strains do not infect humans, and efficient person to person spread is difficult for novel influenza viruses to achieve. For this reason, pandemics do occur, but usually only a few times a century, not every year.
What Should I Know About the “Bird Flu”?
The “bird flu” (highly pathogenic avian influenza H5N1) has recently been circulating in Asia. In the past, influenza H5N1has been a serious disease of poultry in much of the world, but not a cause of human disease. The first human cases of infection with influenza H5N1 were seen in Hong Kong in 1997. The infection in humans was exactly like regular influenza, but more severe. There were 18 cases, with 4 deaths. It was believed that the patients caught the infection through close contact with live poultry. This outbreak resulted in Hong Kong’s temporarily closing all its live animal markets and slaughtering all poultry. Poultry was later re-imported, and no further human cases were reported by Hong Kong.
However, since 1997, the H5N1 underwent further evolution in wild waterfowl, and in 2003 H5N1 reappeared in southeast Asia. Initially, cases were found throughout the region in chickens, ducks, and other domestic poultry in 8 countries. Later, most of the cases have been in 5 countries (Thailand, Viet Nam, Cambodia, and, more recently, Indonesia and China). Sporadic human cases also began to appear. All appear to be in people who had close contact with live poultry. There have been a few cases where several family members have become infected; these have mostly been thought to be due to bird contact, but some limited human-to-human transmission cannot be ruled out in a few of these cases.
So Why Do I Hear So Much About “Bird Flu”?
We are concerned about “bird flu” (H5N1) because it is unusual as a human disease. There were no known human infections with this virus before 1997. Since then, H5N1 has caused cases and even deaths in people who had close contact with infected poultry. Public health authorities, such as the World Health Organization (WHO), the national governments in southeast Asia, and the U.S. CDC (Centers for Disease Control & Prevention) have been carefully watching this virus for any signs that it is evolving to transmit efficiently from person to person. Unless that happens, H5N1 will remain a concern for agriculture and for some people who have close contact with infected poultry, but not a health threat for most people.
If H5N1 were to evolve to transmit efficiently from person to person, it could become pandemic. The WHO uses a 6 step scale for influenza pandemic warning. As of December 2005, H5N1 is at Step 3, “No or very limited human-to-human transmission” (see chart below).
I’ve heard about “Tamiflu”. Should I take it?
There are antiviral medications, such as “Tamiflu” and “Relenza”, that show promise against influenza, but they are not panaceas. We’re not sure exactly when it’s best to take these medications for maximum effect. And we worry that the influenza virus could become resistant if we overuse these drugs. In most cases, it’s better to save “Tamiflu” for the future.
What about Masks?
It’s very tempting to think of wearing masks, especially when going out into crowds, and may make you feel you’re avoiding some risk. However, at this time, it’s not clear whether masks will be useful for preventing flu in the general population (they are important for healthcare workers to wear on the job). Most masks are not comfortable to wear for a long time, can worsen respiratory problems, and can give a false sense of security if not used properly. So while we’re not recommending masks for the public at this time, this may change as more scientific information becomes available. If so, we’ll update this recommendation.
What if a pandemic DOES happen?
Don’t panic. Much of the same advice will apply. As always, stay well informed and look for up to date information from your health department or healthcare provider. Many localities may suggest other measures, such as staying home if feasible, voluntary cancellation of large gatherings, school closings, or immunization programs.
What will a pandemic outbreak mean for schools at the local level? Will schools be asked to close?
During a large pandemic outbreak, through a collaborative decision, public health officials may recommend that many “non–essential” public facilities, such as schools, be closed during the day to reduce the chances of exposing large populations to the identified virus. In addition to potential of school closings, you should also be aware that as a key community resource, that schools may be used as emergency shelters or as points of distribution (POD’s) for vaccines or other forms of medical treatments. The length of time that schools would be used as shelters or POD’s would vary and depend on a number of factors including the extent of the pandemic outbreak. You should consult with your colleagues at the school district level to see if there are plans in place that will be used in the event that schools will be asked to close, either during the school day or prior to school opening for the day. Many times school districts will choose to use the same methods that are used to notify staff and parents about school closings that occur because of inclement weather events or other emergencies. Any plan should, however, provide for a means to properly contact parents and caretakers to apprise them of school closures and to keep them updated as developments arise.
Should I be restructuring my school’s safety plan?
Yes, it would be prudent to do so. Many school safety plans already have a section that addresses the actions that school officials are expected to take in the event of a large scale emergency like one that requires an evacuation. But few if any have components that address the steps that will be taken if the presence of a contagious disease like the flu is suspected. As you begin to rethink and rework your school safety plans to meet the challenges that will present from a pandemic event, it is important that you work closely with your school nurse or assigned health care professional, with colleagues from your school district and with officials from your local and state health and emergency management agencies to ensure that your plans are fully integrated into and consistent with the plans of these important agencies.
What Can I Do?
At this time, this virus is NOT in the United States, and does not represent a major threat to human health. We experience regular flu epidemics worldwide most years, However, many scientists feel that we will see a pandemic sometime in the coming years.
There are several things we can all do to protect ourselves:
- Stay well informed. There is no need to stay awake nights worrying about H5N1 or the next pandemic. But it is important to be well informed about the situation, so that you can be prepared if the situation changes.
- The annual “flu shot” can help prevent disease from flu. Even the “ordinary” flu causes millions of lost work days and about 35,000 deaths annually in the United States. Flu shots can help.
- Take good care of yourself and your family. If you think you or a family member has the flu, stay home and take care of the symptoms (bed rest, lots of fluids, “Tylenol” – not aspirin -- for the aches and fevers).
- If there is a heavy flu season, avoid large gatherings or crowds when feasible. And stay away from crowds if you think you have the flu!
- If you need to, call your doctor or usual healthcare provider for help, but DON’T go to the Emergency Room unless absolutely necessary (in a bad flu year, flu patients can flood the hospital and also spread the infection to many other people)
- Cover your coughs and sneezes
- Wash your hands appropriately (before and after preparing food, before eating, after using the bathroom, after touching your nose or coughing). Ordinary soap and water, or alcohol-based hand cleaners, work fine.
- Flu on surfaces is easily killed by detergents, disinfectants, bleach, and other normal household cleansers.
Where Can I Get More Information?
More information is available from your local health department (especially if they have a website), and from the websites below:
CDC: http://www.cdc.gov/flu/
U.S. Government Pandemic Flu Information: http://www.pandemicflu.gov
World Health Organization: http://www.who.int/csr/disease/avian_influenza/pandemic/en/index.html
ProMED-mail (outbreak reports): http://www.promedmail.org
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