Friday, April 18, 2008

Have Your Heard of TED?

Have you heard of TED? TED stands for Technology, Entertainment, Design. It's an annual event where the world's leading thinkers and doers gather to share information. They have a listing of prominent people in those fields who are invited to "give the talk of their lives" in 18 minutes. This site makes the best talks and performances from TED conferences available for free. There are more than 200, with more added each week and are freely shared and reposted.

For the research work we're doing here at Pitsel & Associates, Ltd., the talk given by Dr. Larry Brilliant is notable. He's in epidemiologist and philanthropist and speaks, in this video clip, on pandemics.

His video is very conversational in tone and easy to listen to, and his message, in brief, is that having overseen the very first eradication of a disease, namely smallpox, he believes the answer to pandemic prevention is "Early detection. Early response."

He goes on to describe the 1980 efforts, without the advances of today's technology, to mark that as the first year in the history of mankind, that a disease was eradicated through human intervention. He describes how even Sovereigns were killed by smallpox, and underlines that diseases spare no one. With an army of volunteers his team canvassed every household in India as part of their awareness and treatment campaign.

Today, he is an executive director of and supports GPHIN, Global Public Health Information Network, which uses advanced technology to track diseases worldwide, which is credited with preventing a worldwide outbreak of SARS because of early warning capability. The GPHIN has capabilities unavailable to the World Health Organization by virtue of the fact that they are not limited, as WHO is, to only government reportage. They were able to find and contain areas of outbreak before they reached levels where governments were compelled to report to the WHO, giving them a full 3 months advance on SARS.

Here's the site:

On the first page, at the top, is "Speakers". Click on that.

At the bottom of the new page that comes up, in red, it says alphabetical listing of speakers A-Z., click on that.

Under the "B" heading, near the end of the list, click on Dr. Larry Brilliant. It's well worth your time.

Thursday, April 17, 2008

Low Tech Solutions

Laurie Garrett is the only writer to have won the three "P's" of journalism, the Pulitzer, the Peabody and the Polk prizes.

Ms Garett was speaking yesterday as a senior fellow at the Council of Foreign Relations in New York. Referring to widespread panic as a possible reaction to a bird flu pandemic she said, "Personally, I am a lot more worried about pandemic flu than Al Qaeda."

In her statements she not only underlined the low tech solutions of basic hygiene and personal responsibility as our best defense against this disease, she also outlined community solidarity and social resilience as critical elements.

The implications are that the solutions lie in improved frequency and content of information, message, and education. The more people prepared and reassured with knowledge, the best able we are, collectively, to protect ourselves. It is a collective problem, and those who are not involved in being part of the solution, will, detrimentally to us all, be part of the problem, and it will be all of our problem.

The larger implication is that if more people take simple, adequate precautions, perhaps it can prevent the mutated virus from full pandemic spread. We don't know and can't guess, because it is, so far, beyond our knowledge, and beyond our experience. But, at no time in history has a message been so dispersable as it is today with the light speed of communications. Words spread even more quickly than viruses. Is it possible that since we know how to protect ourselves individually with sanitary precautions, and ourselves collectively with socially responsible behaviours such as cough and sneeze etiquette and social distancing, that more people solidly behind these measures could ameliorate some of the effects of influenza spread?

It would, indeed, be very naive to assume we could prevent the pandemic wave in this way, but surely besting this threat is going to require the combined will of everyone to minimize its effect. This will require massive education measures. Governments have been reluctant to overtly address this issue for fear the threat of pandemic would result in panic. Messages of this order, "from the top down" so to speak, would no doubt be seen as alarming.

Precautionary messages must be supported from "the bottom, up", from a common understanding that we all develop, and new behaviours that we all adapt. We cannot wait for the Government to "do something about it." "The Government" is less able than we, individually, to impact social behaviour.

Now is the best time to discuss it in the open, while there is time to prepare and prevent. Talk to your friends and families. Calm and open discussions in workplaces, along with informed presentations, and home and workplace planning would be the best efforts to convert panic into planning.

Thursday, April 10, 2008

If Not NOW, When?

If not NOW, when?

It sounds like a silly question, but there are events in our lives we know are going to happen, but they seem so far away it's hard to take them too seriously. Saving for a rainy day. Making a will. Yearly dental and medical appointments. Investing in life insurance.

We're all the same. "It's a good idea, but...." "Oh, yeah, I'll do that later, just after...." We say these things to ourselves, especially when the task requires some of our time or some of our money.

Making a home preparedness kit for a disaster or a pandemic situation is one we also tend to settle comfortably into the "One Of These Days," category, and then forget about it.

A likely trigger to motivate this preparation may very well be the first human-to-human transmission (H2H)of the H5N1 virus. This is when the influenza virus that is killing birds worldwide has adapted itself enough to become easily transmissible to humans, not just through contact with birds, but from other humans. Up until now, if you weren't a bird farmer, or lived in the far East, the idea of catching the bird flu seemed very remote indeed, despite what scientists have encouraged us to prepare for.

This week, the World Health Organization has confirmed a small number of H5N1 influenza in humans occurring as a result of human to human infection. In China and in Pakistan there have been isolated incidents and reported deaths.

The cases of suspected H2H transmission have been limited to blood relatives. 91 other, non-related, people coming into contact with the 24 year old man in China, who died, and his 52 year-old father who contracted the disease from his son and survived, have all remained free of infection. Scientists who have examined the particular virus in this incident are saying it shows no indication of an H2H mutation. They believe there are still several barriers the virus must overcome before it acquires easy human transmissability.

Until a vaccine is developed for the particular strain of influenza the virus will eventually mutate to, prevention is still more effective than cure. Prevention will require preparation. Washing hands frequently, observing cough and sneeze etiquette, and maintaining social distancing, and keeping your immune system healthy are still the best proactive measures.

The time and money to stock supplies to "shelter at home," to reduce your exposure in public places where contamination will take place, can take place over time. The effort and added cost to assembling 2 - 4 weeks of food and supplies can be spread out. No one can foresee when the window of time to prepare will close, but the fact that human-to-human transmission has begun, however limited, adds to the credibility of what scientists have been telling us.

If you are not going to begin these preparations now, then when? What other time seems more likely. If you're waiting for a signal, these first H2H transfers are as good as any.

Friday, April 4, 2008

No One Wants to Yell "Fire!"

You remember the story about the consequences of yelling "Fire" in a crowded movie theatre. Mother nature has designed us to flee, and quickly, from emergencies until we are at a safe distance and with a bit of time to think about how best to save ourselves. We call it panic, and can see that it's the least productive preparation for dealing with attack.

International agencies are very cautious about announcing pandemic information for this reason. Now is the time and this is the distance we have to save ourselves from possible pandemic consequences. With each new development, or viral mutation, we move closer to what scientists and history tell us is most likely to happen.

The most recent news is from Pakistan that at least three brothers were infected with the bird flu virus, and it is likely there was human-to-human spread in that instance. This is confirmed by WHO, a cautious and thorough monitor of the world pandemic situation.

Though this news has been expected for some time, no one wants to name this as the signal that the virus has mutated to the point where we now expect widespread contamination. It is, however, an indicator that another obstacle has been breached, and the virus continues to adjust to new hosts.

There is, however, encouraging news in this new stage. There is a great deal of awareness and preparation going on world wide, and the best minds are helping to analyze and track the potential threat.

This news is also a reminder that awareness leads to precautions, and being prepared is our best hope of besting this threat. Even though in China and Vietnam there are human trials entering a second stage for an experimental bird flu vaccine, the nature of a virus is for it to mutate and change, perhaps rendering this vaccine, in its current form, useless. These vaccine trials do lay the ground work for an eventually effective vaccine.

More good news is that our best protection still lies in our own hands, so to speak. Frequent hand washing, social distancing, and proper cough and sneeze etiquette are still our best lines of defence.

The recent news of the isolated human-to-human transmission of the H5N1 virus is perhaps the motivation we need to not only practice our personal hygiene habits with regularity, but to prepare the home and family with information, materials and supplies to shelter at home. A stockpile in the home of food and other supplies gives us the option of reducing our public exposure (where the virus is going to be exchanged) to a minimum.

It appears that we still have time to develop our stockpiles gradually. This spreads costs over time, and gives time to develop storage and maintenance strategies.

Most websites recommend: a supply of water to supply four litres per person, per day; non-perishable foods that need a minimum of preparation; and first aid supplies and medications. Don't forget pet supplies and special considerations if there are infants or others with dietary restrictions to provide for. There are many excellent web sites on-line for more details regarding disaster preparations.

Personal disaster preparedness can sustain you and your family through any emergency or disaster that could potentially happen, from a natural emergency, to service disruptions, or environmental disaster.

If you are unprepared for a disaster, it can be devastating. Your best protection is having a plan and knowing what to do. Set up a family meeting to discuss how each of your family members can contribute to the plan and be best prepared.

Friday, March 28, 2008

Fifty Percent Staffing Level

The following is the experience of an accounting person, SZ, who had to operate with only half the staff due to resignations and retirement - and how difficult she found it, with musings on how well organizations might cope during a pandemic

Fifty Percent Staffing Level

Tomorrow we will be half way through the month of March, and tomorrow I hope to "put February to bed" at work. For those that do not know, or may have forgotten, I work in the accounting department of a Vacation Rental Company that is wholly owned by a publicly traded Holding Company. The department started the year with a staffing level of four, a controller, his "second" (me), and two others.

At the beginning of January one of my coworkers announced his unexpected and immediate retirement and I absorbed his duties in their entirety. Then in February the controller left us. My department has been running with a staff of two. But since we are a subsidiary of a publicly traded company the reporting that we have to generate and submit to our corporate office is federally mandated... and rigidly scheduled to meet those federal mandates.

It is widely suggested, as well as supported, that businesses and organizations will find themselves operating at somewhere around a fifty percent staffing level during a moderate to severe influenza pandemic, something I can relate to personally.

Although I do not work in a business or industry that will find itself operating during a time of pandemic, and accounting is not exactly an "essential service", although, to be sure, money will still have to flow, I thought I would share with you a few of the things that I learned and equally enlightening, what had to happen to support my efforts and success.

I had an existing broad base of knowledge of all aspects of the department, database, and accounting software, however, since I am not the controller there were reporting functions, data collations, and spreadsheets that I only had a basic superficial knowledge of. I found myself hour-by-hour struggling to comprehend how "this or that" fed into "this or that", often getting it wrong any number of times until I finally managed the logic of the data flow and plopped the right number(s) in.

I had adequate basic knowledge of the myriad functions. I had a well established and proven matrix to follow. I had an entire company at my beck and call to support my stupid ill-informed questions. I had our software programmer made available to me at a moment's notice to assist with database malfunctions and miscellaneous support questions. I had a General Manager that "baby sat" me for two weeks, checking on me every other hour offering encouragement, cheerleading, offers of providing anything else that I might find myself requiring (within a business framework of course). At one point in the process the entire company was "booted off" the server for several hours so that I could have its resources all to myself, and lastly, I was determined to succeed.

And even with all of that, with every resource and advantage I could be given, I was only able to just manage. Perhaps a better way to state my point: The only was I could have been in a better position to succeed was to have my former boss standing over my shoulder walking me through the processes.

During a moderate to severe pandemic those who find themselves struggling to perform the duties of two or three missing colleagues will probably not (read surely not) have all of the wonderful support that I had. Many will not have a clear "play book" to refer to as they find themselves struggling with unfamiliar processes and procedures. And, unlike my situation where it was "just numbers" those struggling people may hold someone else's health, or even more frightening, life in their hands with their actions.

After my experiences these past three weeks I have a brand new appreciation about how impossible those tasks will be - and my concern about our critical infrastructure has deepened considerably.

S.Z. Exhausted, but pleased with accomplishing the impossible with a great deal of wonderful support.

Thursday, March 20, 2008

Inaccurate Media Reporting

You may have heard reports from Ontario about flu cases being hospitalized there.

There are two very important elements to this information. First is to realize the speed with which rumours will spread. The fact is that there is NO medical evidence that the people in hospital suffering from Influenza A have bird flu. However, rumour spread that one patient had recently arrived from Bangladesh - and since that country has been experiencing H5N1 in their poultry, a false conclusion fueled the rumour rocket.

The second consideration is to realize how easy it is for media outlets to get information and to attempt to quickly to be the first to broadcast, film, or print information - sometimes without checking the accuracy of the reports.

This suggests to us that everyone should rely on at least two sources they trust to be assured of accurate and timely information about the progress of H5N1, and its possible mutation to a form that can easily be passed between humans (H2H).

We at Pitsel & Associates, Ltd. will endeavor to keep you abreast of the news on H5N1 and possible pandemic implications. We do believe that a pandemic is inevitable as we know historically that a pandemic occurs every 40 years or so, the last one being the Hong Kong flu in 1967. It is important to have facts and not hysteria guiding our reactions.

The official news release regarding the Ontario cases of flu is as follows:

"Media Statement - Bird Flu Speculation: Inaccurate Media Reporting

"Toronto, March 19/CNW - Toronto East General Hospital (TEGH) is concerned about inaccurate media speculation and reporting regarding human cases of avian flu. TEGH has no reason to speculate that any patients in the hospital have avian flu.

"Toronto is experiencing steadily increasing cases of seasonal flu in the community. For example, during the week of March 2 to 8th, 2008, there were 47 new cases of seasonal flu (not avian flu) in Toronto. Although TEGH has effectively responded to an increased number of patients with seasonal flu-like symptoms, including those from other facilities experiencing seasonal flu outbreaks, the hospital has no reason to believe that any patients at TEGH have H5N1 avian flu.

"Furthermore, media reports are indicating that the individuals suspected to have avian flu had recently traveled to Bangladesh. It is important to clarify that, according to the World Health Network, there have been no reported human cases of H5N1 avian flu in Bangladesh.

"TEGH has a comprehensive screening program to identify patients who present with potential respiratory illness. The hospital is proud of our record in identifying such individuals. Effective identification enables TEGH to provide appropriate treatment, to utilize respiratory precautions, and to protect staff and others. We are confident that no staff, patients or visitors have been inadvertently exposed to seasonal influenza at TEGH.

"We wish to reassure the public that the hospital is safe and that there is no reason for anybody who has visited the hospital to be concerned. All services, including scheduled procedures, continue to be fully available. We do not anticipate a need for any reduction in service or visitation restrictions."

Friday, March 14, 2008

Pandemic Influenza Update

The good news is that Indonesia has at last agreed to submit influenza samples for testing to the World Health Organization (see previous blog posting, Feb 21, 2008)

The recent news from Hong Kong is also encouraging in their responsiveness to recent events. Hong Kong is closing its schools for two weeks due to an influenza outbreak that unfortunately took the life of one young boy. This step indicates how seriously governments and institutions are viewing the influenza threat. Hong Kong is assuring us that the infection is not due to the H5N1 virus called bird flu, but is taking precautions as though it were.

A recent article in the Proceedings of the National Academy of Sciences in the United States suggests we can reduce the likelihood of a pandemic influenza outbreak by quickly implementing social-distancing measures alongside antiviral treatment and preventive measures (frequent hand washing, cough and sneeze etiquette, prompt and careful disposal of used tissues) until a vaccine becomes available. This is what they are doing in Hong Kong.

What follows is the most recent summary of pandemic flu matters. It indicates the 15 most populated countries and their percentage of the world's population.

A) shows the country has reported bird flu in poultry, and

B) shows the country has reported human cases of bird flu.

The summary shows that 4.3 billion people live in these 15 most populated countries, and represent roughly two-thirds of the entire world's population. The percent figure following each country's population total represents the percentage of the world's population that lives in that country.

1. China: 1.32 B. 20% of the world's population (both A and B)

2. India: 1.12 B. 17% (A only)

3. United States: 300 M. 4.6% (neither A or B)

4. Indonesia: 225 M. 3.5% (both A and B)

5. Brazil: 186 M. 2.8% (neither A or B)

6. Pakistan: 165 M. 2.5% (both A and B)

7. Bangladesh: 147 M. 2.3% (A only)

8. Russia: 143 M. 2.2% (A only)

9. Nigeria: 135 M. 2.1% (both A and B)

10. Japan: 138 M. 2.0% (A only)

11. Mexico: 108 M. 1.7% (neither A or B)

12. Vietnam: 87 M. 1.3% (both A and B)

13. Phillipines: 86 M. 1.3% (neither A or B)

14. Germany: 82 M. 1.3% (A only)

15. Egypt: 75 M. 1.2% (both A and B)

Bird flu in poultry (infestation) has been reported in eleven of these countries, and human infections have only been reported in six countries. Note that India and Bangladesh have reported and continue to report extensive and repeated poultry outbreaks, massive culling operations, but not one human infection.

Friday, March 7, 2008

Insights From the Conference Board of Canada Pandemic Planning Conference, March 2008

These are some of the helpful insights from the 2 day Pandemic Planning Conference sponsored by the Conference Board of Canada, in Toronto:

1. SARS - Toronto has had a "dry run" so to speak, in preparing for a pandemic because of their experience with SARS. Health Care workers were among those most heavily impacted by this disease, and the session on Mental Health during Response and Recovery states that of those who had recovered from SARS (the vast majority), more than 50% had long lasting psychological impact.

This suggests that as part of your pandemic planning you will want to have conversations with your Employee Assistance Providers to see if they will be abil to provide support services during and after a pandemic.

2. "Presenteeism" - is the practice of coming to work when you are ill. A Decima study showed that 79% of Canadians go to work sick. You can begin to plan for a pandemic now by starting to change employee health habits. Frequent hand washing and clearning surfaces are the two most effective areas to focus on, but having people stay at home and NOT come to work when they are infectious will be a major part of your plan to manage the pandemic.

3. Retirees - people who have recently retired from your organization, are a good source of people you can ask to return and fill in for people who are ill during a pandemic. Include them in your pandemic planning BEFORE the pandemic hits. Make information and supplies available to them that are being dispensed to staff. In this way you are much more likely to have them willing to return and assist in a time of staff shortage that might reach 40%.

4. Most presenters at the conference stressed communication, communication, communication. Companies who had successfully weathered the SARS event laid their success to the amount of communicating with staff that they did during the event. Ontario Hydro (who runs nuclear plants among other things), would send out messages two or three times a day on some days, to keep the staff informed. Studies have shown that staff look to and trust information that they get from their employer (if there is a trusting relationship between employer and staff) more than they trust media. This means that you will have to have dependable communication channels for everyone working for you.

5. Privacy Issues - Personal privacy issues will probably come up during a pandemic, and one has to consider individual rights vs. the rights of the whole. Ordinarily, organizations may not disclose health problems of employees to anyone - but what do you tell people in your organization if the person working next to them is ill with the flu? This issue should probably be checked with your corporate lawyer prior to a time of pandemic when it will probably be impossible to reach a lawyer in a timely fashion.

6. Incident Control Room - Most organizations that have to plan for emergencies and business continuity planning that deal with things like fire, floods, etc., will want to re-think the value of having a central incident control room. People will want to maintain social distancing during a pandemic, and a central room with phones, faxes, computers, etc. that are used by everyone has a high likelihood of spreading viruses. How will you ensure that people in a critical incident room are not going to infect one another, thus taking out the very people you need most?

7. Force Majeure - Speakers from law firms stressed that a pandemic would not fall under Force Majeure clause in contracts that you have (this type of clause excludes liability from non-performance) unless it is specifically mentioned. This means that ALL contracts should be checked. As well, a pandemic event is probably non-insurable (again, check with your Insurance people to see what advice their company is giving).

8. Ethics - Ethics is a huge issue for the medical profession but will also play a part in businesses as well. Companies may have to make difficult decisions in choosing who to ask to perform certain duties that may be hazardous - and what action they will take if staff refuse this request.

Thursday, February 21, 2008

Politics and the Pandemic

The H5N1 virus may well flourish because of political as well as biological conditions.

There is currently an international agreement in place whereby all countries share samples of avian flu virus collected from local incidents. This is an effort to track the various mutations that the virus is undergoing to anticipate how close we are to a mutation that allows human-to-human transmission, and to construct an effective anti-viral for it. At this time, we are told, there are seven or eight sub-varieties of the virus in various stages of adaption to a new host - us.

However, one should be cautious in expecting a pure motive of mutual aid and benefit to be the primary motivator between nations. Nor do we have ample evidence of world wide governments being transparent and forth coming with all pertinent data.

Reports today describe the Indonesian Health Minister accusing the United States of using bird flu samples to produce biological weapons, and consequently Indonesia refuses to submit viral samples to the World Health Organization. Their suspicions have prompted Indonesia to state they intend to resume sharing of bird flu virus samples only if nations agree on a fair and equitable framework. The United States denies Indonesia's accusations.

Indonesia is reported to be the nation worst hit by bird flu. They have held back virus samples since last August and intend to continue to do so until they receive guarantees from richer nations and drug makers that poor countries get access to affordable vaccines derived from their samples.

Indonesia claims that foreign nations misunderstand their non-compliance in the sharing of viral samples, "but concrete cooperation has to be based on fairness."

WHO specifies that sharing samples is vital for tracking the H5N1 virus and for developing vaccines against a potential pandemic. Meetings to work out a new virus sharing draft with key nations are scheduled to take place in March or April.

Thursday, February 7, 2008

Where Is Our Concern Level Now?

When multiple daily threats compete for our attention and adrenalin supply, it's often difficult to keep all the causes for concern on the front burner, all of the time.

Many of the day-to-day warnings and predictions have come from someone's interest in making money. We are too often bombarded with scare tactics and sensational reportage because someone, somewhere, wants to sell us something. It may be a product they are selling; it may simply be the news they are selling.

Needless to say, we are exhausted by analysing our personal vulnerabilities at every turn we take. A new study tells us that Canadians have lost interest in the influenza pandemic. It no longer "sells".

We are told that fewer than half of Canadians think a pandemic disease outbreak is likely in the next five years, and only one in 10 has drawn up any sort of emergency plan for how their family would cope if one occurred (based on a survey of 4,463 of our friends and neighbours). Science and history assure us that the pandemic event is not an "if" event, but a "when" event.

However, preparation can replace that low level anxiety we experience when we are facing a threat that is not immediate, but real none-the-less. A few simple sheltering-in-place precautions can give you the flexibility to reduce your time spent in public spaces during an influenza crisis. Many internet sites outline supplies to have on hand that could be vital for any emergency from an environmental one to a public health event.

The Calgary Health Region provides one at:

Preparation = pre-prepare.

Friday, January 18, 2008

Looking After Yourself and Your Family

There are many good sources for self-care information regarding practices for the pandemic.

Scientists from Geneva's University Hospital were asked by a Swiss bank to carry out a study amid worries that a flu pandemic could be prolonged due to the millions of bank notes incirculation.

Between 20 and 100 million banknotes change hands in Switzerland alone each day, it said.

The researchers left small samples of the flu virus on used banknotes which were then left at room temperature. Most of the virus survived only a few hours, but highly concentrated samples were viable for several days.

In the worst case, the virus mixed with human expectorant survived for two and a half weeks.

This type of virulence reinforces the observance of good self-care habits.

Prevention tips are especially essential, because each infected person is expected to transmit infection to two other people.

The following link will be a reminder of what you can do now, and what to do when the pandemic strikes.

Friday, January 4, 2008

New Vaccine Development

There has been a new step in the development of an effective vaccine against H5N1, the bird flu virus that's also dangerous to humans.

A preventative vaccine has been almost impossible to develop because of uncertainty over the final form of the virus when it mutates to a human pathogen.

According to virologists at the Erasmus Medical Center in Rotterdam, a vaccine currently being tested protects against different variants of the H5N1 virus, including new strains.

With the addition of a substance that stimulates the immune system, the vaccine response is improved.

Human trials (and trials in weasles, also susceptible to viruses) are currently underway.