Birdflu Mailing List: CDC briefing 5/18/09 "H1N1 is not going away"

[William Weir (wweir1]

 I find this CDC telebriefing transcript quite clear and valuable now in
understanding the situation with H1N1.  I hope you find it worth reading and
forwarding it or its URL (at bottom) to others.  Please note the greater
severity and prevalence in people 5-24 years old.Would you agree that extra
precautions are needed for them?   Based on my research I suggest:
1> P*rovide an N-95 mask* (blue like some spray painters wear) with
instructions to put it on and fit it snug (not leaking beside nose or at
facial hair) when approaching anyone who is coughing or sneezing, and to
keep at least 6 feet away if possible.
*2> Cleanse hands* thoroughly back/front/wrists (killing the virus with
alcohol-based hand sanitizer or washing with soap for at least 20
seconds);otherwise, avoid hand contact with eyes/nose/mouth/food, etc.3>
Avoid* shaking hands *(Instead, smile and touch elbows as at CDC?  Or smile
and hold up a hand or two with thumbs up?  Or smile with a nod of the
head?), avoid petting dogs/cats/etc., and use a paper towel between your
hand and door handles, stair railings, faucets, dispensers, etc. *unless
planning to cleanse hands before contacts such as above.*
4> Be sure to cover your *mouth and nose* before coughing or sneezing,
preferably
with tissue (disposed of properly ASAP); otherwise if you can, covering with
a sleeve at elbow (putting garment when taken off into your laundry
basket).  Or better, if coughing/sneezing persist, wear a rectangular
(yellow) surgical mask to catch droplets carrying a virus that could infect
others.5> Take note if you are possibly/probably/surely exposed to the
virus, and discuss this with a parent/health aide/physician, considering
precautions, such as  wearing an N-95 (or surgical) mask when near others.
An infected/infectious person may show no symptoms for 24-48 hours. *6>
Also, after last symptoms are gone, since a recovered person can still
transmit the virus to others for another 7 days so wear a surgical mask when
near other people.*
Best of health to you and yours,
Bill
Rev. William M. Weir, DB (U of Chicago) MHA (health care mgmt., U of MN),
Chair, Comte. on Emergency Preparedness (for Pandemic Flu), First Unitarian
Society of Minneapolis.*PS - **The transcript is also attached in MS Word
format for printing as four pages (such as on one 11" x 17" sheet).

PPS - I used the BCC box to send this to those of you not yet subscibing to
birdflu [at] muusja.org; to subscribe, simply send "At Bill's invitation, I 
would
like to subscribe" to this address to be added to the "discussion group" to
receive (and if you wish, to send) relevant questions, answers, bulletins,
etc. to help reduce the toll of the coming influenza pandemic.
=============================================================================================
**CDC Telebriefing on Investigation of Human Cases of H1N1 Flu*

Transcript of opening remarks of Dr. Anne Schuchat, with the CDC
Immunization and Respiratory Disease Center, spokesperson for the US Centers
for Disease Control and Prevention re H1N1 on 5/18/09:

*The H1N1 is not going away, despite what you may have heard.  *

As you know, the World Health Assembly is convening [in] Geneva, and the
Department of Health and Human Services is [well represented] at the
Assembly.  We are expecting the H1N1 issue to dominate the meeting, and I
wanted to alert you to Director General Margaret Chan's statement from the
W.H.O.  She said that *influenza viruses are the ultimate moving target*,
and I think that really captures that scenario we're coping with right now.


This novel H1N1 virus is still circulating in the United States.  *People
are continuing to get sick, to get hospitalized, and unfortunately, to die*.
At this point, there are six deaths that have been reported officially.
And, you know, we feel for the families that are experiencing those losses.


As of today, there are 22 states around the country that are reporting
widespread or regional influenza activity.  And unfortunately, based on the
trends we're seeing, we do expect more illness, more hospitalizations and
more deaths.  You may have heard that New York City and a few other places
have had a number of outbreaks in schools, and some of them have issued
recommendations for school closures at individual schools that have been
affected. Those measures are consistent with the school guidance that we
have updated, which suggests that there is a need for a localized response.


The illness severity that we're seeing continues to be pretty similar to
what is caused by seasonal influenza, and we feel this means we need to
remain vigilant.  We are now experiencing higher levels of influenza-like
illness than is normal for this time of year.  We're also seeing *numerous
outbreaks in schools*, which is also very unusual for this time of year.
Influenza is always serious, and influenza viruses are very unpredictable.
So unfortunately, it's uncertain right now how severe this outbreak will be
in terms of the ultimate illness and mortality toll that it takes, or
whether this virus will turn out to be worse than others that we've handled
through the seasonal flu experience.  Things could change quickly, and we do
*continue our efforts to prepare, particularly for the fall, where history
tells us we might have a second wave of this new virus.**

As of today, our official case counts are a total of 5,123 cases throughout
the U.S.  We are seeing some geographic variation in the H1N1 flu activity,
with activity appearing to be highest right now in the Pacific Northwest and
the Southwest.  We know that *our case counts are very incomplete*.  They
are just what we call *the tip of the iceberg*.  We're also looking at
influenza-like illness, and we're seeing more reports of influenza-like
illness from our outpatient visits that are monitored than would be typical
for this time of year.  There have been over 200 hospitalizations, and, as I
mentioned, six fatalities.  The illness that we're seeing and the *
hospitalizations* that we're seeing are *primarily in younger people*.*
Between *5 and 24* is the age group of the majority of cases so far.
And *unlike
the seasonal flu*, we're seeing relatively *few cases or hospitalizations in
people over 65*.**  That's a very different feature that seems to be holding
up through the surveillance that we're doing.  In terms of the international
situation, the W.H.O. latest figures stand at 8,480 confirmed cases in 39
countries; recently added to the countries that have had at least one case
are India, Malaysia and Turkey.  Japan is now describing the first cases of
in-country transmission, and those are being further investigated.  And I
want to mention a little bit about Mexico.  As you know, Mexico has been
hard-hit, similarly to the United States.  But the overall trend appears to
be downward in Mexico with more sporadic cases rather than the larger
reports we were seeing earlier.  On Friday, the CDC and the Department of
State issued updated travel advice.  We downgraded our travel *advice for
Mexico*.  Earlier, we had recommended that travelers defer nonessential
travel.  But since Friday, our advice went down to a precaution.  Our main
advice now is for those *people who are at risk of complications from
influenza because of underlying illness, pregnancy, or age, that they ought
to check with their health care provider before embarking on a trip.*  But
so that we think that's an important change in our travel recommendations,
and want to make sure people know that.  We do think it's fine for most
people to travel to Mexico at this point.  As I've mentioned, the numbers
that we give you are really not as helpful as the patterns.  And so I want
to alert you to our website where we are continuing to use our routine
seasonal flu systems, which we call FluView, and you'll see there a lot of
different ways of describing what's going on.  A map that shows the states
that have had widespread disease or regional disease, as well as the trends
in the viral originic testing and the influenza illness.  We do see in that
system that the seasonal influenza viruses are continuing to circulate.  But
about half of all of the influenza viruses we're seeing recently are this
novel H1N1 virus.  Some people have been asking, has the virus changed, is
it mutating or causing more disease.  From the stains we're testing there is
*no evidence right now of any mutation toward a more virulent strain*, but
they can change and we will continue to look at them and track whether the
virus is acquiring resistance, whether other features are changing. That
would be important as we move forward towards our control efforts, or even
towards vaccination development.  We do think that the way the virus is
spreading *in the U.S. we are not out of the woods, and disease is
continuing.*  Our CDC efforts continue fairly aggressively.  We still have
more than 80 people deployed in the field, and we have continued to support
the laboratories and states here in the U.S., as well as in countries
shipping our diagnostic kits to 95 labs in 50 states, and to 237 labs in 107
countries.  At this point, 40 of the states here in the U.S. have got
validated testing going on.  And that is really good news, meaning they
don't -- they no longer need to have us confirm their results for them.

*We're in active discussions regarding vaccine development and potential
production.*  CDC and others are working on development of a seed strain to
make a candidate virus that could be turned over to manufacturing for
production.  This is in very active stages of discussion right now.
Because, as you know, if you want to make a vaccine, it takes several months
before it can become available, depending on how the manufacturing and
clinical trials go.  You may also have been hearing about W.H.O. and whether
or not they will change their phase to a phase 6.  We're currently at Phase
5.  The Phase 6 designation has not been decided upon.  A Phase 6 means that
the virus is spreading in a sustained way, in at least two regions of the
world.  And we haven't -- that hasn't been officially declared.  It's
important to know that we're seeing sustained spread here in the U.S., and
we're acting very aggressively.  And so if it changed to a Phase 6 would
have less impact for us here in the U.S. than for countries that haven't yet
gone into full -- a full court press on this virus.

I want to just close by saying that I think it's *important to dispel the
idea that we're out of the woods, or that this was a problem that really
didn't merit response.*  I think that we continue to see illness, it's a new
virus, it's capable of causing severe disease.  We hope that it will not
continue to cause illness and outbreaks in the Southern hemisphere the way
it's been causing problems here in the U.S.  But we really need to continue
to have our guard up, and to continue to be vigilant as we look towards the
summer in the Southern hemisphere and the fall back here in the U.S.  So,
you know, the final comment is *influenza is unpredictable*, and we really
need to *stay attuned to that, to be prepared for surprises in the days and
weeks ahead.*

* *

*Excerpts from her answers to questions from news media:*

* Most summers the seasonal influenza strains have [far fewer cases] here in
the northern hemisphere.  Unfortunately, we don't know whether we'll get any
break this summer with this virus.

*That's *very unusual to have so many people under 20 requiring
hospitalization and in … intensive care units.*  We're trying to actively
investigate those and get better characteristics of what the illness looks
like.  We have not yet found strong evidence for bacterial pneumonia that
might be complicating an influenza illness.  That's one of the hypotheses
people have had about why people might need to be hospitalized.  It's
something that we look for, we don't yet have a final answer on that, but so
far, we believe it's a little bit more of a virtual pneumonia pattern than a
later secondary bacterial pneumonia pattern. … Children may be more likely
to have nausea and vomiting (versus adults) with this new virus. … It's very
unusual to have several outbreaks in schools this late in the year in
multiple states.  So this is another one of those unusual features of this
novel influenza strain that we're seeing.  And it's certainly been a
challenge for the communities, you know, to manage those problems.

**  One of our working hypotheses is that *older adults may have some
preexisting protection against this virus due to exposure they had long ago
to some other virus* that might have been somewhat related.  We haven't
gotten that totally confirmed through laboratory testing, but it's an active
working hypothesis.  Of course, the alternate hypothesis is that it just may
take longer for this virus to make its way into the senior population.  If
kids hang around with other kids, and seniors hang around with other
seniors, and the virus is really spreading rapidly among the kids, it just
may take a bit of time, and then it may enter that senior population more
aggressively than it has so far.

*Lisa Schnirring: *Hi, thanks for taking my call.  School is going to be out
in most places in a couple of weeks.  And how do you think that might affect
community spread of the new flu?

*Anne Schuchat: *We are very interested in that question.  The school
circumstances involve lots of people in a particular place, with lots of
mixing.  Whether children will be congregating in similar environments in
summer, perhaps in summer camps, on trips, [or in summer schools], might be
similar to the way that kids are congregating in a school environment [the
rest of the year].  On the other hand, most of the U.S. changes quite a bit
in the summer, and conditions in the summer months, warmth and humidity, may
be less conducive to influenza virus circulating, at least for seasonal
flu.  So we would love to see a decrease in cases, and to see the end of
these outbreaks that are affecting schools.  But my influenza expert
colleagues tell me there have been [summer] influenza outbreaks in camps,
etc., even with seasonal influenza, and so we really need to be alert to
that possibility.

*The above transcript is excerpted and slightly edited from
http://www.cdc.gov/media/transcripts/2009/t090518.htm*