Diseases-Swine Flu

POTENTIAL PANDEMIC
INFLUENZA A,N1H1(SWINE FLU)

1	Inter-pandemic Phase	Low risk of human cases
2	New virus in animals, no human cases	Higher risk of human cases
3	Pandemic alert	No or very limited human-to-human transmission
4	New virus causes human cases	Evidence of increased human-to-human transmission
5		Evidence of significant human-to-human transmission
>6	Pandemic	Evidence of sustained human-to-human transmission
The designation of phases, including decisions on when to move from one phase to another, is made by the Director-General of World Health Organization (WHO). Each phase of alert coincides with a series of recommended activities to be undertaken by WHO, the international community, governments, and industry. Changes from one phase to another are triggered by several factors, which include the epidemiological behavior of the disease and the characteristics of circulating viruses. Definitions for Pandemic Threat Level

DEFINE THE WORDS "INFLUENZA" AND "PANDEMIC"?

Influenza is an infectious disease caused by a virus. Some strains of influenza affect humans exclusively, while others occur naturally in birds or other mammal species. Some flu viruses infect multiple species. Unfortunately, new influenza viruses are constantly being produced by genetic mutation. Influenza A designates a virus that one can become sick from being exposed to and the N_H_ designates subspecies in Influenza A family. Influenza viruses enter the body through the eyes, nose, mouth, sores, and cuts. The exposure can be an airborne droplet (typically, coughing and sneezing) which can remain that way for up to 30 minutes with direct contact or indirect contact by the hands touching surfaces (grocery handles

The well publicized "bird flu", for example, is an avian influenza caused by a virus that occurs naturally in birds. In 1997, an influenza outbreak occurred in Hong Kong when a strain of bird flu infected 18 people, raising concerns about the virus's spread from birds to humans. About half the people who caught this strain of influenza died. Scientists worry about viruses like this one that could spread very quickly and have a high mortality rate. Fortunately, in the Hong Kong outbreak, the virus was not easily transmitted from human to human through something as simple as a sneeze, for example, and transmission from birds to people was rare.

An influenza pandemic can occur when a new influenza virus subtype emerges and spreads easily among human beings. Pandemics have been observed for several hundreds years. The best documented pandemics was in 1918 (Spanish flu), 1957 (Asian flu) and 1968 (Hong Kong flu). These varied in severity with an estimated 1-50 million excess deaths during the pandemic. A new pandemic is considered inevitable but nobody can predict when and where it will emerge, who it will affect or how severe it will be. The consequences of the next pandemic may be large numbers of cases and deaths globally, as well as disruption of societies and economies due to e.g. staff absenteeism and disruption of trade within and between countries. The current threat level is at 5.

HOW IS THIS FLU DIFFERENT FROM ORDINARY FLU AND SPANISH FLU?

The swine flu is characterized by common flu symptoms -- sudden fever, muscle aches, sore throat and dry cough -- but may cause more severe vomiting and diarrhea. New flu strains, such as this one, can spread fast because no one has natural immunity and a vaccine can take months to develop. This strain is confusing because it is an H1N1 -- a type that has been around since the 1918 "Spanish Flu" pandemic that killed at least 40 million people globally. Characteristics of the Spanish Flu that are similar to Swine Flu are:

The Spanish Flu started in the Spring of 1918 as a very mild flu with a low death rate, thus not much attention was paid to it.
The target group of the Spanish Flu was the under 35 age group and somewhat the same has been true for the Swine Flu; however no one will be immune to this virus and those in community leadership, ministry, and medical roles may have high exposure rates.

Characteristics of the Spanish Flu yet to be fulfilled by the Swine Flu.

By August 1918, the virus had mutated to a very dangerous flu which appeared at four points in the World. The death rate was high and moved through communities in about six-week waves with two to three waves occurring over the winter of 1918-1919.

· In 1918, there was no organization to research and produce a vaccine. Today, there is no certainty that the vaccine being developed and manufactured will be effective against an outbreak as the virus is very active with its mutations and it will be months before there is enough vaccine.

· If there is a pandemic of this nature, there are many roles that Methodists will be call upon to become the hands of Christ - care giving; special needs community; food preparation, distribution, and /or POD's (Points of Distribution); and many more.

Usually if a new flu strain is related to one that has been around for years, people have some immunity and they no longer can cause pandemics. But this new strain has taken on genetic elements from animal viruses, and this may be genetically unique enough to pose a pandemic threat. Also, this is unlike the common flu that we experienced during the winter months of each year; however the methods of transmission are the same. As the virus moved through communities, all public assembly (schools, church services, theaters, etc.) were canceled. In many cases everyone was confined except critical infrastructure.

WHAT CAN I DO?

Stay informed This website will be updated as information becomes available.
Swine flu is spread by person-to-person through coughing, sneezing, and hand contact (hands and common surfaces) of infected people. The death rate in Mexico is running about 3% of those infected and is running about 0.1% in the U.S.
The best ways to prepare for a pandemic are the same steps to prepare for other emergencies. Stay informed and build a family disaster preparedness kit with the supplies your family will need during an emergency.
Take everyday actions to stay healthy
- Cover your nose and mouth with a tissue when you cough and sneeze, put the used tissue in a waste basket and clean your hands. Too often people won't and every surface they touch next becomes contaminated.
- Cover your mouth and nose with your upper sleeve (not your hands) if you do not have a tissue and need to cough or sneeze.
- Clean your hands as soon as possible after coughing, sneezing, or blowing your nose.
- Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
As a church leader, educate others. The Bible says "Be shepherds of God's flock that is under your care, serving as overseers - not because you must, but because you are willing." (1 Peter 5:2). One of the duties of a shepherd is to warn the flock under his care of danger. Educate your congregation and your community about the truth and myths of pandemic flu and encourage them to develop their own emergency plan.
Prevent Contamination by Hand
- Kitchen
  - Germs are transmitted from unclean hands to food, usually by an infected food preparer who didn't handwash after using the toilet. The germs are then passed to those who eat the food.
  - Germs are transmitted from raw, uncooked foods, such as chicken, to hands; the germs are then transferred to other foods, such as salad. Cooking the raw food kills the initial germs, but the salad remains contaminated.
  - Germs from uncooked foods are transferred to hands and then to infants. If a parent handling raw chicken, for example, doesn't wash his or her hands before tending to an infant, they could transfer germs such as salmonella from the food to the infant.
  - Keep hard surfaces like countertops, tabletops, desktops clean and disinfected.
  - Wash hands before eating and after meals and snacks
- Bathroom
  - During diaper changing, germs are passed from an infant with diarrhea to the hands of a parent; if the parent doesn't immediately wash his or her hands before handling another child, the germs that cause diarrhea are passed to the second child or others.
  - Wash hands after using toilet or helping a child at the toilet
  - Wash hands whenever your hands come in contact with body fluids including vomit, saliva, runny noses
  - Keep hard surfaces like countertops, and bathroom surfaces clean and disinfected by a commercial product that both cleans (detergent) and kills germs (disinfects). For visibly dirty surfaces, use the commercial product followed by a water rinse, and a disinfectant.
- Laundry

§ Gently gather soiled clothing, bedding, and linens without creating a lot of motion or fluffing; for example, do not shake sheets when removing them from the bed.

§ Clean your hands after handling soiled laundry items.

§ Use washing machine cycles, detergents, and laundry additives (like softener) as you normally do; follow label instructions for detergents and additives.

§ Dry the cleaned laundry items as you normally do, selecting the dryer temperature for the types of fabrics in the load. Line- or air-drying can be used to dry items when machine drying is not indicated.

§ Clean your hands before removing clean laundry from the washer or dryer, especially if you have coughed or sneezed on your hands.

Waste Disposal

§ Toss tissues into waste baskets after they have been used for coughs, sneezes, and blowing your nose.

§ Place waste baskets where they are easy to use.

§ Avoid touching used tissues and other waste when emptying waste baskets.

§ Clean your hands after emptying waste baskets.

Elsewhere
- Use disinfectants on surfaces that are touched often. Examples are elevator push buttons, doorknobs, push plates and bars, copy machine, group printers, refrigerator door handles, microwaves, computer keyboards, desktops, phones, remote controls, handheld games, car door handles, steering wheel, gear shift,
- Germs that cause colds, eye infections, and other illnesses can spread to the hands by sneezing, coughing, or rubbing the eyes and then can be transferred to other family members or friends.
- Wash your hands often with soap and water, especially after you cough or sneeze. It is proven to be the best way to protect against infection with a range of germs, including flu. Alcohol-based hand cleaners are also effective.
- Avoid touching your eyes, nose, or mouth. Germs can be spread from your hand to an body entry point.
- Use the paper towel to open the bathroom door at work and elsewhere
- Use the towel wipes in the gym and and for the shopping cart at groceries, drug stores, discount stores, and variety stores.
- Wash your hands after handling money
- Consider washing your hands after petting an animal (repository of sneezing and coughing germs).
- Avoid sharing personal care items such as drinking straws.

Experts generally agree that some face masks, especially the surgical masks now seen on the street of Mexico City, offer very little protection. Flu viruses can float on little particles of spit or mucus, in general no further than three to six feet, but they then settle on surfaces, penetrate the material, and can be transferred to the mouth, eyes or nose. Masks that meet N95 or N100 specifications are satisfactory. The masks are one-use disposables and should not be worn for more than a day. Viruses may be on the outside of the mask
Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
Develop a family emergency plan as a precaution. This should include storing a supply of food, medicines, facemasks, alcohol-based hand cleaner and other essential supplies.
Plain hand soaps, antimicrobial hand soaps, E2 rated hand soaps (a USDA Classification requiring equivalency to 50 parts per million chlorine), and instant hand sanitizers were evaluated for their effectiveness in reducing bacteria on hands. Results showed that all three types of hand soaps were effective, when using a 20-second wash procedure, in reducing bacteria on hands, with the E2 soaps significantly more effective than the other two types of soaps. The instant hand sanitizers resulted in a significant increase in bacterial numbers on hands.

ARE THERE ENOUGH DRUGS AND VACCINES?

Most countries have been stockpiling supplies of two antiviral drugs -- Tamiflu, known generically as oseltamivir and made by Roche AG and Gilead Sciences Inc; as well as Relenza, known generically as zanamivir and made by GlaxoSmithKline and Australia's Biota Inc.

A third company, BioCryst Inc. is working to license its experimental flu drug peramivir.

Older flu drugs called amantadine and rimantadine do not work very well any longer against any influenza strain except sometimes in combination with newer drugs.

There is no vaccine yet against this new strain and health officials say the seasonal flu vaccine is unlikely to provide any protection against it. The CDC and WHO are working with companies to start making a new vaccine if it is needed, but the process takes months.

Historical Influenza Outbreaks

Historical records show that influenza pandemics occur with some regularity. About 30 influenza pandemics have been recorded; three of which occurred in the last century.

Pandemic Death Toll Since 1900 is as follows.

Pandemic Event	Estimated U.S. Fatalities	Estimated Worldwide Fatalities
1918-1919	675,000+	50+ million
1957-1958	70,000+	1-2 million
1968-1969	34,000+	700,000+

The worst of these pandemics occurred in 1918 at the end of World War I with the Spanish Flu. This virus strain was unusual in that it killed many young adults and otherwise healthy victims. People without symptoms were struck suddenly and, within hours, were too feeble to walk. Many died the next day.

I was six and living on a farm when the Spanish Flu hit. Everyone in the family got sick. No one was well enough to cook so Mama opened cans of fruit and we lived off that until she got better. The preacher came into the yard and hollered, "Are you all O.K.? Papa responded that we were and thanked him for coming. The preacher said, "I don't want to come in because this is really bad stuff and I am afraid of it.? MGR

My brother signed up for the Army and they shipped him to Texas for basic training. The flu swept through the camp and he died. His body was shipped back by train and we opened the container outside to reduce the possibly of anyone catching the flu. RYN

The illness was so prevalent in some areas that most everyday life activities were stopped due to illness, death, and to prevent further spread of the virus. Some communities closed all stores or required customers to place their orders outside the store for filling. Local governments in the United States held that any type of gathering of people, with "the mixing of bodies and sharing of breath in crowded rooms," was dangerous. Nonessential meetings were prohibited. Saloons, dance halls, and cinemas were closed and public funerals prohibited since they were deemed "unnecessary." Health care systems were overwhelmed with many communities reporting that there were no health care workers to tend the sick and insufficient able bodied grave diggers to bury the dead.

Potential Impact to Churches

The impact of an influenza pandemic on churches could be substantial. A serious outbreak would cause significant absenteeism among staff, challenging the church's ability to remain open and to continue to minister within the community. Traditional church services would be dramatically altered as human contact would be limited and mass gatherings cancelled.

Many "at-risk" populations which the church traditionally serves, such as children, elderly, and the homeless, may be among the hardest hit by the virus. Economically-disadvantaged and single parent households may struggle to make ends meet if they must stay home to care for a loved one or if schools and businesses are ordered closed. As local governments plan to cope with a pandemic, Methodist should be engaged in planning and preparedness to support emergency response efforts.

In addressing these issues, one might consider the following:

Human Resources

- Establish mandatory staff leave for ill employees (or those caring for ill family members). This will reduce the possibility of spreading the infection among healthy co-workers.

- Adopt "leave" policies that do not penalize workers for absenteeism during a pandemic when it is related to personal illness or care for sick family members.

- Be prepared for heavy absenteeism in jobs that interact with "at-risk" populations, such as children, the elderly, or homeless. Workers may fear that working with these groups places them at a higher risk for exposure to infection.

Church Services

- Be ready to temporarily suspend physical contact, including shaking hands and hugs, as part of church services.

- Limit mass gatherings. This may include canceling Sunday services, weekday events at the church, weddings, and funerals.

- Devise alternate methods of providing spiritual care, particularly to those who have lost loved ones due to the illness. This may include offering church services via the Internet or television and creating phone networks of prayer partners.

Social Services

- Develop contingency plans to care for dependent populations, including those in resident care facilities, such as homeless shelters, assisted living, and ARC facilities. Develop sanitary practices to reduce the spread of infection within these facilities and procedures to address the needs of sick individuals.

- Be prepared to provide financial aid to the poor who are unable to work and need emergency income for housing, medicine and other essential needs.

Individual / Family Pandemic Planning

Pandemic Planning for Individuals and Families
Control of Pandemic Flu Virus on Home Surfaces
Family Emergency Health Information Sheet