Pitsel Pandemic Updates

Have Your Heard of TED?

2008-04-18T10:37:00.002-06:00

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 Google.org 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: www.ted.com/speakers

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.

Low Tech Solutions

2008-04-17T10:13:00.004-06:00

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.

If Not NOW, When?

2008-04-10T12:01:00.002-06:00

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.

No One Wants to Yell "Fire!"

2008-04-04T09:27:00.002-06:00

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.

Fifty Percent Staffing Level

2008-03-28T10:47:00.002-06:00

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.

Inaccurate Media Reporting

2008-03-20T09:39:00.002-06:00

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."

Pandemic Influenza Update

2008-03-14T09:47:00.003-06:00

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.

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

2008-03-07T11:26:00.003-07:00

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.

Politics and the Pandemic

2008-02-21T13:31:00.002-07:00

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.

Where Is Our Concern Level Now?

2008-02-07T10:09:00.000-07:00

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:

www.calgaryhealthregion.ca/hecomm/envhealth/program_areas/emergency-planning/Documents/AHW-shelter

Preparation = pre-prepare.

Looking After Yourself and Your Family

2008-01-18T09:24:00.000-07:00

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. http://www.pandemicpractices.org/practices/resource.do?resource-id+234&-id=

New Vaccine Development

2008-01-04T10:37:00.000-07:00

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.

Why Does Flu Spread in Winter

2007-12-21T09:02:00.000-07:00

New York researchers tell us that winter months foster the spread of flu virus because of the construct of the virus itself. The virus is more stable and remains airborne longer when the air is cold and dry. This describes our winter conditions exactly, and explains why these months see an increase in influenza type illness.

Influenza is more likely to be transmitted during winter on the way to work and school than it is in a warm room says the chairman of the microbiology department at Mount Sinai School of Medicine, Peter Palese.

This reinforces the reminders of infection prevention: wash your hands frequently, cough and sneeze into your sleeve (rather than into your hand), dispose of used tissues immediately, and if possible, avoid face-to-face contact with people suffering from influenza.

Washing Your Hands Of It

2007-12-04T09:19:00.000-07:00

The United Nations recently reported that finding bird flu in German waterfowl is a sign the disease is being transmitted by seemingly healthy ducks and geese.

If birds do not show symptoms of the disease it is almost impossible to isolate or eradicate it. Because of this, they warn, Europe should prepare for more outbreaks. The source of bird flu in Britain remains unknown. It has now spread to 60 countries.

The BBC News informs us the UK is doubling its stockpile of antiviral medicines, but researchers believe simple low-cost physical measures could potentially provide an important defence against a pandemic.

"Wash your hands, and if it is a really bad epidemic, avoid contact with people and keep your distance... Soap and water is cheap and it could save your life or your baby's life."

Rising Number of Incidents

2007-11-14T09:37:00.000-07:00

A 31 year old man has died in of bird flu in Indonesia, bringing their death toll there to 91. It is yet unclear if the man contracted the disease by coming into contact with sick fowl or by another means.

Meanwhile, outbreaks of bird flu in fowl are now occurring on a farm in Llanfihangl Glyn Myfyr in North Wales, and in Suffolk, England.

Governments world wide continue vigilance in keeping track of outbreaks of bird flu in fowl, human illness and death due to bird flu, and viral mutations that allow transmission from human to human.

Authorities in all countries are concerned about the need for preparedness in their populations without inducing panic. They continue to urge pandemic planning for everyone including large business continuity planning to individual preparedness and personal hygiene precautions.

Uganda: Bird Flu Spreads Among Humans - WHO

2007-10-31T09:28:00.000-06:00

The influenza pandemic will likely start without warning, and reach crisis stage within days, to weeks.

Researchers have, for the first time, proven that the virus has now spread between a "cluster" of people.

The H5N1 strain of bird flu has finally managed to spread from person to person, according to officials of the World Health Organization (WHO).

Previously it was believed that bird flu could have spread between humans on several occasions. Person to person infection was suspected but could not be confirmed.

Two distinct family clusters, one in Thailand, one in Turkey, have been declared to have been contaminated through intimate or close contact.

Full details can be found at: http://allafrica.com/stories/200710220119.html

Database Lists Choice Pandemic Planning Resources

2007-09-28T09:58:00.000-06:00

A newly launched website is an on-line collection of peer-reviewed resources for pandemic planning. The site describes, and provides links to, 130 promising practices from 4 different countries.

It is compiled to save time and resources, rather than leaving everyone to craft strategies from scratch.

The site addresses three key areas: altering standards of clinical care; communicating effectively about pandemic flu; and delaying and reducing the impact of a pandemic.

Look for: www.PandemicPractices.org

"Pandemic: A Possible Look at the Future"

2007-08-31T09:05:00.000-06:00

BBC has produced a 1hr. 28 min. "docu-drama" entitled "Pandemic: A Possible Look at the Future".

It shows how one individual, infected with the H5N1 virus, could affect every nation on earth within a matter of weeks. It makes the plausibility of such an event very real.

The documentary portion of this video uses the latest scientific research, presented by experts in the field, to explain how the virus operates, how it mutates, and how we are at risk.

The dramatization shows in a powerful way how realistic the threat is, and how ill-prepared we are at present.

If you take the time to watch the video at the following URL you will have a clear picture of what we are facing:

http://www.video.google.com/videoplay?docid=-7443717071229476088&q=pandemic+duration%3Along&total=73&start=0&num=10&so=0&type=search&plindex=5

For more information on Pandemic planning from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta (403) 245-0550. is “The time to plan when you have time to plan.”

Look After Yourself

2007-08-16T10:48:00.000-06:00

During an influenza pandemic, demand for health care services will increase at the same time as health care workers are ill with influenza themselves or are staying home to look after sick family members.

Most people who get influenza will not be sick enough to require medical care and can be looked after at home.

For more information check the following link: http://www.google.ca/search?hl=en&q=look+after+yourself+-+vancouver+coastal+health&btnG=Google+Search&meta=

Source:

Vancouver Costal Health

For more information on Pandemic planning from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta (403) 245-0550. “The time to plan is when you have time to plan.”

Indonesia – 80% fatality rate update

2007-08-16T10:41:00.000-06:00

The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 17-year-old female from Tangerang District, in Banten Province developed symptoms on 9 August , was hospitalized on 13 August and died in hospital on 14 August . Her source of exposure is currently under investigation.

Of the 104 cases confirmed to date in Indonesia, 83 have been fatal.

Source:

World Health Organization http://www.who.int/csr/don/2007_08_16/en/index.html

For more information on Pandemic planning from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta (403) 245-0550. “The time to plan is when you have time to plan.”

2007-08-16T10:24:00.001-06:00

Indonesian government witholds important info for political ends.

2007-07-26T09:57:00.000-06:00

We recently passed on a news item about a possible H2H (person to person) flu’ death in Indonesia.

According to Reuters, a report from Government officials there says:

"She had indirect contact with dead chickens near her school," Joko Suyono, an official at the ministry's bird flu centre, said by telephone. The victim, from the city of Cilegon in Banten province, had initially been identified as a six-year-old boy, but Suyono said this was due to a mix up between the hospital where she was treated and a laboratory. The official said that tests on dead chickens found near the girl's school showed they were infected with bird flu.

"We cannot know whether she touched sick chickens or not because she died. But we know surrounding her school the virus is endemic (in fowl)," he added. Suyono said tests for the virus on people who may have had contact with the girl had proved negative and also said the findings in this case ruled out the possibility of the virus being transmitted between humans. "So far, there have been no human-to-human cases in Indonesia," he said.

Now we have different reports, and speculation is rife that the Indonesian government is withholding important information for its own political ends.

Indonesia has been playing “hardball” with WHO over providing them with virus samples from cases that have occurred there – their fear being that they will provide the critical data required for producing a vaccine but will not be able to enough of it for their own populations when a pandemic hits. I’d say their fears about being short are probably pretty well founded, but it calls into question what information is believable when issued by government spokespeople.

What we do know, to date is that the virus has mutated several times since first isolated in 1997, that the strain in Egypt appears to be somewhat resistant to Tamiflu (and primary anti viral stockpiled by Western Countries, including Canada), and that the virus appears to be endemic in all poultry in Indonesia and possibly a number of other Asian countries. This means that there will continue to be a transmission from birds to people in the Far East with the high possibility of a mutation occurring making it transmissible from human to human.

WHO is very cautious about releasing data unless confirmed through their own laboratory, and thus has not moved their pandemic stage from 3 (animal to human) to stage 4 (human to human in small, contained areas). However, there are some researchers in the area who believe that WHO should, in fact, move their stage from 3 to 4 based on small clusters that do not appear to have been infected from direct animal contact.

We will keep you up to date as additional information is acquired.

Source:

Reuters (2007). Indonesia still probing source of bird flu death (Electronic version). Retrieved July 12, 2007
http://www.blogger.com/post-create.g?blogID=7093628848455704242

For more information on Pandemic planning from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta (403) 245-0550. “The time to plan is when you have time to plan.”

Flu victim had no poultry contact'

2007-07-13T14:56:00.000-06:00

According to the AgenceFrance-Presse, a six-year-old Indonesian boy who died of bird flu last weekend had no apparent contact with poultry, an agriculture ministry official said.

The boy from Cilegon in Banten province, just west of the capital Jakarta, was Indonesia's 81st bird flu victim. Contact with infected birds is the most common form of transmission of the deadly virus to humans, experts say. Memed Zulkarnaen, director of the agriculture ministry's bird flu unit, said no infected poultry had been found within a radius of up to 300 metres (yards) from the boy's home.

"The Indonesian medical community is still puzzled and does not understand from which source the victim was infected with the bird flu virus,'' he said. "We are puzzled because the H5N1 virus needs to 'stick' to an object such as poultry and cannot freely circulate in the air,'' he said. Asked whether there was a possibility the boy had contracted the virus from another person, Mr Zulkarnaen said it was too premature to tell and investigations involving personnel from the UN's health and agriculture agencies were ongoing.

Sardikin Giriputro, deputy director of Jakarta's Sulianti Saroso hospital, where the boy died, said on Tuesday that the boy had visited relatives who lived near a zoo elsewhere in Banten province, four days before he fell sick. Indonesia is the nation worst hit by avian influenza. It confirmed its first human case in July 2005, but the source of infection in that particular case was never determined. Scientists worry the bird flu virus could mutate into a form easily spread among humans, leading to a global pandemic with the potential to kill millions.

The fear stems from past influenza pandemics. A flu pandemic in 1918, just after the end of World War I, killed 20 million people worldwide. Separately on Wednesday, the national committee overseeing Indonesia's bird flu fight along with UNICEF were to begin distributing 7,000 protective kits to villages in Banten province, where at least 10 bird flu deaths have occurred. The kits contain gloves, masks, soap, an informational VCD, a banner and booklet.About 100,000 kits were distributed in high-risk areas in May, a statement from the committee said. Indonesia stepped up its campaign this year to battle bird flu, barring Jakarta residents from the popular practice of keeping poultry in their backyards.

Officials were criticized for being slow to act when avian influenza first appeared in the archipelago nation.

Source: The Daily Telegraph, Australian newspaper, 11 July 2007.

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

Attitude survey on Bird Flu

2007-07-03T14:17:00.000-06:00

University of British Columbia is conducting a survey on attitudes about Bird Flu – the url is: http://www.psych.ubc.ca/~adlab/avianflusurvey.htm

For facts and updates about the Bird Flu, please visit the following sites:
http://www.cdc.gov/flu/avian/
http://www.who.int/csr/disease/avian_influenza/en/

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

Bird flu resurfaced with a vengeance in Vietnam

2007-07-03T13:38:00.000-06:00

According to the London Free Press, five people fell ill in as many weeks - after no human cases had been reported for a year and a half - in Hanoi, Vietnam last month.

Health experts say the spike is a sobering reminder that the H5N1 virus remains deep-rooted and can kill at any time. The virus also has flared elsewhere, with people falling ill in China, Egypt and Indonesia this month alone. And poultry outbreaks have surfaced in Myanmar, Malaysia and as far afield as the Czech Republic. Vietnam, previously hailed as Asia's bright spot for beating back the virus, has seen an unexpected surge since last month, when it reported its first human case since November 2005. Two patients have died, two have recovered and one is critically ill.

Source: London Free Press, 23 June 2007.

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

New Bird Flu strains show spread to the West.

2007-04-30T10:28:00.000-06:00

A recent paper released from the University of Maryland, indicates an international team of researchers reported the first ever large scale sequencing of western avian flu genomes.

In case you were wondering..... a 'genome' refers to all of a living thing's genetic material. It's the entire set of hereditary instructions for building, running, maintaining and reproducing an organism. The whole shebang. 'Genome sequencing' is figuring out the order of DNA neucleotides which consists of a code of genetic letters. DNA sequencing on a large scale, is mostly done by high-tech machines.

These researchers collected 36 genomes from wild birds (follow the arrows of the map on the right). The study basically confirms the spread of H5N1 from the Far East to Europe, the Middle-East and Africa. It is the virus' capacity to rapidly mutate into a pathogen that may eventually be passed between humans, that concerns health officials about a world wide pandemic.

The interesting thing is that Steven Salzberg, the study's lead author says: "The migratory pathways of wild birds don't correspond with the movement of the genomes that we sequenced." This points to the possibilty of human movement, rather than wild birds as the reason for the quick spread of the H5N1.

Source: http://www.yubanet.com/artman/publish/article_54924.shtml

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

Insurance coverage during an influenza pandemic

2007-04-18T16:47:00.000-06:00

"The federal government recently urged the health insurance industry to gird itself for business continuity, protect its employees, and consider changing certain practices to help enrollees get and pay for care during an influenza pandemic.

In a checklist released Mar 21, the US Department of Health and Human Services (HHS) encouraged health insurers to provide cross-training for employees, prepare retirees to backfill essential roles, and contract with temporary staffing agencies.

Among practices and policies that HHS recommends insurers consider during a pandemic to maintain "access to healthcare and health insurance coverage" are:

- Deferring rate increases
- Temporarily suspending business rules for prior medical authorization, precertification, and pharmacy refill limitations
- Extending time periods for filing claims
- Waiving copayment obligations

Among insurers working on business continuity plans, Indiana-based WellPoint Inc., which provides healthcare benefits to approximately 3.2 million people, says it will comply with all state and federal regulatory guidelines, including those that could override benefit language.

At Regence BlueCross BlueShield of Oregon, spokeswoman Samantha Meese says her organization agrees that topics outlined in the HHS checklist need to be addressed. Regence is consulting with the BlueCross BlueShield Association, America's Health Insurance Plans (a national lobbying association based in Washington, DC), and HHS to ensure their organizations can work together during an outbreak.

Kevin Goodlin, a senior manager in Deloitte Touche Tohmatsu's Global Security Office, brings a different point of view to the discussion. Whether employees are insured or not will not matter in a pandemic, he says. "Since healthcare is in finite supply, having health insurance may not be enough in a major pandemic," he says. Deloitte encourages employees to buy supplies of over-the-counter medicine, order more than a month's supply of prescription drugs, and ask their doctors about antivirals such as Tamiflu".

Source: Apr 12, 2007 (CIDRAP Source Weekly Briefing)

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

Will there be enough food supply available during a pandemic?

2007-03-27T15:35:00.000-06:00

Gloria Galloway from The Globe and Mail says food industry reps and government are meeting this week to talk about ways of getting food to your table in the event of a pandemic.

Much focus around pandemic preparedness has been on the health sector, while grocery store shelves could be left empty when the pandemic hits. Worst case scenarios predict that the pandemic can take out a third of the work force. Bear in mind that farmers, food producers and distributors are not immune against the disease.

It is suggested government would have little control over food distribution during a pandemic because the responsibility for the supply chain lies in the hands of private industry. Nick Jennery, CEO of the Canada Council of Grocery Distributors says food producers and suppliers have started to work on pandemic preparedness two years ago. "Being prepared for a crisis, whether it's pandemic or otherwise, is part of the business we're in" Mr. Jennery said in an interview with The Globe and Mail on Monday.

According to Galloway, Agriculture Canada asked industry to come up with a list of 20 non-perishable food products that could continue to be produced here in Canada in the event of a crisis.

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

Managing your mental health during a disaster

2007-03-21T20:02:00.000-06:00

According to a recent article from the Mayo Clinic widespread disease such as an Avian flu outbreak, can cause mental health issues for those who have to live through the trauma. But, how would you cope with an existing mental health issue when disaster breaks out and health care services are disrupted?

Here are some coping strategies:

1. Plan ahead.

Talk to your health professional - some points you may want to talk about include getting to the clinic, changing appointment locations, how you can care for yourself or even general concern about the psychological effects of a disaster.

Have an emergency survival kit - be sure it is stocked and you kow where it is.

Have a contact network - make sure people know to check on you.

2. Managing medications during disaster.

Have a buffer supply - keep at least a 5-day supply. Remember you may not be able to get a refill immediately. Phone lines may be down and pharmacies closed or you may not be able to travel. Be sure to talk to your health insurance provider in advance about prescription refill requirements.

3. Managing therapy during a disaster.

Plan for disruption - prepare yourself now for possible closures so that you don't run into unpleasant surprises. Consider talking to your therapist now about possibly trying to connect by phone or email.

Call on your skills - if you can't get to a therapy session, then use that time to reflect on what you've learned in therapy. Remember the healthy coping tools you've learned and problem solving skills you've gained. Use positive self-talk to help chase away negative thoughts.

Do your own version of group therapy - if you attend group therapy, consider talking to the group about disaster planning.

4. Self-care strategies during a disaster.

Get in touch with disaster workers - remember that health care professionals are trained in disaster management. Hospitals and clinics have disaster plans in place.

Touch base with others - if possible, talk to family, friends, faith groups and others who can offer you help, comfort and support. People can work together to solve problems and encourage each other. Let them know if you need help.

Help someone else - if you're able, then lend a hand to someone who is less fortunate. This can give you a huge morale boost and make you feel better about yourself, besides helping the other person.

Build skills for resilience - people who are resilient can weather hardships and stress better than those who aren't. Even if you're coping with depression, anxiety or any other mental condition, you can still be resilient. Some ways to build this, may be by developing a strong support network, having goals, thinking well of yourself and remaining flexible.

Keep a positive frame of mind - look for the small nuggets of hope and good things during a disaster. This can help you find meaning and purpose, help you think positively about the future and help you function even in the worse of times.

One of the ironic things about disaster is that they have the potential to bring out the best in people. You may also see people helping each other in ways you never thought possible - the world may not seem so uncaring after all.

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

Ethical issues in Pandemic Planning

2007-02-28T14:16:00.000-07:00

South Carolina is buying enough medicine to cover at least a quarter of its 4.3 million people. The likelihood is high that more than a quarter of its population could get sick from the first wave alone.

So the question is; who should receive the vaccine first? The answer to this ethical question could decide who lives and who dies. South Carolina's state epidemiologist, Dr. Jerry Gibson points out some of the main ethical issues when planning for a pandemic:

1. Who gets to decide what is done, and how?
2. How do you make sure more good than harm is done?
3. How do you minimize the harm done, while trying to do good?

Some ways in deciding who gets the limited medicine may include:

People could be chosen randomly, but this wouldn't necessary treat the sickest or the most likely to survive. Those with occupations considered to be critical to public health, could receive the vaccination first. But who gets to decide what those are? Federal recommendations call for those who are hospitalized with the flu and front-line health care workers. Lower on the list are outpatients and workers in other critical areas. Civil liberties questions could arise too.

Some folks may be isolated or quarantined. Will this violate their individual rights? Who will take care of their medical, food and other needs?

Will people get a chance to say how they will be affected by restrictions or provisions, during the pre-planning stage? Last summer a pandemic in each county was held and included people from business, schools, ethnic minorities and other groups.

How will you provide folks with the opportunity to "speak up" on issues involving possible ethical dilemmas?

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

HUNT PERSONNEL / TEMPORARILY YOURS PRESENTS:

2007-02-23T17:36:00.000-07:00

Breakfast Workshop March 22 Register now!

Preparing for a Pandemic

Presenter: Dr. Pat Pitsel
When: Thursday March 22, 2007
Time: 7:30 - 9:00 a.m.
Location: Sheraton Eau Claire
Cost: $125 pp
includes continental breakfast, workshop & Pandemic Planning Guide

The Time to Plan is When You Have Time to Plan…

The Motivation!

Planning for a potentially catastrophic event that has never occurred in the lifetime of most of us… is particularly difficult.

It is especially challenging for businesses that may have a business continuity plan that covers physical disasters but who have no plans for a catastrophe that impacts the Human Capital in the organization.

Be Ready! Join us as renowned presenter, psychologist, educator and Human Resource professional Dr. Pat Pitsel leads us in an interactive workshop.

The Purpose!

Preparing for a Pandemic – The Time to Plan is When You Have Time to Plan…

…is designed to give senior executives and Human Resources Professionals an extensive, high- level overview of the issues they must be aware of in order to guide their pandemic planning team.

Three major business areas will be addressed, including the provision of critical questions that every President, CEO, COO, or CFO needs to ask.

- Key Human Resource policies that need to be considered
- Communication strategies – pre, during and post pandemic
- Critical supply chain issues to establish continuity of your business

The Expertise!

Dr. Patricia Pitsel is a psychologist, educator and Human Resource professional. A registered psychologist in the Province of Alberta, Pat received her M.Sc.Ed. in counselling from Fordham University in New York City, and her Ph.D. in counselling psychology from the University of Calgary.

Dr. Pitsel has worked with a wide range of organizations and companies in both private and public sector both in training and in a facilitation capacity. Her current work with clients is in the field of preparing for a possible Pandemic, her motto being: The time to plan is when you have time to plan.

Dr. Pitsel has served on a number of community Boards and Agencies including the Calgary Police Commission, The Duke of Edinburgh Young Canadian Challenge Award, the Federation of Calgary Communities and the Calgary Convention Centre. She was awarded the Outstanding Instructor Award from the Faculty of Continuing Education, University of Calgary, for four years in a row; she is enthusiastic, frequently amusing—and recognized as a Calgary leader in the area of Pandemic planning.

Decision makers are encouraged to attend. Human Resources, Purchasing and Executive leaders need to plan NOW for your organization’s business continuity in the event of a Pandemic.

Resources provided are valuable. Register today!

Register to: Myra Lever
mailto:myral@huntpersonnel.ab.ca?subject=Pandemic%20Planning%20Seminar%20-%20March%2022,%202007
(403) 269-6786 (tel)
(403) 237-9016 (fax)

Hunt Personnel / Temporarily Yours has a reputation as a highly respected, successful career placement agency providing guaranteed temporary and permanent staffing services.

Our company is built on a commitment to quality, ethics, service leadership and innovation. By integrating these values into everything we do – and devoting ourselves to meeting the needs of our clients and candidates – we have earned the reputation for …Staffing and Building successful Companies for over 30 Years…

Please share this information with other business colleagues/organizations who may also value this important workshop content.http://www.hunt.ca/

Single point of failure

2007-02-16T16:54:00.000-07:00

Martin McKeay reminds us of the importance of 'single points of failure' in our organizations. He was watching Dr. Michael Osterholm talk on Oprah's show about the inevitability of a flu pandemic and how we can prepare for it.

Apparently many of the drugs we depend on today all come from one or two manufacturing plants in the whole world. Can you imagine how a disaster at one of the plants would affect the entire world's drug supply? Now think about some of the parrallels in your own network and business. How many single points of failure do you have and what is your plan in the case of a failure?

What if someone by accident takes out the cable up the street? Would your business survive until the phone company can get you back online? What about your back-up system for files? What will the impact on your business be?

Step away from the technology for a second and think about the people. Who knows how to get the critical jobs done? Are you reliant on a single person? What if anyone of us get hit by a bus or just get sick for a couple of days?

Dr. Osterholm said there is a lot to learn from Hurricane Katrina and New Orleans. If we look at it that way, then it's really not a question of if a disaster is going to strike, but when. By simply being prepared, we can minimize its impact. So, you may not need to prepare for a hurricane, but you do need to identify your single points of failure.

Click on this link to see the video clip

http://www2.oprah.com/tows/pastshows/200601/tows_past_20060124.jhtml

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

If bird flu grips the nation, doctors will need guns!

2007-02-12T16:37:00.000-07:00

The National Health Service (NHS) in the UK will be unable to handle a pandemic, says Dr Andrew Lawson.

"Towards the end of the film Dr Strangelove, Peter Sellers discusses who will go into the mines to survive. A surreal echo came for myself and colleagues recently when we were in discussions about planning for a bird flu pandemic in the UK as part of an ethics committee.

If a true pandemic of bird flu hits these shores then our notions of what we can expect from the National Health Service will have to change. Some people will have to be denied potentially life-saving treatment: there simply will not be enough beds.

Managing such a pandemic is unimaginable. While it is possible to work out what will happen if a bomb goes off in central London — we can empty intensive care units, mobilise extra staff and stop elective work — what we cannot plan for is 200,000 extra patients who need a life support machine.

Arnie Schwarzenegger, the governor of California, says his state will buy thousands more machines, but who will man them? A gut reaction is to blame the government for underresourcing. It is true that we have a chronic underinvestment in intensive care compared with the United States, Australia or other European countries. In any normal situation such a criticism would be valid, but in a pandemic it becomes a statistical irrelevancy.

Who will decide, and on what criteria, those getting the chance of survival? If you and a friend get bird flu and you both end up in hospital, the estimates are that within 48 hours one of you will need life support. At conservative estimates the need for intensive care will be about two-and-a-half times more than we can provide.

Allocation of such resources will have to be either on a first come first served basis or on an explicitly utilitarian basis of capacity to benefit. This shift from an egalitarian free access to a limited one based on expected outcome represents a profound shift in how we deliver healthcare.

Exclusion criteria have already been drawn up in Canada and the United States and include such contentious issues as restriction based on age or on preexisting disease such as cystic fibrosis or metastatic cancer. Saying “no” to a desperately ill child with cystic fibrosis or to a previously fit 85-year-old is not something we are morally or emotionally prepared for. By an ethical analysis it may be the correct thing to do, but will patients or their relatives be prepared to accept it?

Such arguments may, of course, be purely academic. Assumptions as to what we can do are based on the doctors and nurses, porters and technicians turning up to work. But if we do not have enough masks to protect staff dealing with infected patients, then do the staff have a moral duty to turn up for work and get infected themselves? It may be that they go to work but only once — who will want to return home and potentially infect their own family?

In Victoria, Australia, it was suggested that patients would not go to the GP but to a “flu centre”. The idea that patients would go to where flu is concentrated displays an astounding lack of comprehension of human nature. Similarly, staff will be reluctant to put themselves at risk. HSBC, the banking group, was accused of scaremongering when it announced that perhaps 40% of its staff would not turn up for work in the event of a pandemic, but the NHS may suffer just as badly.

It is not only the risk of infection that may stop staff turning up to work. With such limited access to intensive care, it would be expected that hospitals might not be safe places at all. If I decide not to ventilate someone, his or her relatives might not be too happy. Threats to staff are all too common and many are worried about personal security. Consequently it has been suggested that the decision as to who gets the intensive care bed should be taken away from frontline staff in order to protect them.

At a discussion over how we would react to a biological emergency, where casualties would be decontaminated before we resuscitated them, it was asked who would protect the staff. The answer given was hospital security. Pleasant and helpful as they are, these guys are hardly equipped to deal with an angry mob. One doctor said that the most useful thing staff could be given in such an event was a gun.

Another concern is the legal position of staff who refuse treatment. In the absence of any measures put in place to protect them, one can imagine a raft of legal actions being taken out against them.

If attempting to allocate resources on the basis of capacity to benefit is the right thing to do, then those making the decisions need to be protected, otherwise people will not make the decisions required. Perhaps the only equitable and fair way is to shut the intensive care units and limit treatment to the best we can achieve without artificial ventilation".

Dr Andrew Lawson lectures in medical ethics at Imperial College, London, UK.

Source:

TIMESONLINE (2007). If bird flu grips the nation, doctors will need guns (Electronic version). Retrieved February 12, 2007 http://www.timesonline.co.uk/tol/news/uk/health/article1363825.ece

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

More recent outbreaks in Japan, UK.

2007-02-06T19:48:00.000-07:00

BBC News world has confirmed the recent outbreak of bird flu in Japan. Samples taken from 3 000 dead chickens revealed that all had been infected with the H5N1 virus. There have been a number of H5N1 outbreaks in Japan since early 2004, but there have been no reported human deaths from the virus. However, Japan is one of the five countries who have put an immediate ban on the importation of poultry from the UK.

Health officials across Asia are on alert as a growing number of countries have reported cases in both birds and humans in recent weeks.

This past weekend saw the official bird flu outbreak in Suffolk, England. According to the Health Protection Agency, a vet who attended the outbreak is in hospital suffering from a mild respiratory ilness. The vet is undergoing tests at Nottinham hospital and his condition "is causing no immediate concern".

The H5N1 strain which has caused dozens of human deaths in Asia, was found in Suffolk. The H5N1 virus does not pose a large-scale threat to humans because it can't easily be transferred from human to human. However, experts fear the virus could mutate at some point in the future and trigger a bird flu pandemic.

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

Information crucial if new flu pandemic hits

2007-01-18T16:32:00.000-07:00

The Irish Medical Times says the Government’s response to a flu pandemic must ensure the open flow of information about the pandemic to the public, according to two documents published this week.

The Department of Health and the Health Service Executive (HSE) published the National Pandemic Influenza Plan as well a draft of an advisory document by the Pandemic Influenza Expert Group. A final draft of the group’s advice is expected in April.

The purpose of the National Pandemic Influenza Plan is to limit the effects of any pandemic and to inform the public about pandemic influenza; explain what the Government and the health services are doing to prepare for a possible pandemic; and to give information on what members of the public need to do if there is a pandemic. HSE CEO Prof Brendan Drumm said all sectors of society have a role to play in preparedness and response.

“If a pandemic arises each of us have a role to play in ensuring that it is managed,” he said. The pandemic plan is based on eight core elements of response. These are communications strategy, telephone hotline, public responsibilities, surveillance, antiviral drugs, pandemic vaccine, reorganization of health services, and essential supplies.

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

Bird flu spreading again in Asia

2007-01-16T16:22:00.000-07:00

Reuters reported an Indonesian hospital was on Monday overwhelmed with patients suffering bird flu symptoms while the virus spread further among flocks in Vietnam and flared anew in Thailand.

A recent spurt of human infections with the H5N1 bird flu virus, which re-emerged in Asia in late 2003, has alarmed health officials. Four Indonesians have died this year after a six-week lull in cases, taking the number of people killed by bird flu in the country to 61, the highest in the world.

Source:

Msnbc (2006). Bird flu spreading again in Asia (Electronic version). Retrieved January 16, 2006 http://www.msnbc.msn.com/id/16635479/

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

2007-01-12T13:43:00.000-07:00

“Complacency is our biggest enemy” - new head of WHO

Helen Branswell from the Canadian Press says the new head of the World Health organization that took office on Thursday, warns that complacency endangers efforts to prepare for the avian flu.

Dr. Margaret Chan, 59, holds Chinese and Canadian citizenship and received her medical degree from the University of Western Ontario. She was nominated by China for the WHO’s top job. Before taking up the director general position, she served as head of the WHO’s pandemic preparations.

In response to the threat that the H5N1 virus may trigger flu pandemic, she says “...we need to have a balanced view. One should not take the alarmist approach and on the other hand, complacency is our biggest enemy.”

Branswell notes that the sense of a pandemic alert has somewhat subsided in many quarters, because of the decrease in human infections during the past few months. Chan however, says this should be kept in perspective. Chan further reminds us that South Korea and Vietnam are still fighting outbreaks of the virus in poultry. Even though Vietnam had gone more than a year without an outbreak, they suddenly saw the virus flare up again in poultry late last year.

And just before Christmas, three people in Egypt died after contracting the virus. Branswell reports WHO statistics, which points out that 261 people, have been affected since 2003 and 157 of them have died.

During a telephone news conference in Geneva, Chan is reported to say, “We learned from past experience it goes into cycles. There would be periods of high H5N1or low activity". As we are moving into the peak season of influenza again, she advises health authorities to be vigilant.

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

Avian flu jumps to humans in Egypt

2007-01-05T14:01:00.000-07:00

According to Donald G. McNeil who wrote an article in the International Herald Tribune (Africa & Middle East), several cases of avian flu have spread from poultry to humans in the Nile Delta.

Egyptian health authorities reported nine confirmed human deaths from H5N1 since it was first discovered in birds during February and in a person in March, 2006.

McNeil points out that the health and veterinary authorities cancelled duck hunting season, banned imports of live birds and did not allow anyone to keep birds in their homes. Diseased flock were culled and healthy ones, vaccinated. This task didn’t go well without problems. Not only were there were vaccine shortages, but poor rural people disregarded the newly implemented regulations and hid birds under their beds, as they could not afford to loose their livestock.

An Egyptian newspaper, The Daily Star reported an estimated slaughter of 30 million birds mostly from the poultry industry. Although reports of the disease tapered of during the summer, new cases were reported during the month of September when the bird migration stopped over in the delta area. McNeil says local news media reports suggest that there have been about 20 suspected human cases in the northern part of Egypt.

For more information on Pandemic planning from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta (403) 245-0550. “The time to plan is when you have time to plan.”

Pandemic Preparedness Staff Survey

2006-12-15T14:10:00.000-07:00

How much would your company be impacted in the event of an avian flu pandemic? It is, of course, impossible to know with any certainty in the absence of the actual crises; however that does NOT mean that you can’t begin to anticipate what some of the problems might be.

The biggest difference in preparing for a pandemic as opposed to more common business continuity planning is that one of the biggest challenges will be the possibility of massive staff absenteeism due to personal or family illness, fear of becoming ill or of infecting family members.

How can you know how many staff might choose to stay home rather than come to work? One way to get an idea of a possible impact would be to survey all your staff now before a pandemic does occur in your area. While there are no guarantees that the responses that people give now when the concern of a pandemic is still theoretical and how they might actually respond during a real crisis, it can provide some idea of the potential disruption to your business.

Staff Survey to Estimate Potential Effects of a Pandemic on Our Organization:

The purpose of this survey is to provide information which will help in pandemic planning preparation in our organization.

NOTE: ALL INFORMATION IS CONFIDENTIAL AND NO NAMES ARE TO BE ATTACHED TO THIS SURVEY.

1. Do you take public transportation to or from work?

- Yes, all or most of the time
- Occasionally
- No, or almost never

2. If our geographic region were experiencing an avian flu pandemic, how likely would it be that you would use public transportation to get to or from work?

- Highly likely
- Somewhat likely
- Somewhat unlikely
- Highly unlikely
- Not applicable

3. Do you car pool to work?

- Yes
- Occasionally
- No

4. If our geographic region were experiencing an avian flu pandemic, how likely would it be that you would use a car pool to get to and from work?

- Highly likely
- Somewhat likely
- Somewhat unlikely
- Highly unlikely
- Not applicable

5. If schools and/or day cares were closed by order of the Medical Officer of Health because of an avian flu pandemic, would you most likely:

- Stay home to look after your children.

- Stay home to look after grandchildren, nieces, nephews, or other young relatives.
- Be able to arrange for alternate child care.
- Be unaffected by the closure of schools or day care.

6. If the Medical Officer of Health declared a medical emergency situation due to the existence of an avian flu pandemic, how likely do you think it would be that you would come to work?

- Highly likely
- Somewhat likely
- Somewhat unlikely
- Highly unlikely

7. If someone in your family other than yourself were ill with the avian flu during a declared pandemic, how likely do you think it would be that you would come to work?

- Highly likely
- Somewhat likely
- Somewhat unlikely
- Highly unlikely

8. If you knew that a work colleague had a family member at home who had been diagnosed with avian flu, how likely would it be that you would come to work?

- Highly likely
- Somewhat likely
- Somewhat unlikely
- Highly unlikely

9. Do you think that coming into contact with the avian flu virus would present a higher risk to you than it would to the majority of your colleagues?

- Yes
- No
- Not sure

10. Do you think that you have sufficient information to protect yourself and your family from an avian flu?

- I think I have sufficient information to protect myself and my family in the event of an avian flu pandemic.
- I don’t have sufficient information on how to protect my self and my family in the event of an avian flu pandemic.
- I don’t know if I have enough information to protect myself and my family in the event of an avian flu pandemic

11. Has your organization done enough to provide information to staff about organizational preparedness in the event of an avian flu pandemic?

- My organization has done an excellent job in providing information to everyone.
- My organization has provided some information on planning for an avian flu pandemic.
- I am not aware of anything my organization has done with respect to planning for an avian flu pandemic.

For more information on Pandemic planning from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta (403) 245-0550. "The time to plan, is when you have time to plan."

Does the flu shot do more harm than good?

2006-11-23T22:31:00.001-07:00

Connie Howard from the VueWeekly, an Edmonton Independent news and weekly columnist says we should be taking the available vaccination programs with a pinch of salt.

One of the things to consider, is Thimerosol which is a mercury derivative primarily used as a preservative in vaccines. The only thing to keep in mind though, is the toxicity of mercury to our brains. It is no longer used in childhood vaccines in Canada, but still used in flu vaccines, because adult brains are less susceptible to toxicity than developing ones.

Connie reminds us to consider the whole efficacy debate around the flu vaccine. Health officials make educated guesses about which flu strains are most likely to appear the following year. Based on their information, the efficacy in groups most recommended for the shots is 30 to 40 percent. The irony is that pneumonia and flu hospitalization rates for those in the high-risk category (newborns and the elderly) are less than one percent during flu season.

This seems to indicate a gap between flu prevention policy and evidence of efficacy and safety. Some of you may be aware that the flu medicine called Tamiflu, is being stockpiled like mad in the event of a bird flu outbreak. Although experts have questioned its efficacy, other flu medicines just don’t seem to rake in the same big profits.

Source:

VueWeekly, Edmonton’s 100% Independent news an Entertainment Weekly (2006). Well, well, well (Electronic version). Retrieved November 23, 2006 http://www.vueweekly.com/articles/default.asp

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

Latest information on the situation in Indonesia – November 2006 update

2006-11-23T20:43:00.001-07:00

According to WHO (World Health Organization), the Ministry of Health in Indonesia has confirmed an additional two cases of human infection with the H5N1 avian influenza virus.

A 35-year old woman from Tangerang in the Banten province developed symptoms on 7 November and was taken up in hospital 3 days later. She remains hospitalized while her source of exposure is under investigation.

The second case is that of a 30-year old man from Karawang in the West Java province. His symptoms developed on 5 November and he was hospitalized on 10 November and died three days later.

An initial investigation about the source of exposure showed reports of chicken deaths near his home in the days before his symptom onset.

Of the 74 cases confirmed to date in Indonesia, 56 have been fatal.

Source:

World Health Organization: Epidemic and Pandemic Alert Response (ERP) (2006). Avian influenza – situation in Indonesia – update 37 (Electronic version). Retrieved November 23, 2006 http://www.who.int/csr/don/2006_11_13/en/index.html

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

Who gets the vaccine?

2006-11-23T20:14:00.000-07:00

When (and not “if”) a flu pandemic strikes, one of the most critical issues will involve the medical ethics of providing scare resources to the community. Hospitals and Health Regions across North America are having conversations on the guidelines to follow in delivering a scarce treatment such as a vaccine, or respirators to people who are hospitalized. Who should be first in line? Who decides this?

The following is an article from StarNewsonline.com – an online newspaper serving South Carolina.

N.C. panel prepares for morals of flu pandemic Associated PressRaleigh With a flu pandemic inevitable, North Carolina's medical professionals must prepare now for what could be wrenching moral decisions about who will be treated and who won't if the illness overwhelms hospital resources, members of a state task force said. The Task Force on Ethics and Pandemic Influenza Planning met recently to discuss a strong set of ethical guidelines for the state's doctors and nurses in the event of a global outbreak of a new and more virulent strain of flu virus. The list would help them decide who gets priority for medical care in the face of a wave of flu-stricken patients that would rapidly outstrip the supply of hospital beds, medicine and equipment."

It's going to exceed our capacity," Philip Rosoff, director of clinical ethics at Duke Hospital, said during a four-hour meeting of the task force Monday. "The more stringent and robust our guidelines are, the less chance there is for decisions being made for arbitrary and morally unjustifiable reasons. "Medical authorities say the next flu pandemic is long overdue and inevitable, based on the history of three deadly outbreaks in the 20th century: the Spanish flu pandemic of 1918-19, which killed 50 million to 100 million people worldwide; the Asian flu pandemic of 1957; and the Hong Kong flu pandemic of 1968.Hospitals across North Carolina are already at 85 percent to 90 percent capacity, and even a mild pandemic would force doctors and nurses to ration medicine and equipment.

The 40-member task force, a joint project of the North Carolina Institute of Medicine and the state Division of Public Health that began meeting in May, wrestled with the wisdom of giving children priority for scarce anti-viral drugs and vaccines.They also worried whether their guidelines would cut off the poor and disadvantaged, or Hispanic immigrants.They debated a scenario involving three gravely ill patients - a 10-year-old with a 30 percent chance of survival, a 40-year-old doctor with a 25 percent chance and a 65-year-old retiree with a 10 percent chance - whom all needed the only ventilator available to help them breathe."

Let's say I've got a hospital full of 85-year-olds on ventilators and I've got a 20-year-old who needs a ventilator: Do I take an 85-year-old off and give it to the 20-year-old?" Rosoff asked. The task force settled on two broad guidelines for rationing vaccines, anti-viral drugs and medical equipment during a flu pandemic. The first is to assure that crucial functions of society aren't disrupted. That means giving priority for vaccines and anti-viral medication to health care workers, police, firefighters and employees of critical industries such as utilities. The second is to reduce the number of deaths and infections and prevent the spread of the illness. The panel is due to issue a report in the spring.

In earlier meetings, members had discussed the responsibility of doctors and nurses to provide care during a pandemic, along with a hospital's responsibility to make sure those workers are safe, properly trained to handle unfamiliar tasks and paid for service during a crisis. The panel also has drafted recommendations about the movement of people during a pandemic, including the use of quarantine and the closing of schools, churches and other mass gatherings. Leaders of the task force have so far resisted issuing strict directives. But John Morrow, health director for Pitt County, called for a more direct approach."We're up here at 30,000 feet making these broad, philosophical statements, but nobody's going to read a paper like that," he said. "We've got folks with 100 doses of vaccine and everybody wants it, and we've got to give them specific guidelines on who gets it and why."

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

University of Western Ontario: Paul Mayne - October 2006 update

2006-11-23T20:13:00.000-07:00

A researcher at the University of Toronto says it’s a matter of time before the emergence of a flu pandemic is expected to hospitalize and kill millions around the world.

Kristy Duncan is the author of a book called “Hunting the 1918 flu: one Scientist’s Search for a Killer Virus”. She speaks about the Spanish flu which killed about 50 million people worldwide and even went as far as exhuming the bodies of seven people who were killed by the 1918 flu.

Determined to find out what the virus looked like, she took samples from the brain, heart, kidney, liver and lung. She did this believing that the H5N1 has similar genetic paths than the Spanish flu. Kristy insists that the scientific world has a unique opportunity in becoming more prepared for the future by learning from the past.

Other leading scientists and the WHO say a pandemic is not only evident, but imminent. The question is; if it is imminent, then why are so few people concerned around the world? So far, to her knowledge only 15% of American businesses and 4% of Canadian businesses have a pandemic flu plan in place.

As a responsible scientific researcher, Duncan says the pandemic is very real and the challenge is not to create panic and fear mongering. Individual preparedness includes building a supply of food, water and medication to last for a period of six to eight weeks.

Something to think about for the next time you go shopping!

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

Execs not prepared for workplace disasters – Calgary Herald Tuesday, September 26, 2006.

2006-11-23T20:12:00.000-07:00

A recent article that appeared in the Calgary Herald spoke about how Canadian bosses have a ‘false sense of security’ according to a survey done by Leger Marketing. This survey measured how prepared Canadian firms are for the unexpected. The results, released on Tuesday, 26th September 2006, suggest the “majority of Canadian business leaders are operating under a false sense of security.”

According to the article 75 percent of Canadian business executives feel personally responsible for their company’s disaster preparedness. The analysis of the results conducted for Fusepoint Management Services warns that the majority of leaders have not thought about what to do when it comes to threats posed by hackers, terrorists or even natural disasters like blackouts and ice storms.

It seems only a small proportion of the 520 senior executives who were surveyed, say their company has a disaster recovery plan. And fewer than half of those leaders have a full-blown plan in place.

With the risk of terrorist threats and natural disasters, including a potential outbreak of the avian flu ever increasing, Canadian businesses simply cannot afford to take disaster preparedness for granted.

The article also quoted findings of a separate survey of employees, done by Leger Marketing, which suggests employees fear a pandemic outbreak to be of great concern. Almost 60 percent of employees replied that they would not go into work if someone in the office came down with the avian flu.

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

Chinese lack of transparency could trigger bird flu pandemic

2006-11-23T20:11:00.000-07:00

A real concern was expressed last week when news of a new strain of the deadly H5N1 bird flu virus reached virologists. This new strain has spread from southern China to South East Asia and re-ignited very real fears of an imminent pandemic.

According to the article, China’s Agricultural Ministry has come under sharp criticism from the World Health Organization for not sharing samples of the newly discovered strain of bird flu. China’s reluctance to share vital information and lack of cooperation has been an ongoing source of aggravation for health experts.

Scientists have been collecting bird faecal samples from poultry markets in the southern provinces from July 2005 to June 2006. They have found that the new strain from the Fujian province has become more predominant. Furthermore, 1 out of every 30 ducks and 1 out of every 30 geese in live markets tested positive for H5N1 but in that same period, Chinese authorities reported only three outbreaks in those same provinces.

Health experts feel it is important to know when a strain becomes more predominant than another in order to develop methods to detect and fight the disease. According to the article, it is believed some countries are reluctant to share genetic information or samples of viruses because they are afraid they will be pushed aside in the global race to produce a “lucrative vaccine”.

Source:

News-Medical.Net (2006). Chinese lack of transparency could trigger bird flu pandemic (Electronic version). Retrieved November 1, 2006 http://www.news-medical.net/default.asp

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”

Article from the Irish Medical Times released on 27 October 2006

2006-11-23T19:55:00.000-07:00

When it comes to who does and who does not receive treatment, doctors and policy makers would have to make hard decisions in the event of flu pandemic. This is according to Prof. Frederick Burkle who is a Senior Fellow with the Harvard Humanitarian Initiative at Harvard University’s School of Public Health.

Exploring the populations who have the greatest chance of getting the virus, shows that the metropolitan areas are going to be the ones where epidemics can take off. According to Prof. Burkle “…that is exactly where the virus will want to go if it wants to stay alive. If you are living in a rural area where people aren’t living close to each other, the disease is not going to spread.”

The way doctors currently treat patients will fundamentally change to take on a population-based health care approach. He says: “The individual is really not important. My goal is to make sure that every patient will not transmit it to somebody else. In a normal ICU situation, you have a special nurse, two or three other nurses, and a whole team of doctors. In (a pandemic) it will be like Africa. The definition of intensive care of a hospital in Africa is that you might have a nurse that day.”

A shortage of ventilators in Ireland poses a tough question to doctors in deciding who gets to live or die – just as ventilator shortages elsewhere in the world, including the US. Prof. Burkle adds that exclusion criteria must be agreed upon before the event. He adds: “Someone may come in with a cardiac arrest or respiratory arrest because of the disease. Resuscitation is high maintenance. We use a lot of medication and equipment. Chances are, resources will not allow (resuscitation) to happen”.

For additional information on Pandemic preparedness from a business continuity perspective, please feel free to contact Pitsel & Associates Ltd. Calgary, Alberta, (403) 245-0550. “The time to plan is when you have time to plan.”