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Conference Summary, More on CDC Mitigation Strategy

by: DemFromCT

Sat Feb 03, 2007 at 11:30:15 AM EST

I had the opportunity to participate in the recent Seasonal and Pandemic Flu 2007 conference in Arlington, VA. Members of the audience (and presenters) were the science community, public health workers at every level, CDC, business, and health advocates of all disciplines. and since the CDC mitigation strategy was presented, this is another place to discuss the implications and implementation issues raised.

The Big Picture view of the meeting is summarized as follows:

DemFromCT :: Conference Summary, More on CDC Mitigation Strategy
  • There is no imminent pandemic, as far as anyone can tell "The current situation does not indicate that the pandemic event has already started" was the prevailing sentiment
Some people are more worried than others, we all respect the potential, (else there'd be no NPI mitigation strategy), and none of us know. That, in no way, stops people from being concerned about what happens next. We saw the video of a cat grabbing a dead chicken in the Indonesia poultry markets. But the current Indonesian situation does not change the thinking about where we are.

  • Work being done at the Federal level is filtering down to the state level. The NPI (non-pharmaceutical intervention) mitigation strategy is one such example, but the investment in vaccine production and infrastructure is another.
    • The questions about mask utilization for the population are on fast track and a document setting out policy, and what we know and what we don't, is to be forthcoming within months.
  • The CDC NPI Mitigation Strategy was praised and critiqued.
It's clear that there's two separate tracks here. One is vaccine development, the other is what happens if a pandemic happens prior to vaccine development and production capacity.

The NPI mitigation strategy is an attempt to wrestle with the latter. It is a working paper. It is incomplete. It does not cover day care, which may have been off the radar and may be unwieldy to manage. BUT (and it's a big "but") it represents a sea change for this agency in that it represents a level of transparency and consultation that has not been seen before. This and projects like the vaccine prioritization project need to be given the attention they deserve, so that the consultation and public discussion gets the credit it deserves.

In the meantime, local and grassroots prep plans need to continue, not just in the US but everywhere. Examples of what companies and schools are starting to do were presented. The CDC will be sitting down with all the professional societies (I hope that includes nurses!) including the college folks to start to put together coherent and consistent plans.

  • Federal funding and Federal leadership remain a critical issue
Should a pandemic start today, it is not a pretty picture. Our surge capacity is non-existent (this is not new info, but it is better quantified now). A different standard of care would have to be accepted, but the regulations and mindset to allow that have not happened yet. And, re funding, most states can't afford to stockpile tamiflu (assuming it would work). That more Federal funds were needed to help the states was a point frequently made.
  • H5 is not the only candidate pandemic flu virus out there
Again, this a point made before, but H7, H9 and others need to be watched for as well. However, the response (assuming rapid testing identifies the novel virus) would be similar from a public health perspective.

In the end, the idea that a pandemic and seasonal flu are both vastly different and similar was one that was difficult to reconcile. If this is treated as a science problem with a science answer (i.e. vaccine), you are going to look at it a bit differently than if it's a public health problem or a business problem or a communications problem. It's all of the above, with both known unknowns and unknown unknowns. And the time frame (soon vs. 2 years vs 10 years) that you assume will also color your thinking.

While there were a handful of throw-away comments about panic, most of the attendees were very serious about the topic and treated all of the concerns raised respectfully. SusanC, Melanie and I all attended different sessions, so they have their own thoughts about the meeting. I will not discuss private conversations online, but they are consistent with what I am writing about here.

In the meantime, there are excellent news reports of the CDC conference here and here. But one splashy piece of news did get reported from Alexandria:

All health-care workers should be required to get a flu shot every year, unless they formally refuse in writing, the Infectious Diseases Society of America (IDSA) said today.

The society called on the federal government to plug what it called a "critical weakness" in the nation's influenza preparedness by ensuring health-care workers are protected.

"It's our professional duty to first do no harm," pronounced Andrew Pavia, M.D., chief of pediatric infectious diseases at the University of Utah and chair of the society's National and Global Public Health Committee.

"Voluntary systems haven't brought immunization rates up far enough," Dr. Pavia said, calling for a regimen with "more teeth in it."

"For the sake of our patients, all health-care workers must get a flu shot every year or they must be required to opt out in writing," Dr. Pavia said. He said fewer than 40% of health-care workers get an annual flu shot, although many are routinely exposed to the virus and therefore can spread it.

ISDA is the professional society for infectious disease docs in America, and there are many others for different specialties. This reflects greater involvement by the professional societies on the topic, and that can only help.

Your comments are most welcome, and I will try to answer questions today. Tomorrow, I'm off to Orlando for the next conference, this one with a business orientation.

Please be respectful of your fellow commenters and posters.

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the ISDA call for mandatory flu shots for HCW
was a few days prior to the conference, but was discussed there as well.

A key observation for me is
that what is being presented at this forum is, in the main, what we at Wiki have known for a long time - we don't know when, we cannot pinpoint what will be the cause, and the current systems and processes cannot cope.

Good, we all recognise the same issues .. now, to get some processes and procedures in place to collectively prepare for this.  The only stumbling block could be the words "a pandemic is not imminent" - if this is seen as a sign that we have plenty of time, then we will spend another 5 years or more (in some countries) thinking about it!  If the "not imminent" statement was clarified as "the current situation does not indicate that the pandemic event has already started" then action may occur in a timely manner.

(Of course, if one person gets infected from the turkeys in England, then H5N1 is no longer "over there" (asian and middle east countries) and some perspectives may positively change again.)

Eat pudding first - who know's what might happen next! - Anon

the only place I would disagree with Dem, and this is subjective impression for both of us ;-), is this, that 'a pandemic is not imminent' was not prominent, rather what I got was more like 'we just don't know'. 

Or, a better reflection IMHO might be WE JUST DON'T KNOW!

with a full range of variations on the meaning of the !


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

[ Parent ]
interpret it as "no one was saying that it was immanent". There's no uniformity on this. No one knows (that's crystal clear), but this was not a conference of 'we're unanimously worried, but we haven't told anyone'.

In fact, no one knows. But I'm certain that the prevailing opinion was that events in Indonesia do not, to us, signal the start of something different. At this time. As far as we know.

As a matter of fact, the idea of looking at seasonal flu -> pandemic flu as one continuum is an interesting one. It led to the idea that one should not ignore seasonal flu (see Alabama) because of laser focus on pandemic flu. it perhaps understates the potential for panflu when it's a cat 4/5, but the addition of those categories addresses that.

[ Parent ]
well, I accept these friendly amendments
and have changed the language to reflect what I heard and saw. There remains as wide a range of opinion there as we have here. Some people are more worried than others, we all respect the potential, (else there'd be no NPI mitigation strategy), and none of us know.

[ Parent ]
hey, you rock ! ;-) n/t

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

[ Parent ]
so, now what? :)

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

now the Feds move the directives
to the states. The states give directives to the local communities so the schools can begin planning. The local communities wrestle with what to do with the kids, how many school lunches go unserved, where's the social service network at, what do we do about long distance learning via cable, what if cable is out, do the teachers get paid, etc.

I'm guessing the unions get more involved, too.

[ Parent ]
More from Infectious Diseases Society of America
article that Dem posted link to:

The society also urged the government to:

Build health-care systems that can respond to mass emergencies.

Develop and test "community mitigation" measures, such as closing schools, sending workers home, and isolation and quarantine.

Improve flu surveillance, working with international partners.


Testing the measures would be great to get the message across that this can happen!

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

good point, Jane
Part of the 'next round' is tabletops and local exercises. when you fail, you get the idea of what you need.

However, the ability to handle 'surge' will differ depending on the scope of a pandemic or other event. Mild is easier than severe. In fact, we can't do severe in hospital. It can't be done. That will have to include a non-hospital solution.

[ Parent ]
there are 100 levels
Just have to digress for a moment to the Pandemic cat 1-5 biz...

What they didn't say was that there are 100 levels to the Pandemic chart and 1918 was only a 5.

Tell the truth

click for bigger pic

[ Parent ]
If they say there are 100 levels,
most will wait until the news say it is a Category 99, which they will then refuse to believe, until people are dying right next to them.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
If TPTB says there are 100 levels ... (mixing they's) n/t

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]
Re: they will then refuse to believe
And many of those will then blame it on the weather!!

[ Parent ]
LOL n/t

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

[ Parent ]

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