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The use of good judgement during the discussion of controversial issues would be greatly appreciated.

LIVE blogging the H1N1 Influenza Summit

by: DemFromCT

Thu Jul 09, 2009 at 07:50:53 AM EDT


Secretaries Sebelius (HHS) and Napolitano (DHS) along with Arne Duncan (Education) and other experts from CDC and elsewhere will be conducting an all day flu summit at NIH today. The agenda is here (and below the fold). The purpose of the summit is to help states prepare for an expected worsening of the pandemic in the fall, and that includes preparing for occasional school closures.

Plenary sessions will air live from 8:30 AM - 12:30 PM EDT and from 2:45 PM - 4:00 PM EDT. Watch live here.  Follow on twitter here.
DemFromCT :: LIVE blogging the H1N1 Influenza Summit

Modeling shows that even the same virulence in more people this fall will result in higher fatality (by a factor of 3-5) compared to seasonal flu. The population becoming ill is different than seasonal flu (it's younger) and this is leading to a change of plans regarding vaccine strategy.

Evidence to date suggests that population immunity to this virus is low, particularly among the young.  In one small serologic study of samples collected during 2006-08, cross-reacting antibody were found among some older persons but not in any younger adults or children.  Widespread susceptibility to this virus among young persons creates the potential for large numbers of cases with more hospitalizations and deaths among younger age groups than would be expected for a typical routine seasonal influenza virus. Importantly, severe disease and death caused by novel H1N1 thus far have affected younger adults, children, and pregnant women, in addition to persons of all ages with certain underlying medical conditions more than the elderly.  The virus has also caused numerous outbreaks in schools and summer camps.

Vaccine won't be available right away, and when it is, the high risk groups that will be targeted will change form the norm:

Planning Scenarios
The following are best-case planning scenarios that would be recommended in a setting of limited initial vaccine availability.

From AP:

"I want to be clear: This summit is not about raising alarms or stoking fears. It is about being prepared," Health and Human Services Secretary Kathleen Sebelius said. "We must avoid complacency."

We'll have more coverage of the summit when it's done, but this appears to be a gearing up of the public messaging on the part of the Feds, including an invitation to make a video public service announcement. Readers here will be familiar with the issues. Today, we get some of the details. And keep an ear open for the vaccine strategies before the fall. If the decision is made to vaccinate, it will be a separate shot (or two, still to be determined) from the regular seasonal flu jab, and will need to be offered in a variety of venues (schools, doctor offices, special flu clinics, etc.) Whatever the final plan, it won't be business as usual.

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cross-posted at Daily Kos


read Dem's live blog on Kos
here http://www.dailykos.com/story/...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
twitter hashtag is "#09fs"
http://twitter.com/#search?q=%...

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
Money! Sorry, I know that's not important ;-)
http://www.flu.gov/general/200...

2009 Flu Prevention PSA Contest Rules
Eligibility

All US residents and residents of Puerto Rico. Ages 14 and over.

Sponsor

U.S. Department of Health and Human Services (HHS)
200 Independence Ave., SW
Washington, DC 20201
www.flu.gov

Timing

Contest opens July 9, 2009.
Deadline for submissions: 11:59pm EDT,  August 17, 2009

Content

Create a 0:15, 0:30 or 0:60 second PSA that will inform and motivate people to take steps that will help prevent the spread of H1N1 flu. Make your video fun, smart, and entertaining.  VPSA must close with visual mention of www.flu.gov.

To Enter

You will need to have a YouTube account. Produced video should be posted to YouTube as a video reply to HHS Secretary Kathleen Sebelius' call for contest entries (link).  Once posted, you must complete the online entry form.

Screening

All video entries posted as replies will be moderated by HHS for adherence to video requirements (below).

Winner Selection

HHS will select the top ten videos submitted.  The top ten PSAs will then be presented to the YouTube community to vote on which video is the very best.

Judging Criterion

Message and appropriateness to theme (50%), Creativity, (30%), Entertainment value, (20%)

The Prize

One grand prize of $2,500 cash

Top video(s) will be featured on broadcast TV and on government Web sites and will remain available on YouTube.

cont.


And the HHS Prioritization Tiers?
Will the new CDC guidance for the H1N1 Vaccination Program "trump" the HHS prioritization guidance issued last year?

Also, I am not seeing anything on the LIVE H1N1 Summit.  Has it not started?  Thanks.


started
frieden is speaking.

[ Parent ]
Just a red box
Do you need a particular video player to see it?

[ Parent ]
don't know, I'm using firefox and it plays fine n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
I'll try that
Have been "on" since 8:15 EST, 5:15 my time.  Thanks, Susan.

[ Parent ]
try refreshing
you need flash player installed.

[ Parent ]
Tried Everything
Maybe too many people on before me.  Tried with Firefox and Explorer.  Did need to download Flash player and did that.  I will read what you guys write and hopefully get to see it later.  Thanks!!!  And thanks for the live blog.

[ Parent ]
I had the same problem getting in but then it suddenly worked.
I don't think I did anything different. All I can say is 'try again'.

[ Parent ]
"what the coming youear will hold...
time will tell"  Frieden

[ Parent ]
now truly a pandemic
it's not over, and things will change.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


effective communication depends on accurate information
fog of war in NYC.  Challenging to manage that information in the 'fish bowl' environment that we work in.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
only posting snippets here, not really taking down everything n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
interesting slide from Frieden




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Fauci
part of the challenge of preparing for emerging infectious diseases in general.  Many diseases, SARS, now novel H1N1.

Fortunate with a headstart - long history of studying seasonal flu - serious problem year in year out.

Have seen well coordinated response across hhs, CDC, NIH, BARDA etc



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


prepare for potentially more severe outbreak
each has important role.

NIH - research

building on CDC early work, NIH molecular analyses, transmissibility, evolution, virulence, and how immune system respond

will inform development of countermeasures

vaccine - NIAID involved in testing of vaccines - incl H1N1 and H5N1 - we look forward to challenge

have seen orderly and collaborative process of development of vaccine

CDC developed pilot lots, NIH clinical trials quickly evaluate pilot lots, to determine safe, ability to produce protective immune response, appropriate dose and number of doses, hope to start early august, critical to how and if to implement H1N1 vaccine program this fall.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
notice the "how and if" n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
i noticed it too


You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
Sibelius
introducing and thanking various people

response to H1N1 has been my priority - within an hour of swearing in

didn't expect a pandemic in my welcome wagon, proud of the work that has been done since I got here and over the years

virus has not gone away, working with various sectors

administration has been actively preparing, scenarios that may develop

science must lead the way

action steps based on best scientific info available

summit is not about raising alarms or stoking fears, it's about being prepared
\
this is a serious virus, serious disease, must avoid complacency

president announced national framework with 4 components:
surveillance
community mitigation
vaccination
communication



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


virus could worsen
community mitigation - everyone doing basic things

continually remind Americans, wash hands, cough into sleeve, if sick stay home, keep kids home if sick, don't get on airplane.

during outbreak, may involve close gatherings, temporary school or workplace closings

make sure healthcare providers to prepare what to do with surge, strategic use of antivial



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
vaccination
good idea to take seasonal shot, but all flus are not the same

antivirals effective, possibility of resistance is serious consideration

safe and effective vaccine important

researching now on appropriate vaccine, purchase bulk

made no final decisions on scope of vaccination campaign, have off-ramps, at this point, anticipating voluntary fall vaccination program, dependent on having safe and effective vaccine, depend on PH best advice

need to prepare for fall vaccination campaign

even modest campaign involve large scale

responsibility shared one, at fed level, scientists at NIH CDC, FDA - prepare and test safe and effective vaccine

will be limited at first

vax production involves many steps

some vax for initial distribution mid October

will determine which target population in what order
\
purchased by fed and made available by state tribal and local, make resources available to assist

we need you to enhance your fluy preparedness, prepare for fall vaccination campaign

may not be possible to use standard channels, identify right now potential vax sites

final decision whether to move forward will be made in consultation of top scientists and advisory committeess

young people disproportionately affected, school aged children, non-edlerly with condidiont, pregnant women, healthcare coming into contact  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
communication
very important, mention summits, etc stuff that's been done.  including international and worldwide activities

we'll tell you what we know and what we don't know

4 pillars essential - won't be easy, logistical and communication challenges, make decisoins without all the information

prudently prepare for the worse, evaluate plan a day at a time and adjust it.  

3 steps to prepare nation:

tomorrow announce preparedness plans $350 million, 260M to state health dept to support ongoing work and to support vaccination, 90M for surge,

upgrading and expanding website - www.flu.gov - include guidance that will be updated regularly, informed by science and best PH practices, fact sheets that families and communities can use, encourage all Americans to use, encourage link to the site, want to help stop the spread of the virus, info on site is easy to use and helpful, but worthless if ignored

launching new campaign to get more americans to get involved and prepare, PSA, invite PSA submissions, best PSA will air nationwide, average citizens and creative young americans have creative ideas, sites like facebook, this is a youtube challenge

we hope these steps will engage american people and ensure they will be prepared, we can't do this alone.  important for every family and every business to prepare household and business plans.  Responsibility we all share, state, territories, and tribes, critical role.  

Asking you to prepare your own flu summits in states throughout the country - with leaders and communities, discuss.  

Calling states to update vaccination plans, put them into action

President dedicated to working with you.  Tremendous challenge, valuable opportunity.  Accelerating our work to improve PH system.  lessons help us in years ahead, strengths and weaknesses, will improve PH infrastructure for whatever comes next

under no illusion this is easy, ensure well prepared for this fall and years to come



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
4 pillars
surveillance, community mitigation, vaccination, communication

Mentioned the president?

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


he's supposed to address the summit later


[ Parent ]
deep breath here


You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
a Fall vaccination campaign - hmm


You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

twitter
@FluGov Sebelius: Tweet to your friends about #h1n1 preparedness and response. #09fs

(Your wish is our command.)

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


President Obama message to summit
waiting for the live feed



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


President Obama from Italy
first, everybody is asking about Janet, including pres Napolitano (Italian president has same last name)

it's queer that although we are fortunate not to see a more serious situation in the spring, when we first got news of outbreak, that the potential for a significant outbreak in the fall is large(?). Entire team have tried to engage in most rigorous planning exercise to make sure anything that may occur in the fall, we are prepared for.  won't go into details, I'm sure others have laid out.  we want to make sure we are not promoting panic, but vigilance and preparation.  most important thing to do is to make sure state and local officials to prepare implement vaccination program, working on overall public ommunication campaign with WH, possibility we may be dealing with school (closure?), past situations properly handled and improperly handled.

where well handled - state and local have complete ownership, provide info to feds, what's working and what's not

may end up averting crisis, ardent hope,.  we are all working together in thoughtful systematic way, based on best science available.  even if serious situation, can mitigate damage

main message, thank you, outstanding team.  if any issues at all you think we have not raised, that affect our general approach or your specific community, please let us know.  We don't want to find out after the fact things we could have done better.  We want to find out now.

Conversations with world leaders - we are way ahead, may need to provide some guidance and direction to others in other countries who may not have made such preparation.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Napolitano
emphasize the work we do now is not wasted, applications in other scenarios.

Even though science cannot tell us whether we are in 1918 or1968 situation, the preparations we do now will apply to many other scenarios.

what does DHS have to do with flu

HSPD5 - DHS head is principal federal official - PFO

HHS has to lead on science and epidemic, eg vaccine, analysis of situation.  But a serious pandemic affects many other things, eg school, workplace, natinoal security, continuity of operation, high rates of absenteeism - issues that dhs is charged with coordinating

Flu pandemic crosses all sectors - public and private,  so we need to make sure plans are in place, exercised now, so that greater rates of absenteeism, operations continue.  For example, look at utility company, train some backup individuals

government - same thing - make sure plans are in place so functions of govt, esp public safety and public health, will continue.  Make sure your payroll continue.  

Have to reach out to state and local, not all here, when you leave here, plan your own summit - have the discipline to force work at local level.

Business and private sector - one lesson we learned how critical schools are - particularly for this one where school age children disproportionately affected, working through guidance for school district is not easy, not always uniform.  When you close a school, there are ripple effects all across community.  working parents, at least one of them, have to stay home.  Contribute to absenteeism.  Need to think through issues.

Kids get breakfast and lunch at school - how is food going to be made available

Government officials who work with public all the time, eg TSA, police, border, there are issues about PPE.  Have we stockpiled them, do we know how to get them to employees.  Public safety community - at what point do you require masks be worn, at what point are they optional.  These are hard issues.

Every state and locality has incarcerated populations - prison, jail, juvenile.  Epidemic there is PH of great dimension - also affect your guards, correct officers.  What do you do with these institutions.  

Role of DHS - will be working with you on these plans, encourage you to have plans and do some tabletops at least, at least leadership in your area have sat around the table worked this through over the summer

regional coordination teams - this afternoon learn how they will work

communication is key - with public, preparation message - the more we are prepared, the less fear people have.  State and local communication systems will be in place (conference calls with dhs etc).  Lastly with congress.  Brief House and Senate, what we are doing to prepare for outbreak of serious proportion

preparation is key.  Think about nuts and bolts types of questions.  Anticipate high absenteeism for several weeks in fall and winter.  DHS is prepared and preparing to coordinate among agencies also with state local etc, to help and make sure planning is being done.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


Duncan - Education
Great partnership, huge learning curve

I'm a parent, young children.  

Take stock, make plans, schools open in about 2 months.

most districts have made good plans.  However school districts, we are constantly asking them to update, >200M in grants in 700 districts in past 2 years.

lead have to come from scientists, doctors, develop strong partnership with cdc hhs dhs, strongly encourage all schools to develop such partnerships.

Try to keep schools open.  recognize may have to close, 726 schools closed, impacted >5000 children.  Learning continues, schools must provide learning services.

Tough decisions, fine lines, have to be made at state and local level

don't want bureaucratic issues to get in way of doing the right thing.  We'll do everything we can to waive a request.  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


I have to pause here, and rest my arms n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
but this is recorded, is it?


You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
I'll try
I'm nowhere near as good as you susan.

GetPandemicReady.org - non commerical website with practical ways for families to prepare.

[ Parent ]
decisions at school by school level n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Q and A
Q:

Sebelius mentioned funds to states.

difficult budget issues in states.

What funding might be availabel to states for H1N1 prep?

Sebelius:

knew that would be a question.

Formal annoucnement tomorrow.  

$350 million wil be made availabel immediately.  $260 million to states and territories.

$60 million to hospitals for surge capacity.

Applications due 24th of July; money out by 31st if July.


GetPandemicReady.org - non commerical website with practical ways for families to prepare.


Stafford Act Q
Governor of Maine Q:

trigger for Stanford act funds?  What would trigger a presidential declaration?

Napolitano:

Act wasn't designed for a pandemic.  Was designed for natural disasters.

Will measure as this develops if there is an impact on state so we can wedge it into a declaration.  Act and flu do not match up very well.

GetPandemicReady.org - non commerical website with practical ways for families to prepare.


important question about Stafford Act funds
Napolitano - flu and Stafford act does not match up very well.  May look at how it impacts specific states.  

COMMENT - that means a no, in general.  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


question about severity
Sibelius - truth is we don't know.  Prepare to be surprised.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


we've been advised to anticipate a very severe outbreak
the worst case scenario.  Can walk back if not so severe.  What we can't do is wait till October.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
what to expect
Kansas Governor Q:

Had first diagnosed case from Colby, rural area.  Demonstrates this is both an urban and rural problem.

DO you anticpate we'll have more cases in the fall, and will severity be worse?

Sebelius A:

Prepare to be surprised.  1918 was very different from 76 and the late 60s.  We don't know what will happen with this new strain.  What we know is there is widespread transmission.  Significant numbers of surveillance personnel, they have seasonal flu, have H1N1 and no vaccine.  We can watch what occurs up close and personal.

What we advise, is to anticipate a worst case sceanrio.  KNowing it is a lot easier to walk back as we learn more.  If we learn that the flu is not that severe, or goes away and doesn't reappear, then we can step back.

What we can't do is wait till October and suddenly decide we have a problem.

We need to be prepared with a mass vax program and contingency plans for businesses and schools, for a very serious outbreak.


GetPandemicReady.org - non commerical website with practical ways for families to prepare.


safe and effective vaccine
making sure the vax is not worse than the virus itself.  Begin mid October.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


who will pay for vax program?
Gov Jim?? Q:

Prospect of a mass vax effort this year?  Will there be enough doses?  Who will pay for it?

Sebelius:

Good news is antivirals are effective.  That can change.  Having antivirals pushed out to states is a good thing.

Vax program:

(missed some)

We think the vax program will be ready by Mid-October.  We want states to begin to prioritize.  All vaccine won't be availle at once.  Need to prioritize.

Will be federally funded.  May get some funding back from private insurers, but vax campaign will be a federal funded program.

GetPandemicReady.org - non commerical website with practical ways for families to prepare.


school closures decisions
Connecticut governor (I think) questions:

If attendance counts drop off and they don't meet federal requirements for recieving federal funds; if there is a waiver required for NCLB, will you grant a waiver quickly?  Also we have statutes that require a number of days in school?  Can you waive that requirement?  We need an assurance that we can get those waivers and funds quickly?

Duncan A:

(missed some)

We will move very very quickly to make sure those funds are available.

GetPandemicReady.org - non commerical website with practical ways for families to prepare.


"not penalised for doing the right thing"
earlier they said they need clear triggers

We're taking the test.  Who writes the question?  The virus or the federal level?  Some will get caught, others will learn fast.

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


[ Parent ]
the whole school thing sounds unclear to me
I guess no one wants to take responsibility for the decision?  The governors sounded like they were asking for  more guidance.  

GetPandemicReady.org - non commerical website with practical ways for families to prepare.

[ Parent ]
it's totally unclear
I gather that it's supposed to be made on a school by school level, but beyond that it seems a bit contradictory.

I just sent them a question.  Don't know if I'll get a response.

OK break ended now.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Duncan twice said "keeping children safe" at beginning of statements,
and "doing the right thing", but I missed his next remarks.  Hearing what I wanted to hear?  That "last resort" re: school closing contradicts the protective attitude that he expressed first.

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
that was Jodi Rell (Gov - CT)


[ Parent ]
She asked a good, specific question
Whether local school districts will be penalized by having federal funding withheld if they make the decision to close is a very important one for them.  

Duncan said waivers would be available, and would be processed in a timely manner.  I think the intent is a good one, I'm just not sure they can do it on a case by case basis in the midst of a crisis.  Best that they get these mechanisms in place now, make them simple, very simple, so that they can be adequately responsive and truly timely.


[ Parent ]
Duncan - don't want bureaucracy to get in the way
school closure will be last resort not first resort.  In response to question about waivers etc.

COMMENT - Um - last resort, not first resort?  Is that bureaucracy going ahead of science?  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


now going into break n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Panel on school preparedness
lesson - it's all about partnerships

2 groups that we tend to ignore, thank parents.  We promise to do better next time around

also students - putting up with us not knowing whether we'll come back to school, thank you



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


more
effective mitigate consequences while learning continues - community mitigation has tremendous impact on schools and students.  at height, >700 schools closed

take daily count of students >2M school days missed.  Even closing for short period has tremendous impact on ability to teach and learn.

May have to close, cognizant of difficulties,  panel to help us think through how to work through these issues.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
poignant comments from Belinda Pustka
(didn't take them all down) school superintendent from Texas.  

How parents thank them for making sure the health of the children come first.  Parents very supportive.

I think more people should keep saying that to Secy Duncan - parents are not stupid.  They appreciate it when their lives are disrupted BECAUSE of health and safety issues related to their kids.  Disruptions are only problematic when they are irrational, not supported by science, and not well explained.  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
same comments from St Francis school nurse
parents are cooperative and grateful.  They were thankful.  

Got a lot of emails from parents and community, with questions, and thankful.  Thought she handled it well.  

Kids have to be healthy to learn.  No one else than a nurse that can help prevent and assess things.  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
I want to know
How the schools dealt with (or will deal with) parents who do NOT wish to send their kids back to school, when schools decide it is OK to reopen.

GetPandemicReady.org - non commerical website with practical ways for families to prepare.

[ Parent ]
Texas school superintendent
got a call from health department, a student identified as H1N1, school had to close.

found out many different entities had a say as to whether school close.  most helpful is to determine right now, what is the method for closing and closing.  




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Wisconsin
at the beginning, some concern from parents.  Some of it had to do with communication - so fast, changing, became confusing.  

What we have talked about now is the need to talk to community, this is probably going to be the case, rapid and changing communication.  Have to get word out to families now so they can anticipate

very helpful to have state nursing consultant - provide technical assistance.  Schools interested in state aid - placed on website, situation in wisconsin, days when schools are closed under health dept order count under teaching days.  

If its not from state health dept, need to apply for waiver.

need to provide more resource, to stress to local school district, MUST work with local health dept.  Have everyone on board before get into crisis situation.

Superintendent and school board, need to be part of the team, not delegate to school nurse



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
things that worked and didn't work
NYC - worked - communication with parents on cellphones

didn't work - very small office - kids hung around and more came in.  So we looked at getting a 'ready room' - they are all sick, with same thing, parents going to come in and pick them up.  Also universal precautions.  If it's wet and it's not yours, don't touch it.  More teaching to kids

Texas - what did well - good communicating - as many methods as we had - technology.  Don't have to be technology rich.  Parents are familiar.  Also had AP test and other tests, there was still instructions that need to happen, when students were home, started hearing from parents to give them some activities to give students at home.  Teachers developed activities posted online.

Flip side - eye opening - looked at technology, online, saw that truly instructions need to be seamless.  Classrooms and online and back again.  Not there yet, but future to consider, so that not separate, but coordinated.




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Wisconsin
what worked well - having solid state plan - provide training and technical assistance, encouraging collaboration.  

What didn't work so well - didn't have opportunity to get into continuing education, but I would agree this is an area that needs somne work.  Have talked about it, have encouraged school districts, but not easy to do.  Online works, in some cases.  Lot of rural areas, students do not have high speed internet, cannot jeopardize their learning during a prolonged closure.  Have to look at eg educational TV - every corner of our state.  Learning packets - old fashioned, but some cases that's what they need.  Have to get parents involved.  




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
was there support for closing (entire district)
A - initially,  Got harder as days went on.  Cos symptoms mild.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
what changes are you going to institute
Wisconsin - after action groups, superintendents, gather info.  More training, to districts.  Enhancing website, electronic toolkit.  State letter similar to Duncan-Sibelius letter that went out to schools.  Help parents deal with childcare and nutrition issues ahead of time.  Continuing education plan.  Let parents communities know this will be evolving situation, what we know now not same as what will know in near future, things will change rapidly.

Texas - we have to have a pandemic plan.  School board had approved MOU with county group.  But I didn't really pay attention too much, assigned to someone else.  Good thing had a plan, connection established.  Going froward, pay closer attention to what that plan means.  Concerned about 2 groups - teenagers are a social group, they would be most at risk.  

Also campuses with high numbers of students for free and reduced lunch.  Those 2 groups, need close attention

NYC - what is going to change, my position much more respected (laughter) cos of what I do.  Administration almost bows to me.  That's a good change.  Plans we have in place (eg ready room = auditorium).  Always communicate to parents on the web, will continue, keep in contact with CDC etc.  Re-introduce phone notification system.  Get cellphone of parents so we can send quick text.  Ordered non-invasive thermomenters - put on forehead.

Teenagers - education education education.  All kinds of talks, universal precaution, handwashing etc.  Hope for a good year



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
what is one thing you want to say
all key agencies here

Wisconsin - communicate, communicate, communicate.  We need communication at state level so we can get it out.  We need it to be accurate meaningful, we need to get out to parents young people.  Need dollars to support education, nutrition, and health services to them.

Texas - we are in education business.  We need an idea of when it is best to close, when it's not.  When it is that students' health are not jeopardized by being in school.  We do a good job of adapting, and we need information

NYC - every school needs a nurse, every child needs to be healthy, safe



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
we need clear guidance (or something along that line)
comment: epidemiological wisdom can't possibly be too local

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
moderator summarizes
1. planning is essential - every school get a plan, partner with homeland security, etc

2. uniqueness of schools - no one size fits all

3. all about partnerships - have to reach out to people we don't normally deal with

4. communicate communicate communicate - also communicate at local level.  Parents interested in district.

5. schools are about teaching and learning - need to find ways to continue that process if we have to close schools

6.  CDC and Dept of Ed - working on system to monitor school closing, hopefully work and develop effective monitoring system



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
what I heard
that is missing from this summary, was repeated references to how parents are grateful that the health and safety of children were coming first, and that the panelists need an idea of when is an appropriate time to close and when not.

I'm not hearing, from the 3 panelists, is that teaching and learning is so important that the health and safety side can come second.  

Anyone else?



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
no parents on the table
i mean, they were probably parents, all or most of the panelists

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
moderator was Asst Deputy Secy
of office of safe and drug free schools, Dept of Education.




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
previous discussion on OSDFS Convention
from 2007 http://www.newfluwiki2.com/sho...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
curious
the way that panel discussion went.

There was almost NO mention from anyone on the panel about the role of schools in amplifying virus in a community.

It seemed to me to be all about just keeping individual kids safe; that we close schools solely to keep kids safe from the disease.



GetPandemicReady.org - non commerical website with practical ways for families to prepare.


[ Parent ]
right, that is my observation as well
where is the strategic role of TLC - targeted layered interventions for community mitigation?  

I think they (the Feds) sort of assume that the role of school closure in community mitigation is understood, the relationship to reducing peak demand for healthcare and surge problems etc.

I'm not so sure that it is either understood or accepted by those on the ground.  Has education as a sector, accepted its role in helping slow community spread as a whole, not just protect their students?



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
have they been told in so many words?
ok, yes, the question is Do they understand it?

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
Does the Dept. of Commerce understand the strategic role of TLC?
Commerce should want to slow down the spread of flu, shouldn't they?

I'd think some department in the Federal government would "get it" and push for school closure as a protective measure for the whole of society.
How about DHS, with its interest in stability?  
Anyone?

"The truth does not change according to our ability to stomach it."  Flannery O'Connor


[ Parent ]
i noticed that too, thanks for writing that ACM


You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
"thank you to parents for putting up with us"
also to students

Two (my words) neglected groups in Education? :-?

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


"two groups we tend to ignore" - his words


You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
School Preparedness Panel
Moderator:

address key issues.

overview of what happens in 3 diverse areas.  Provide lessons learned.  identify obstacles to closing or reopening schools.  Have issues with reopening schools.  find a way to mitigate consequences of flu while ensuring learning continues is most difficult task.  Mitigation actions had tremendous impact.

schools closed in mid-april, continued till June.  May5 over 700 schools were closed.  Approximately 30,000 teachers were impacted.  (missed count of kids)

cumulatively 2 million school days were missed.  Even closing schools for short period of time has tremendous impact on teaching and learning.

If recurrance of flu in fall, may have to take measures.

are aware of difficulties to everyone (inc employers)

3 experts:  

susan todey -- has phenomoenal state plan to deal with flu

Polinda pustka from Texas -- communication strategy in Texas to get info out.

Mary pepys:  school nurse at non-public school; at the leadership of identifying and dealing with flu outbreak.


GetPandemicReady.org - non commerical website with practical ways for families to prepare.


'Ready Rooms'
Set up ahead of time in schools to contain all the sick kids w/ the same thing, waiting for parents to come and pick them up. Ready for large numbers of kids! GREAT idea!!

www.EmergencyHomePreparation.org -- A 'card-catalog' style of prepping information.   -

state and local panel
Stephen Redd from CDC as moderator - importance of planning, not what we prepared for, but the plans were important for establishing process for what we needed to address, and process for answering those questions.

new planning process - but not open-ended.  We need them in place for coming months.  But must maintain flexibility.

importance of partnership and responding - ability to work as a team.  Everybody has a role, know what those roles are.  especially relevant for state and local.  National = sum of state and local efforts.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


guy from Illinois
giving a very long presentation on preparedness.  Very general, won't try to blog it.  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
First slide was 19 (!) critical infrastructure sectors.
Arnold emphasized the importance of sanitation.  If that system fails, we're at risk of secondary outbreaks of illness.  He said that sanitation and public health have become separated during the last century, and now sanitation is often a private system.

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
He found that the staff in IL public health dept. labs got burned out.
Needs more staff, to allow rotatation of workers in and out, because they need rest in a long emergency.  Army motto, On the fifth day, beware!

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
IL DPH has connections with faith-based organizations, including 80 that broadcast.
(7000 in database)  These organizations help communicate to their congregations through their regular weekly printed bulletins, for example.  Simple messaging.

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
Mapping, GIS, important cos you have to know where the people are,
and they move around: migrant workers' camps,  seasonal community events, graduations, census changes.

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
New York City
in midst of revising 2006 pandemic plan.  Some assumptions not applicable\

1.  We thought we would have some warning
2.  Preparing for worst case 1918 scenario, thought we would be able to respond to milder one. But had to modify.

Fortunately identified early.  Challenge was no information on transmission characteristics or virulence.  had to respond in absence of data.

Within 2 weeks after high school, community transmission.  >900 hospitalized cases, 47 deaths.  Not more severe than seasonal but age groups different. 43% hospitalized in children 96% deaths in <65

Surveillance

1 most intense staffing resources put into hospitalized and severe and fatal cases.  

2 wanted to track trajectory, milder illness, existing electronic syndromic surveillance - emergency and primary care services

3 telephone surveys

4 some modeling

Most intense response - schools, jails.  Rationale for school closure not to prevent community spread.

Jail - aggressive screening, isolation, prophylaxis, successful,

Public education - press conferences, fact sheets, share info as soon as available, frequent and very detail epi info.

Medical provider education - health alerts, NYC specific guidance for triage,  provider access line

Surveillance - difficult to compare with seasonal flu, difficult to compare with rest of US since different tests were used,

surveillance to determine hospitalized and fatal cases extremely labor intensive, not feasible in more severe outbreak.  Probably use more sentinel approach.  

Plan ahead of time to address key issues such as how to manage critically ill patients who are not getting better.

School closure - didn't follow federal guidance, unrealistic and unnecessary.  But better prepared in fall, collected data on those that closed and those that didn't.  Assess economic impact.  reassess policy in fall, more aggressive scenario if virus more virulent
\
Risk communication - balancing the need to use more restrictive measures for something that was mild like seasonal flu.  There was no simple cut off or formula.  Difficult to dampen demand on emergency department.  

OTOH, we worry that some who needed early treatment didnt' get message, eg pregnant or mild asthma

Sometimes difficult to reconcile recommendation with CDC, eg use of PPE or avoidance of crowded places

Have some time to improve communication, to use tools, to work our policy differences.  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Navajo Nation
1 of >500 Indian Nations in country.  

Land is mostly rural, only 22% roads paved.  Difficult to get around.  7.1 persons per sq mile. 1 hour 30 minutes to travel 18 miles on dirt track.

multi-jurisdictional issues, sometimes delays

issues related to lack of infrastructure and information technology.  Need for strategic stockpile and information collection system.  

Also issues related to culturally specific information collection.  1/3 speak Navajo language, need translation.  Available mass media - local radio station very useful.  Some individuals very effective in communication.

Due to remoteness - very limited use of phones.  Lack of technical assistance and resources, need help.  Indian Health services only funded at half the amount needed.  

Existing emergency response structures, also not well funded.  

Did mass vaccination exercise in 2006.  Vaccinate 24,000 in 8 hours in one day, 15 distribution sites.  80,000 in following year.  

NIMS - able to utilize protocols, open new doors to resources and technical support.  Have to be prepared.  Want to be partners with states and counties.  Need good public information systems.  

In fall, hope to have more resources.  Public planning, cost sharing, data information sharing, technical assistance and training.  One size does not fit all.  Important that every state work with every indian tribe.  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
panel discussion, what is legacy for initial response
IL - PH response tremendous, have national process going on, require involvement of state, local federal in developing any action plans.  Federal doctrine translate into common language

NYC - hard to engage some key sectors ahead of time.  Real legacy leverage this experience bring together key partners, think through real issues in operational way.  Healthcare, key lessons learned, surge on emergency clinics, public communication more challenging.

Navajo - local involvement is key.  Easy for indian tribes to be left out.  Always some resources that are unique, they need to be involved.  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
question from floor, ASTHO
vulnerable populations - undocumented individuals who feared coming forward.  Also many in service industries with no sick time.

Can you comment on these 2 areas?  How do we assist those who don't have benefits, so that they can stay home.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
NYC
leave policies need to be more flexible, starting with fed (?) guidance

(comment: otherwise the rest of the workforce is more at risk too)

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


[ Parent ]
need to be able to treat people
need policy change, that people can be treated without affecting their status.  

Talk to businesses how to take care of workers, who are disadvantaged cos they don't have access to care, scheduling, healthcare and child support.  

Don't have a very long time to have this model in place.  Doesn't require white paper, require action.

NYC - critical issue - survey high percentage of kids when schools closed or ill, parents still going to work.  Work places need to loosen up so they can stay home.  Responsibility needs to start with government policy.  Now we are on accelerated planning, dealing with this issue.

Navajo - almost some mention of treaty rights, and right to receive services.  Need to have citizenship documentation and identity in order to get help - hope that never happen again.  Many older Navajo don't have birth certificate.  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
question, this is dress rehearsal
and people are very tired.  Strategies for this marathon.  

IL - how to rotate your staff, focus on right place, eg testing.  But all states facing cutbacks and lay offs, cannot happen in PH and education with this happening, and homeland security.  This is critical, these areas cannot afford to have cuts.  

NY - burnout policy - important to take care of ourselves, look out, limit on how many days you can work without taking a break.  Make sure people taking breaks.  Easier done for frontline staff than for leadership

Navajo - probably true for indian nations, always need to get technical assistance for capacity building.  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
question, we know there isn't enough surge capacity
epidemiologists, hiring more for STD services, keep them in reserve.

IL - thank feds for funding, re-infusion of funding

moderator - resources are limited, matching prioritiy.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
difficult to think about issues
when you haven't had the experience

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

this was from NYC epi


You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
"It doesn't require a white paper, it requires action"
Not sure who said that as I just tuned in, but I couldn't agree more!

breaking for lunch and breakout sessions
live again from 2:45pm.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


They're replaying the morning session now n/t


[ Parent ]
Twitter folks can vote for which afternoon session to cover
Twitter #09fs to vote for  for which 1:15 PM breakout session @FluGov will cover: Vaccine & Anti-Viral Use/Dist. OR Continuity Planning & Worker Protection

 I whish they video tape both and have them available for viewing later.

 Even those at the meeting that attened on session might want to hear what was said at the other session later.

 BTW I voted for Community planning as "it needs the most work and is somthign the average person can work on"

 Sorry but vaccine distribution seems like it has been covered faily well.  


from HHS
The Obama Administration sent a strong message to the nation today that it is time to start planning and preparing for the fall flu season and the ongoing H1N1 flu outbreak and that the federal government is prepared to commit resources, training, and new tools to help state and local governments and America's families get ready.

White House Homeland Security Advisor John Brennan, Secretary of Health and Human Services Kathleen Sebelius, Secretary of Homeland Security Janet Napolitano, Secretary of Education Arne Duncan  joined with delegations from 54 states, tribes and territories today at the H1N1 Influenza Preparedness Summit at the National Institutes of Health in Bethesda, Md., to kick-off the government's nation-wide fall flu preparedness efforts.



re lugon's question about
the President's involvement

[ Parent ]
thanks, much appreciated
now let's go for the other N-1 (n minus one) presidents! ;-)

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
I participated in a brief bloggers' call with
Richard Besser and John Brennan. I asked about the educator's 'protect the community' vs 'protect the children' question and dr. besser reiterated that the approach is different depending on whether you think there's great penetration of virus into the community already. as well practically speaking, school closure without alternate plans for kids is not as effective as one would like. But the question was raised, fwiw ;-)

I also asked about burying the personal preparedness link on pandemicflu.gov (now flu.gov) and suggested it needed to be easier to find.


thank you for raising those questions
Not sure that addressed the confusions about school closure.  The debate is likely to continue...  But thanks anyway.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
A\good point was made about conflicting messages made by experts
that may not be wrong but are confusing.

barbara Reynolds is their
risk communication pro.

[ Parent ]
She made a lot of sense n/t


[ Parent ]
Secy. Sebelius with finishing remarks
and it is over.

What did you all think?


missed the afternoon panel
anyone got any notes?



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Check to see if they're replaying it, they did the morning session n/t


[ Parent ]
nope, tried that n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
What Did I think?
brief summary:

Q (from Governors): Money? Guidance??

A (from Feds): We'll see what we can work out. Every case is different. State's rights. We can't do it alone.

GetPandemicReady.org - non commerical website with practical ways for families to prepare.


[ Parent ]
that's a good summary LOL n/t




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Thanks to all bloggers!
I wasn't able to watch today, so I appreciated the summaries and snippets - helpful!

I have to say they all have their hands full, if they want "average folk" to prep for fall... I tried to find any news of this conference on Oregon's news media, and the only way was to search for "flu" -- and even after I found the AP news bits, I could not go back and dig them out from the front page! It's incredibly well buried here in Oregon -- and that doesn't bode well for Fall... :-{


Mushrooms - A Model for Flu Preparation
Keep in the dark and bury with manure.

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
Pass the shovel.
Tonight I asked my staff if they had heard anything about the flu recently. Blank stares. Tomorrow I will ask again. I'll bet they didn't make any effort to see why I would ask them this. Our local media has token "bytes", but no meaningful information IMHO.

[ Parent ]
Where do you live? n/t


[ Parent ]
Thank you for providing some "notes"
I felt like I got the main points.  Sadly, some of it was a step in the right direction but we need strides and full speed running.  

Video archive?
Any word about a video archive of this flu summit?  It's hard for the message to go viral if it's "once and done."  

I posed the question
and am waiting for an answer form conference organizers.

[ Parent ]
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