H1N1: Returning this fall, and with an attitude

The swine flu pandemic is still underway, with little sign of abating.  Here in the United States, cases continue to be reported and deaths continue to mount.  In the Southern Hemisphere, swine H1 has completely displaced seasonal flu and has become King of the Mountain.  This is no small feat and cements H1N1v as a true pandemic influenza virus, on par with pandemics in 1918, 1957 and 1968. 

The absolute and overwhelming number of flu cases here are also swine H1.  So it is completely safe to say that if anyone has the flu -- real influenza, not a cold -- they have swine flu. 

Down in the Southern Hemisphere, the virus has disrupted major events such as outdoor soccer and football games and concerts.  In Argentina, almost every event possible has been disrupted, as the government takes measures similar to those enacted by the Mexican government at the beginning of the pandemic.

The British government just released its official planning specs for this pandemic.  The worst-case scenario?  Off the charts.  But the plan calculates some 65,000 dead Britons by the time the pandemic ends, maybe next year, maybe 2011.  The range of dead, the British hope, is obviously the low end -- 19,000.  That is still half of the number of Americans who die every year from seasonal flu. And Great Britain has one-fifth the population of the United States.

So how many Americans could die?  It could be as small as 50,000 or as high as a half-million.  And that is based on hopes that the virus, as it takes its first lap around the globe, does not come back in a more lethal genetic posture. That it would return as mild or milder is far from certain and is considered very unlikely. 

One of my earliest Computerworld blogs was headlined "For hurricanes and pandemics, plan one category higher." If you haven't read it, or if it has been awhile, go back now and indulge.

OK, welcome back. I wanted to remind everyone about comments made by my friend and now FEMA director, Craig Fugate.  When he was Florida's emergency management director, Craig told USA Today:

To be prepared, Fugate said his team always readies itself for a storm one category higher than what is predicted. He said forecasting intensity has come down to two basic factors: conditions that seem favorable to strengthening and a symmetrical look to the storm.

"If it looks like it's strengthening, it probably is," he said. "It's probably a layman's way of looking at it, but the computer models haven't improved." (bold mine)

I have lived that "plan one category higher" for some time. It shapes every disaster plan and COOP exercise I participate in. And it also comes from five decades of going through hurricanes.

As everyone knows, we are in WHO Phase Six, or full-blown pandemic flu status.  But the US also has a Saffir-Simpson scale of pandemic magnitude, deliberately meant to evoke thoughts of hurricane intensity.  Based on the current US and global Case Fatality Rates (CFR), we sit at the upper end of a Category 2 pandemic.

It will only take a little push -- just a nudge -- to kick the pandemic into a more severe, Category 3 state of being.  And with every public health professional worth his/her salt expecting a very, very bitter fall and winter, we would do well to immediately apply this "one category higher" mentality to your planning.

So you, dear IT Disaster Recovery and COOP planner, must begin making all your plans and preparations as if we were already one category higher. So if a Category Two hurricane heads your way this season, assume it will make landfall as a Three. And if we are at Category 2 pandemic alert status today, make your planning, education, preparedness and purchasing decisions as if we were headed for Cat 3.

Chief among these plans is to have a pandemic planning team assembled now, at your executive levels.  I tell you, if your organization does not have a pandemic planning team, then you are not prepared for a pandemic.

Second: If you have not completed your pandemic plan, you need to rush to completion.  This pandemic is only now working its way through Asia, and it has a long way to go before it is complete.  We have not seen the end of the first wave, let alone the beginning of the second wave. 

This pandemic's second wave could come as early as Labor Day, and will be facilitated by returning grade school and college students. 

Third: Plan for mass absenteeism in your workforce.  Need a reason? In Argentina, the absentee rate is approaching 40%.  That is not necessarily sick people; that is a combination of sick people, people looking after sick people, and people looking after their school-age children sent home as their schools close.

Fourth: You need to make sure you are cross-trained to the hilt.  Cross-train even out of your area of expertise.  No one can say who will and will not get sick, but the hardest-hit workforce is 18 to 50.  Overall, the case rate (and the deaths) are occurring at an excessively-high rate among persons ages 5 to 50.

This means there is a very real possibility that if you employ several persons under 50, you may not get one or two of them back.  Ever.

Fifth: You need to teach and train your people on how to take care of their families.  They won't give a hoot in Hell about your organization or its corporate goals if one of their family members is stricken with this virus. Give them the tools they need to help their families.

Sixth:  Go over proper sanitation with the janitorial staff.  That janitorial staff will become the first line of defense between your employees and the virus itself.  Accelerate their cleaning of solid surfaces.  Do you have enough hand sanitizing stations?  Do you have hand sanitizing stations?

Seventh, don't forget the mail.  Mail brings germs.  How do you think all those remote Inuit villages were wiped out in 1918?  The US Postal Service delivered more than just the mail. Quarantine mail overnight before delivery, or consider investing in dedicated ultraviolet equipment to immediately sterilize mail.

Eighth:  Are any of your employees in a front-line position with customers?  If so, they may need masks and gloves.  Heck, they might not even come to work unless you provide them with masks and gloves.  That might prove scary at the retail level, but at the minimum you'll need to provide them with hand sanitizer.

Think I am crazy?  You watch the wrongful-death suits that will crop up as a result of employers who did nothing to help retail employees who dealt with the public, only to die from this virus.  Trust me: Just buy the damn hand sanitizer.

Ninth: Don't place false hope in vaccines.  Read the responsible press:  The WHO, and all the vaccine makers, are complaining that this virus is not growing well in the eggs that produce vaccine.  This means smaller yields, which translates to delays in producing vaccine. 

The earliest we will see any vaccine at all will probably be the fourth quarter of 2009 or the first quarter of 2010.  By then, and most assuredly, we will be in the throes of a very severe flu season.

But by all means, once a vaccine is available, get the jab or jabs.  Whatever is recommended.  And remember it is impossible to get the flu from a flu shot.  The virus is dead in the shot.

The things that will get us through this are the Things That Momma Taught Us:

1. Cover your cough or sneeze with your elbow, not your hands.
2. Wash your hands.  Anyone who does not wash their hands after leaving a bathroom is an idiot.
3. Keep a respectable distance from strangers.  One meter lengths are being recommended in Argentina as I write this.

Finally: If you need to buy anything, do not wait until tomorrow.  Tomorrow's headlines could bring an event that wipes out supplies overnight.  Ask CVS, whose entire nationwide corporate inventory of N-95 masks was wiped out within days of the Mexican Flu's arrival.

In closing, let me say that I have been preaching about this event for years.  It's here and it's happening.  this is an historical event, but of course it is not the end of the world.  Just make sure it's not the end of your world.  Prepare yourself, prepare your families, and get very smart about this virus and about how influenza works.  Especially if you are a skeptic; once you know just how unpredictable and volatile influenza is, you'll know what to do.