Thursday, September 21, 2017

#NatlPrep : One For The Home, And One More For The Road


Note: This is day 21 of National Preparedness Month . Follow this year’s campaign on Twitter by searching for the #NatlPrep hash tag.
This month, as part of NPM17, I’ll be rerunning some edited and updated older preparedness essays, along with some new ones. 


A little over forty-five years ago - when I was a teenager in a sleepy central Florida town - I took a 3-night first aid class offered by the American Red Cross, and taught by our local fire chief.  Part of our homework was to put together a `cigar-box’  first aid kit, which we would pledge to carry in our cars, or keep in our home.
I made two.  One for the home, and one more for the trunk of my car.
While they weren’t exactly professional quality, and I’ve upgraded many times since, I’ve never lost the habit. The following year I went on to become an EMT, and two years after that, I was a paramedic. I confess to still feeling a bit naked these many years later without having a decent first aid kit within easy reach.
I’ll admit that owning two ambu-bags borders on the excessive, but I certainly feel better knowing they are there. 
In addition to my two main `jump bags', I've a couple of `minor' cuts & scrapes kits I keep stashed in my medicine cabinet and in an overnight bag I keep for traveling. 

Well equipped first aid kits are a necessity in every home, and ideally should also be found in the trunk of every car. While you can purchase a ready-made kit (the quality of which varies depending on price), I’ve always preferred to create my own. 
I undoubtedly have a more elaborate kit than most, but perhaps a look inside my auto first aid bag will inspire some of my readers to make one of their own.
The `bag’ is an old style Laptop computer case, with a handle and a shoulder strap.  I like these, because they have numerous compartments, are soft, and are reasonably waterproof.

On the `trauma’ side of the bag, I’ve got `Kling’ roll bandages, an ACE bandage, a couple of cravat `Triangle’ bandage (sling & swath), sterile 4x4 gauze pads, paper tape, Band-Aids, antibiotic cream and several absorbent feminine pads (they make excellent trauma dressings). 

On the opposite side, I’ve got an `ambu’ bag-mask resuscitator along with a selection of adult and child airways, a foam C-Collar, a B/P cuff, stethoscope, flashlight, and some ammonia caps – hidden away where you can’t see them are bandage shears, tweezers, and a magnifying glass, along with a spare pair of reading glasses.

There is also a penlight, a felt tipped pen, and a note pad.

Under the front `cover’ flap, I keep some basic OTC medicines, including aspirin, acetaminophen, some hand antiseptic, and a bulb syringe (can be used for minor suctioning).

Under the flap on the other side, I’ve got surgical & N95 masks, exam gloves, and a `space’ blanket.

And if that weren't enough, I've a non-medical emergency kit in my trunk as well. Some water, another space blanket, glow sticks (safer than road flares), gloves, a few tools, flashlight, etc.

Of course, having a kit isn’t enough.  You need to know how to use it. 
And for that, you need first aid training.  If you haven’t already taken a course, contact your local Red Cross chapter, and find out what is available in your area.   And don’t forget the CPR training (or recertification!) as well.
Whether you buy a ready-made kit, or make your own, now is a good time to make sure you are fully equipped to deal with a medical emergency.
For more information I would invite you to visit:

Maryland DOH: 7 Fairgoers Test Positive For Swine Variant H3N2v


We've had 3 pretty quiet weeks on the swine variant flu front since the September 1st announcement of the 20th case of 2017 (see FluView Week 34: 1 Novel H1N2v Flu Infection Reported In Ohio). This morning, however, we are learning of 7 additional swine variant (H3N2v) infections in Maryland linked to the Charles County Fair. 

This press release from the Maryland Department of Health, released late yesterday.

Testing points to a flu virus in 7 fair-goers who had close contact with swine 
None of those who attended Charles County event is seriously ill with H3N2v
Baltimore, MD (September 20, 2017) – The Maryland Department of Health has presumptively identified the influenza virus strain H3N2v (variant flu) in seven Maryland residents who had close contact with pigs at the Charles County Fair. None of the infected individuals has developed serious illness or been hospitalized. 

Influenza is an infection caused by the influenza virus which can affect people and other animals, including pigs and birds. Symptoms for the H3N2v strain are the same as seasonal flu and include fever and respiratory symptoms, such as sore throat and cough. Historically, there is limited human to human transmission from this strain of variant flu. The treatment recommendations for this strain of influenza are the same as for seasonal flu. 

Health officials recommend that people with influenza-like illness contact their healthcare provider and inform them if they have had pig contact within the past seven days. Providers are advised to contact their local health departments if they suspect variant flu in their patients to coordinate appropriate testing with their local health department. The Charles County Health Department can be reached at 301-609-6900 ext. 6025 and the St. Mary’s County Health Department can be reached at 301-475-4330. 

Twenty other cases of variant flu have been detected in other states this year. Of those, 18 were also the virus strain H3N2v. Illnesses associated with these variant flu infections have been mostly mild with symptoms similar to those of seasonal flu. In 2012, 13 individuals developed influenza after direct contact with sick pigs at the Queen Anne’s County fair in Maryland. 

Certain people are at higher risk for complications of influenza, including children under five, the elderly, pregnant women, and those with chronic heart, lung, liver, kidney and neurologic conditions or immunosuppression. The spread of influenza, including the possible spread of H3N2v, between humans can be prevented by: 

Avoiding close contact with sick people;

  • Limiting contact with others as much as possible if you are sick to keep from infecting them and staying home from work or school if you are sick until you are fever free for 24 hours without fever reducing medicines;
  • Covering your nose and mouth with a tissue when you cough or sneeze and dispose of the tissue immediately after use;
  • Washing your hands often with soap and water or alcohol-based hand rub if soap and water are not available;
  • Avoiding touching your eyes, nose and mouth;
  • Cleaning and disinfecting surfaces and objects that may be contaminated with germs like the flu; and
  • Getting the seasonal influenza vaccine when it becomes available. Although it is not effective against H3N2v, it is protective against other common strains of influenza.
The spread of influenza between pigs and humans can be prevented by:
  • Washing your hands frequently with soap and running water before and after exposure to pigs;
  • Never eating, drinking or putting things in your mouth in pig areas;
  • Considering avoiding exposure to pigs and swine barns this summer, especially if sick pigs have been identified and if you are high risk of complications from influenza;
  • Watching your pig for signs of illness and calling a veterinarian if you suspect they might be sick;
  • Avoiding close contact with pigs that look or act ill; and
  • Avoiding contact with pigs if you are experiencing flu-like symptoms.
Additional information from the Centers for Disease Control and Prevention regarding Swine Influenza/Variant Influenza Viruses is available here.

Due to concerns over additional possible transmission, Maryland's Secretary of Agriculture has issued an order closing the swine venues at two upcoming county fairs.

Last month, in EID Journal: Transmission Of Swine H3N2 To Humans At Agricultural Exhibits - Michigan & Ohio 2016, we looked at the risks of novel flu transmission in these types of venues, including from healthy-looking pigs.
Most years fewer than a dozen `swine variant' infections are reported in the United States, mostly involving farm or livestock workers. Most are mild, but it is likely that many others go undiagnosed.
A far cry from 2012, when 10 states reported more than 300 confirmed cases (see H3N2v Update: CDC Reports 52 New Cases, Limited H2H Transmission) assuming these 27 cases are confirmed by the CDC - would make 2017 the 2nd busiest swine variant year on record.
With state and county fair season continuing over the summer and into fall, it would not be unexpected to see additional, scattered reports of swine variant infection. 
While rarely as severe as avian flu in humans, swine influenza viruses nevertheless are considered to have some pandemic potential. The CDC's IRAT (Influenza Risk Assessment Tool) Rankings monitors and characterizes 14 different novel flu viruses, and has this assessment on H3N2v

H3N2 Variant:[A/Indiana/08/11]

Swine-origin flu viruses do not normally infect humans. However, sporadic human infections with swine-origin influenza viruses have occurred. When this happens, these viruses are called “variant viruses.” Influenza A H3N2 variant viruses (also known as “H3N2v” viruses) with the matrix (M) gene from the 2009 H1N1 pandemic virus were first detected in people in July 2011. The viruses were first identified in U.S. pigs in 2010. In 2011, 12 cases of H3N2v infection were detected in the United States. In 2012, 309 cases of H3N2v infection across 12 states were detected. The latest risk assessment for this virus was conducted in December 2012 and incorporated data regarding population immunity that was lacking a year earlier.
Summary: The summary average risk score for the virus to achieve sustained human-to-human transmission was in the moderate risk category (less than 6). The summary average risk score for the virus to significantly impact public health if it were to achieve sustained human-to-human transmission was in the low-moderate risk category (less than 5).

For some recent blogs on Swine variant influenza, and why the CDC closely monitors these infrequent human infections, you may wish to revisit:

Ohio: Henry County Fair Closes Pig Barn Over H1N2 Swine Flu

Second Ohio County Fair Closes Hog Barn Over Swine Flu

A Reminder About The `Other' Novel Flu Threat

MMWR: Investigation Into H3N2v Outbreak In Ohio & Michigan - Summer 2016

Wednesday, September 20, 2017

#NatlPrep: Because Sometimes It Is Darkest After The Storm

Note: This is day 20 of National Preparedness Month . Follow this year’s campaign on Twitter by searching for the #NatlPrep hash tag.
This month, as part of NPM17, I’ll be rerunning some edited and updated older preparedness essays, along with some new ones. 

Short term power outages affect most of us each year, usually lasting anywhere from a few minutes to a couple of hours.  Longer outages, while less common, are far from rare - as anyone who found themselves in the path of hurricanes Harvey, Irma, and Marie over the past month will attest.
While my power was restored late last week, there are still a few thousand without power in Florida, and with Marie's landfall a few hours ago, likely millions more are without electricity now in Puerto Rico. 
As so many have recently discovered (or rediscovered), after about 12 hours without electricity, the quality of life begins to sharply decline.  After 48 hours life just sucks.
While having no TV, or Internet, or electric lights might seem more of an inconvenience than anything else, sometimes not having power can be deadly (see Ninth person dead in Florida nursing home where Irma knocked out power).
During the summer of 2012, a powerful Derecho swept across the Mid-Atlantic states (see Picking Up The Pieces), killing 15 and leaving nearly 4 million people without power, some for more than 2 weeks. While 15 people died during the storm, at least 32 died of heat-related illnesses in the two weeks that followed.   This from a 2013 MMWR:
Heat-Related Deaths After an Extreme Heat Event — Four States, 2012, and United States, 1999–2009


June 7, 2013 / 62(22);433-436 On June 29, 2012, a rapidly moving line of intense thunderstorms with high winds swept across the midwestern and eastern United States, causing widespread damage and power outages.
Afterward, the area experienced extreme heat, with maximum temperatures exceeding 100°F (37.8°C) (1). This report describes 32 heat-related deaths in Maryland, Ohio, Virginia, and West Virginia that occurred during the 2 weeks following the storms and power outages. 

Most decedents (75%) were unmarried or living alone. Common underlying or contributing conditions included cardiovascular disease (14) and chronic respiratory disease (four). In at least seven (22%) of the deaths, loss of power from the storms was known to be a contributing factor. Overall, 22 (69%) decedents died at home, with lack of air conditioning reported in 20 (91%) of these deaths.
       (Continue . . . )

As I've written often (see #NatlPrep: Disaster Buddies) people who live alone - nearly 1 person in 10 in the United States - are particularly vulnerable during a disaster.
For some of them, having a place to go when staying put would endanger their safety, and a way to get there, can literally mean the difference between life and death.
Hurricanes, ice storms, Nor’easters, tornadoes, floods, tornadoes . . .  and even solar storms (see Solar Storms, CMEs & FEMA) are capable of crippling power production and delivery.
Add in our aging infrastructure, and the potential of cyber (or physical) attacks on the system, and the odds of seeing more major power outages only increases.
Without electrical power, water and gasoline doesn’t pump, elevators and air conditioners don’t run, ATM machines and banks close, grocery stores can’t take debit or credit cards, produce, meat and frozen foods spoil, and and everything from cooking, to flushing toilets, becomes a major challenge.
Particularly in urban settings. 
If a disaster struck your region today, and the power went out, stores closed their doors, and water stopped flowing from your kitchen tap for the next 7 to 10 days  . . .  do you have:
  • A battery operated NWS Emergency Radio to find out what was going on, and to get vital instructions from emergency officials?
  • A decent first-aid kit, so that you can treat injuries?
  • Enough non-perishable food and water on hand to feed and hydrate your family (including pets) for the duration?
  • A way to provide light (and in cold climates, heat) for your family without electricity?   And a way to cook?  And to do this safely?
  • A small supply of cash to use in case credit/debit machines are not working?
  • An emergency plan, including meeting places, emergency out-of-state contact numbers, a disaster buddy,  and in case you must evacuate, a bug-out bag?
  • Spare supply of essential prescription medicines that you or your family may need?
If your answer is `no’, you have some work to do.  A good place to get started is by visiting  
Unfortunately, a lot of people make the wrong choices when they do prepare.  They buy candles instead of battery operated lights, they use generators inside their house or garage, or resort to dangerous methods to cook or to heat their homes. 
As a result, when the power goes out, house fires and carbon monoxide poisonings go up. Each year hundreds of Americans are killed, and thousands affected, by CO poisoning (see In Carbon Monoxide: A Stealthy Killer).  
While preparedness may seem like a lot of work, it really isn’t.  You don’t need an underground bunker, an armory, or 2 years worth of dehydrated food.  But you do need the basics to carry on for a week or two, and a workable family (or business) emergency/disaster plan. 
But you need to make these preparations now, before the next threat appears on the horizon.  In central Florida, there wasn't a case of water, a flashlight, or a battery to be had a full 5 days before Irma struck.  Those who procrastinated were out of luck.

For more information on how to prepare, I would invite you  to visit:

A final note:  Living in Florida, and having endured some mighty uncomfortable power outages, I've come to really appreciate having a battery operated fan in my emergency kit.

The little fan above cost me about $12, runs for roughly 24 hours on 3 D cells, moves a pretty good amount of air, and makes a great little preparedness item. There are also USB fan options, which can run off of USB powerbanks (which in turn can be charged by solar panels).

CDC Update: Candida Auris - September 2017


Last summer (June 24th, 2016) the CDC issued a Clinical Alert to U.S. Health care facilities about the Global Emergence of Invasive Infections Caused by the Multidrug-Resistant Yeast Candida auris.
C. auris is an emerging fungal pathogen that was first isolated in Japan in 2009. It was initially found in the discharge from a patient's external ear (hence the name `auris').  Retrospective analysis has traced this fungal infection back over 20 years.
Since then the CDC and public health entities have been monitoring an increasing number of cases (and hospital clusters) in the United States and abroad, generally involving bloodstream infections, wound infections or otitis (see August Update).
Adding to the concern:
  1. C. auris infections have a high fatality rate
  2. The strain appears to be resistant to multiple classes of anti-fungals  
  3. This strain is unusually persistent on fomites in healthcare environments.
  4. And it can be difficult for labs to differentiate it from other Candida strains
Last month the CDC promoted the first ever Fungal Disease Awareness Week, and presented a COCA call webinar called Tackling an Invasive, Emerging, Multi-drug Resistant Yeast: Candida auris — What Healthcare Providers Need to Know, which is now archived and available online.

CIDRAP's Antimicrobial Stewardship Project (ASP) also held an hour long webinar (see below), which is now available on the CIDRAPASP Youtube channel.
 (Note: you'll find more than a dozen other on-topic videos available on this channel as well).
This week the CDC updated their C. Auris surveillance page, where they now show 126 confirmed cases and 27 probable cases, across 10 states (California was added this month). The number of colonized asymptomatic cases has risen to 143.

Tracking Candida auris

September 18, 2017: Case Count Updated as of August 31, 2017

Candida auris is an emerging fungus that presents a serious global health threat. C. auris causes severe illness in hospitalized patients in several countries, including the United States. Patients can remain colonized with C. auris for a long time and C. auris can persist on surfaces in healthcare environments. This can result in spread of C. auris between patients in healthcare facilities.

Most C. auris cases in the United States have been detected in the New York City area and New Jersey. Strains of C. auris in the United States have been linked to other parts of the world. U.S. C. auris cases are a result of inadvertent introduction into the United States from a patient who recently received healthcare in a country where C. auris has been reported or a result of local spread after such an introduction.

Please note that as of September 18, 2017, the total case counts reported include both probable and confirmed clinical cases; previously reported case counts included only confirmed cases. Case counts for some states are quite a bit higher than those listed before September 18, 2017 because of the change in reporting, and not because of a large increase in new cases. Read more below about how cases are defined.

WHO: The World Is Running Out Of Antibiotics


While pandemics and outbreaks of novel diseases like avian flu, MERS, and Zika make the immediate headlines, in terms of medium-to-long term threats, there is little that can match the potential harm from the rise of antibiotic resistant bacteria around the globe.
Despite decades of warnings, this threat is largely under appreciated by the public because its progression has been gradual, the loss of antibiotics incremental, and so far at least . . . there have always been replacement drugs available when an antibiotic has failed.
But the number of new antibiotics in the pipeline are desperately few, and the pace of newly emerging resistant bugs has increased greatly in recent years. While the numbers remain small, we are beginning to see the emergence of pan-resistant bacteria.

A few (of dozens) of unwelcome antimicrobial resistant milestones reported in the past couple of years include:

Eurosurveillance: Mcr-One, Two, Three And Counting
MMWR: Fatal Pan-Drug Resistant CRE - Nevada 2016
mBio: 1st Colistin & Carbapenem Resistant E. Coli Infection In A U.S. Patient
Eurosurveillance: Identification Of A Novel Colistin-Resistant MRC-2 Gene In E Coli - Belgium, 2016
CDC HAN: Alerting Healthcare Facilities Of 1st MCR-1 Gene Detection In US Patient

And just three weeks ago CIDRAP reported on a Hypervirulent, highly resistant Klebsiella identified in China, one which a week later was described as New Klebsiella strains 'worst-case scenario,' experts say. 
If we're in a war against resistant bacteria, the news from the front isn't good.
Today the World Health Organization released a grim assessment of the current state of antibiotic development, calling on pharmaceutical companies and researchers to `urgently focus on new antibiotics against certain types of extremely serious infections'.

News release 
A report, Antibacterial agents in clinical development – an analysis of the antibacterial clinical development pipeline, including tuberculosis, launched today by WHO shows a serious lack of new antibiotics under development to combat the growing threat of antimicrobial resistance.

Most of the drugs currently in the clinical pipeline are modifications of existing classes of antibiotics and are only short-term solutions. The report found very few potential treatment options for those antibiotic-resistant infections identified by WHO as posing the greatest threat to health, including drug-resistant tuberculosis which kills around 250 000 people each year.

"Antimicrobial resistance is a global health emergency that will seriously jeopardize progress in modern medicine," says Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. "There is an urgent need for more investment in research and development for antibiotic-resistant infections including TB, otherwise we will be forced back to a time when people feared common infections and risked their lives from minor surgery."

In addition to multidrug-resistant tuberculosis, WHO has identified 12 classes of priority pathogens – some of them causing common infections such as pneumonia or urinary tract infections – that are increasingly resistant to existing antibiotics and urgently in need of new treatments.

The report identifies 51 new antibiotics and biologicals in clinical development to treat priority antibiotic-resistant pathogens, as well as tuberculosis and the sometimes deadly diarrhoeal infection Clostridium difficile.

Among all these candidate medicines, however, only 8 are classed by WHO as innovative treatments that will add value to the current antibiotic treatment arsenal.

There is a serious lack of treatment options for multidrug- and extensively drug-resistant M. tuberculosis and gram-negative pathogens, including Acinetobacter and Enterobacteriaceae (such as Klebsiella and E.coli) which can cause severe and often deadly infections that pose a particular threat in hospitals and nursing homes.

There are also very few oral antibiotics in the pipeline, yet these are essential formulations for treating infections outside hospitals or in resource-limited settings.

"Pharmaceutical companies and researchers must urgently focus on new antibiotics against certain types of extremely serious infections that can kill patients in a matter of days because we have no line of defence," says Dr Suzanne Hill, Director of the Department of Essential Medicines at WHO.

To counter this threat, WHO and the Drugs for Neglected Diseases Initiative (DNDi) set up the Global Antibiotic Research and Development Partnership (known as GARDP). On 4 September 2017, Germany, Luxembourg, the Netherlands, South Africa, Switzerland and the United Kingdom of Great Britain and Northern Ireland and the Wellcome Trust pledged more than €56 million for this work.

"Research for tuberculosis is seriously underfunded, with only two new antibiotics for treatment of drug-resistant tuberculosis having reached the market in over 70 years," says Dr Mario Raviglione, Director of the WHO Global Tuberculosis Programme. "If we are to end tuberculosis, more than US$ 800 million per year is urgently needed to fund research for new antituberculosis medicines".

New treatments alone, however, will not be sufficient to combat the threat of antimicrobial resistance. WHO works with countries and partners to improve infection prevention and control and to foster appropriate use of existing and future antibiotics. WHO is also developing guidance for the responsible use of antibiotics in the human, animal and agricultural sectors.

Note to editors

For more information, download the following reports:
The clinical pipeline analysis data can be explored in an interactive way through:

Tuesday, September 19, 2017

#NatlPrep : Pandemic Planning Considerations

Note: This is day 19 of National Preparedness Month . Follow this year’s campaign on Twitter by searching for the #NatlPrep hash tag.
This month, as part of NPM17, I’ll be rerunning some edited and updated older preparedness essays, along with some new ones. 


Although we are coming up on the 100th anniversary of the deadliest flu pandemic in history, it is worth noting that there have been 3 legitimate pandemics, and a couple of pseudo-pandemics in my lifetime.  As I’m only 63, there is a pretty good chance I’ll see another one before I exit stage left.

Over the past 60 years we’ve seen:
  • The 1957 H2N2 Pandemic 
  • The 1968 H3N2 Pandemic
  • The 1977 H1N1 `Russian Flu’ pseudo-pandemic
  • The 2003 SARS pseudo-pandemic
  • The 2009 H1N1 Pandemic
We are also in the midst of a slow-rolling HIV pandemic, which nonetheless has claimed the tens of millions of lives, and the 7th Cholera Pandemic (which ran between 1961-1975) still claims tens of thousands of lives each year.
While a lot of pathogens can potentially cause a pandemic, it is novel influenza that has historically wreaked the most havoc, and keeps most epidemiologists up at night.
A decade ago - when the H5N1 bird flu virus first threatened - we saw a massive global push for pandemic preparedness. Many groups selected a CPO; a Chief Pandemic Officer.  Someone in their business, organization, or family - whose job it was to coordinate their pandemic plan  (see Quick! Who's Your CPO?). 
Unfortunately, since the 2009 H1N1 pandemic was perceived by many as being mild and the next event thought years away, many corporate, organizational, or agency pandemic plans haven’t been updated – or in some cases even looked at – in years.
While a pandemic may not strike with the suddenness of an earthquake or a Hurricane, a pandemic virus can still spread around the globe in a matter of days or weeks, leaving precious little time to prepare. 

The CDC, and FEMA continue to urge pandemic preparedness, and earlier this year the CDC updated their CDC/HHS Community Pandemic Mitigation Plan - 2017, which recognizes a vaccine could be months in coming, and focuses on reducing the spread of a pandemic virus through non-pharmaceutical interventions (see Community Pandemic Mitigation's Primary Goal : Flattening The Curve)

The CDC’s Nonpharmaceutical Interventions (NPIs) webpage defines NPIs as:

Nonpharmaceutical interventions (NPIs) are actions, apart from getting vaccinated and taking medicine, that people and communities can take to help slow the spread of illnesses like influenza (flu). NPIs are also known as community mitigation strategies.
Social distancing, staying home when sick, avoiding crowds, even the closure of schools or other public venues are all potential NPIs.

Although there may be other pharmaceutical options - like antivirals - available at the start of a pandemic, those will be in finite supply and are not a panacea for infection.  Prevention is always better than treatment, but never more so than during a pandemic, when treatment options may quickly become limited.

Hospital beds, ventilators, even hospital staff - may all be in short supply during a pandemic (doctors and nurses get sick, too) - which makes it all the more imperative we flatten the curve - even if it means extending the duration of a pandemic wave.

While telling people to wash their hands, cover their coughs, avoid crowds, and stay home while sick may seem like a weak response to a pandemic - in truth, they (and other more disruptive measures like school closures, cancellation of public events, etc.) may be our most powerful weapons in any pandemic.

But they must be properly applied, else they could do more harm than good.
It's neither practical or desirable to simply shut everything down at the first sneeze, and try to wait out what could be a year (or longer) pandemic. Very few are equipped to do so, and besides, someone has to keep the lights on, deliver the food, refine the fuel, police the streets,  take care of the sick and injured . . . and do the thousands of other things that hold civilization together.
We'll have to find ways to live and work as safely as possible during a pandemic. Else the virus could quickly become the least of our problems.
If you are an employer, you should know that OSHA considers it your responsibility to provide a safe workplace – even during a pandemic - and has produced specific guidance on preparing workplaces for an Influenza Pandemic  along with Guidance for Protecting Employees Against Avian Flu.

Frankly, few businesses could survive a prolonged shutdown due to a pandemic. Which is why pandemic planning should be part of their overall business continuity and recovery plan. A couple of good resources worth checking out are The Business Continuity Daily and Cambridge Risk Perspectives, both of which provide daily reviews of current threats and advice on preparedness.

And if you follow only one link from this blog post, I’d highly recommend the following 20 minute video produced by Public Health - Seattle & King County -  called Business Not As Usual .

We could easily go years, or even decades, before the next pandemic strikes.  Or, it could begin somewhere in the world tomorrow. Like earthquakes along fault lines, and tornadoes in Tornado Alley, pandemics are inevitable. The timing is really the only question.
For a family or an individual - if you are well prepared for a flood, an earthquake, or a hurricane - you are probably in pretty good shape to deal with a pandemic.  Unfortunately, fewer than half of all American households are so prepared.
Businesses, health care facilities, and government agencies will find that their disaster plans will need to consider pandemics a bit more specifically.  For more information on how to prepare, you may want to revisit:
Pandemic Planning For Business
NPM13: Pandemic Planning Assumptions
The Pandemic Preparedness Messaging Dilemma