Communities

White House Bulletin 9/1/2009

White House Bulletin 10/24/2009

H1N1 Pandemic Influenza

H1N1 and community resilience

Following an initial outbreak in Mexico of what is now termed the “H1N1 novel influenza” in March 2009, the virus has spread to the United States (first confirmed case on April 15, 2009) and the rest of the world. On June 11, 2009, the World Health Organization (WHO) officially announced that “the world is now at the start of the 2009 influenza pandemic.” The first Level 6 declaration in 41 years, WHO confirmed that the H1N1 virus had by that time caused 30,000 confirmed flu cases in 74 countries; before it stopped reporting new cases on July 16th, the case incidence was approaching 100,000 with 429 deaths. In the U.S., as of January 2010, the CDC reported that overall flu activity was steadily decreasing through the month, although it is expected that flu activity will rise and fall for several more months.

CDC estimates that between 39 million and 80 million cases of 2009 H1N1 occurred between April and December 12, 2009, with a mid-level in this range of about 55 million people infected with 2009 H1N1. It is estimated that between about 173,000 and 362,000 2009 H1N1-related hospitalizations occurred between April and December 12, 2009, with between about 7,880 and 16,460 2009 H1N1-related deaths.

Vaccine distribution, while initially slow, is now fully available. Due to initial limited supplies of vaccine, the CDC had recommended that high risk groups, such as pregnant women and school aged children, receive available vaccine first. Now that supplies of H1N1 vaccine are ample, it is recommended that all age groups receive the vaccine.

Community involvement will be the key. The "resilience" of a community - its ability to adapt to such a public health challenge and take concerted actions to reduce the spread of the contagion - will influence the severity of the outbreak and the speed by which it recovers. Advance preparation coupled with active communication can engage the community as an active participant in its own defense, as opposed to being more passive victims awaiting outside relief that will be slow, if ever, in coming. Beyond pre-planning to reduce and mitigate the loss of individuals in key infrastructure sectors (e.g., healthcare, emergency responders, schools, government, food and medical supplies, etc.), attention needs to be placed on how best to influence the behavior and perseverance of the public during the emergency. This will entail leaders within the community to focus on factors such as advance education of the public, timely public information, and necessary trust and equity behind unprecedented civic actions such as quarantine and social distancing.

CARRI will be engaged. CARRI will be engaged with its three regional communities, Memphis, Charleston, and Gulfport, to monitor community efforts to prepare for, respond and recover to the anticipated H1N1 pandemic outbreak, and to feedback lessons learned to both the community and responsible government agencies. The goal is to continue to learn how the resilience of the local community contributes to regional and national response to major disruptions, such a severe N1H1 outbreak.

Related Websites:

• Flu.gov
• Center for Disease Control (CDC)
• University of Pittsburgh Medical Center
• Center for Infectious Disease Research and Policy (CIDRAP)
• Trust for America's Health
• Pandemic Preparedness - Working from Remote Locations (Pennsylvania Governor Ed Rendell's Office of Administration)

Reports and Papers

• "H1N1 Challenges Ahead," Trust for America's Health, October 2009. 
• "Community Engagement:  Leadership Tool for Catastrophic Health Events, " Shoch-Spana, etc. al., 2007.
• "Pandemic Influenza Preparedness:  Adaptive Responses to an Evolving Challenge," Reissman, et. al., 2006.
• "H1N1:  Preparing to be Resilient."
• "Pandemic Flu:  Lessons from the Frontlines," Trust for America's Health.
• "Blue Cascades IV:  Critical Infrastructure and Pandemic Preparedness."
• "State and Local Pandemic Influenza Preparedness:  Medical Surge," Daniel R. Levinson, Inspector General, 2009.