Sunday, November 4, 2012

World Wide Pandemic Watch Version 6.8

World Wide Pandemic Watch Version 6.9 Latest update 1500 January 10, 2013. The purpose of this document is to prepare IT and IT Security people to brief management. We put this news aggregation together and have made it as accurate as possible. I have tried to be careful with the credits to the internet sources aggregated here. No rights are claimed, feel free to repost, copy, link to, harvest information from this document. Just try to be as accurate as you can and be careful about believing everything you read, the two best information sources are WHO and CDC. Also, the Pro Med mailing list has TONS of information, not just on H1N1/A. If you have additional information I would love to hear from you, I am on twitter and for email.

Executive Summary

In January 2013, Boston has declared a public health emergency with a 10x increase in Flu. If you feel sick please stay at home.

In November 2012, a third case of coronavirus has been confirmed by the Saudi government. This is related to the SARS virus which was lethal to 10% of infected persons. Hopefully, the Haj pilgrimage did not allow it to get a toehold.

In September 2012, The Minnesota Department of Health reported detection of 3 infections with an influenza A H1N2 variant (“H1N2v”) virus with the pandemic M gene from the 2009 H1N1 virus. These cases were reportedly associated with prolonged contact with pigs at a fair.

The H1N1 Pandemic was declared over in June 2010. It will be incorporated in the flu shots to prepare for 2011 ( highly recommended). There has been recent activity in Northern Ireland. The most exciting news on the pandemic front right now is the so called "superbug". This is not a virus, but rather bacteria with NDM-1 ( New Delhi metallo-beta-lactamase) which allows it to be resistant to antibiotics. So far this is boutique, but if it was incorporated in something that could spread, it could be a serious problem. India is ground zero, there have been recent cases in Britian. There have also been some animal dieoffs that we are closely tracking.

Organizations in affected areas should be prepared at this point to operate in a quarantine scenario. A key word is cluster, when there are a number of related infections in a day care facility, school, or church, you can expect to see it close for ten to twenty days and people either voluntarily not going there or being directed not to go to that location. Two of the most important issues are how to keep IT up, if no one is in the datacenter and whether the VPN concentrators can handle the load if a large number of employees are working from home. Managers need to start asking hard questions right now about how operations will continue if a significant number of people get sick. Technical people do not tend to look at all of the parts of the system and you do not want to wait till you are in a flu situation before you start asking questions and finding out that everything except backups and fund transfers can be done remotely.

Take common-sense precautions, such as frequently washing hands with soap, covering your mouth when coughing and stay home if feeling ill." The virus is easily destroyed; most cleansers will work, and it appears to be viable about 7 hours on a hard surface and one hour on porous fabric. Patients are most infectious when first coming down with flu, but remain infectious throughout the illness.

How bad could a viral pandemic be?

Nobody really knows. So far H1N1 has been fairly mild, though if you were one of the 500+ that died, you would probably beg to differ. The H5N1 Avian flu is far more deadly than H1N1, but doesn't spread well enough human to human to cause a pandemic at this time. Here is a well researched presentation on the history of pandemics:

What is new is this edition:

CDCEmergency, CDCflu The CDC has a twitter account,

What is a virus, what is influenza? A virus is not exactly alive, "it has some fundamental information (genes made of DNA or RNA) which allows it to make copies of itself. However, the virus must be inside a living cell of some kind before the information can be used. In fact, the information won't be made available unless the virus enters a living cell. It is this entrance of a virus into a cell which is called a viral infection." According to the CDC, "Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccination each year. Every year in the United States, on average 5% to 20% of the population gets the flu; more than 200,000 people are hospitalized from flu complications, and; about 36,000 people die from flu-related causes." "The virus is spread person to person via small particle aerosols (less than 10μm diameter) that can get into respiratory tract. It can also survive for a short time on surfaces and can be spread by this route if the virus is introduced into the nasal mucosa before it loses infectivity. The incubation period is short, about 18 to 72 hours." People do not normally get H1N1/A, according to WebMD, historically, there's a case every year or two in the U.S. among people who have contact with live pigs. Human cases typically involve people who have had direct contact with pigs, but person-to-person transmission is suspected among recent cases in the U.S."

There are several stages a virus must go through to enter the human population. Most viruses originate in animals simply because there are so many more animal species. Many viruses, the base of the pyramid only exist in animals. The next level is either animal type viruses that can exist in several species OR viruses that can, but only are transmitted to humans. In the Nathan Wolfe video, we see that one crossover to humans occurs because we hunt "bush meat" and this often involves contact with the animal's blood. The next level of concern are virus that can fairly easily transmit from animals to humans. The next level of concern are these crossover viruses that can then spread from one human to another, that is what we appear to be dealing with in the H1N1/A outbreak. And finally, for completeness sake, we have viruses that only exist in humans.

Since H1N1 was such a bust, why should I be concerned about the next flu season? The most important observation by June 2009 is that the virus did spread to over 84 countries. This is true even though is was probably the most reported health threat of all time. From the TV News networks to Twitter,we have more tools to share information than ever before. This virus has already reported one measurable mutation (in the Netherlands) as reported in ProMED mail. There are basically two tools in our toolbox, vaccinations and medicine like Tamiflu. We do not have a tested vaccine for H1N1, the earliest is September and history suggests that you don't want to be the first to try a Swine flu vaccine. So if the virus is immune to Tamiflu it is a big issue.

Why self imposed quarantine is the best answer in a future outbreak I just flew from Greece to Virginia. Not one traveler wore a mask, nor did they wear gloves. I tried to focus on how many surfaces you have to touch on a three leg plane flight and was it possible to keep my hands sterile and came to the conclusion that it was not possible. This means it is a matter of dumb luck whether or not I got exposed. Now, as already said, by summer, this was seriously winding down and risk is a matter of exposure, however if we have another outbreak next winter without safe vaccine and are dealing with a drug resistant mutation, this risk is exponentially higher. This means companies should start now to plan for what they can do to keep operations going with a significant number of employees working from home.

How to disinfect and kill viruses Clorox: Lysol: Soap: Alcohol: More info: NOTE: DO NOT combine agents, ammonia + bleach can kill you

What exactly is this H1N1/A?

According to the CDC: "There are many different subtypes of type A influenza viruses. These subtypes differ because of changes in certain proteins on the surface of the influenza A virus (hemagglutinin [HA] and neuraminidase [NA] proteins). There are 16 known HA subtypes and 9 known NA subtypes of influenza A viruses. Because the New York student samples do not match H1 and H3 human subtypes of influenza A by available testing methods, they are considered probable cases of H1N1/A. The specimens have been sent to the CDC in Atlanta for confirmatory testing. Results of those tests are expected Sunday. It is possible that the H1N1/A will be more aggressive in human populations than the bird flu has been to date. According to Forbes, "Dr. Anne Schuchat, the U.S Centers for Disease Control and Prevention's Interim Deputy Director for Science and Public Health Program said Thursday that the virus in the United States is influenza A N1H1 mixed with swine influenza viruses. The virus contains genetic pieces from four different flu viruses -- North American swine influenza, North American avian influenza, human influenza viruses and swine influenza viruses found in Asia and Europe, she said. "That particular genetic combination of swine influenza viruses has not been recognized before in the U.S. or elsewhere," Schuchat said."

What are all these viruses and where do they come from? “Human influenza virus” usually refers to those subtypes that spread widely among humans. There are only three known A subtypes of influenza viruses (H1N1, H1N2, and H3N2) currently circulating among humans. It is likely that some genetic parts of current human influenza A viruses came from birds originally. Influenza A viruses are constantly changing, and they might adapt over time to infect and spread among humans. While it is too early to tell how deadly the H1N1/A will be, either it or the H5N1 Bird Flu could kill tens of millions, if either became a pandemic because there is no vaccine ready to distribute and people will not have built up any individual immunity from having had similar strains in the past.

What should I do if I feel sick? H1N1/A symptoms include runny nose, and fever, muscle aches, lethargy, lack of appetite, fever over 101 and sudden onset. It is difficult to distinguish from other flu types, and does require a diagnosis. Here are the Mayo symptoms. Patients experiencing severe symptoms, such as difficulty breathing, chest pain or pressure, disorientation, confusion, seizures, persistent vomiting, inability to hold down liquid should seek health care and treatment. If affected persons have household contacts at high risk for complications from influenza – young children, the elderly, and people with chronic illness – those at risk should receive preventive treatment. Also, be prepared with BRAT, Bananas, Rice, Applesauce, and Toast, good flu recovery foods.

DO NOT skip the rest step. If you have the symptoms it is time to take a couple days off. Get some rest, that is crucial to recovery.

How can I avoid getting sick?

The most effective way to lower the risk of transmission is for people with symptoms to stay home. Take pandemic preparation sites with a grain of salt; this one seems reasonable. The virus spreads easily from person to person through direct contact and possibly through the air; if it can spread through the air we have a very serious situation. It can cause serious illness and death. Please cover your mouth when you cough and take the additional precautions: Wash your hands often with soap and water. Antibacterial soaps may not be more effective than pure soap to prevent virus infections. Alcohol-based hands cleaners are more effective, go for 60% alcohol. [CDC Hands Together video] Try to avoid close contact with sick people. If you get sick, stay home from work or school and limit contact with others to avoid infecting them. If you have ever laughed at people using a paper towel to open the door of a public bathroom after washing their hands, quit laughing and join them, the virus can remain active for several hours especially if moist and not exposed to direct sunlight. Try not to rub your eyes or touch your hands to your mouth Try to get enough sleep, avoid stress ( not always easy in a pandemic) and treat your body right Respirators and face masks: YouTube video on how to use an N95 respirator, pretty good, I learned a few tips Powered respirator FDA site


The Centers for Disease Control and Prevention said Tuesday tests involving antiviral drugs Tamiflu and Relenza against the H1N1/A suggest the drugs would be effective treatments. Tamiflu is available over the counter in New Zealand. Anti-viral drug Tamiflu must be used with care to avoid the new strain of H1N1/A developing resistance, an expert on infectious diseases has warned. I called several New York City pharmacies this afternoon and was told there’s been a run on Tamiflu. As a physician, I know how tough it can be to “just say no” to an insistent, worried patient. And I haven’t totally gone over to the dark side of not remembering what it’s like to be a patient; believe me, there’s an insistent, worried patient hiding inside many physicians, myself included. But inappropriate use of Tamiflu and Relenza can lead to the becoming resistant to these medications - the same thing that’s happened with overuse of antibiotics.

What if I do get sick and can't get Tamiflu?

There are herbal flu remedies, no one knows how effective they would be. Getting a bit of ginger root and a few bulbs of garlic and a few onions next time you go to the store might be wise and slightly sweetened blended ginger on sliced peeled apples tastes great, and you can use the garlic and onions when you put your Italian chef mindset on. Warning, eating raw garlic can cause you to vomit and, with the flu, you want to avoid dehydration, so a tiny bit at a time is strongly advised until you understand your tolerance. Get plenty of rest and drink plenty of fluids. Vitamin D, especially D3 may help.

Pandemics in the past point to what we may have to deal with 1918 Spanish flu, H1N1, killed healthy young adults, 40 - 50 million deaths 1957 Asian flu, H2N2, killed children and elderly, 2 million deaths 1968 Hong Kong flu, H3N2, killed elderly, 1 million deaths 1976 Swine flu where the inoculation was worse than the flu 2002/2003 SARS (near pandemic), SARS-CoV, killed elderly, 774 deaths.

Skeleton Plan for Companies Don’t Panic! Here is a quick podcast interview with Bill Brenner on the H1N1/A and its implications on IT and IT Security. Warn people about coronavirus etc phishing attacks

Here is a CNN great article on what companies are doing to prepare and respond.

Initial monitoring stage: If you’re sick, stay home Family is sick, stay home Close contact with someone showing symptoms, stay home Wash your hands, cover your cough Then, if multiple cases in your area: Think about telling non-essential workers to stay home Start prioritizing critical workers and make sure they can work from home Recommend workers take kids out of daycare Can you stock some food/liquid in your datacenters, is it possible for someone to stay there for a sustained period of time? Pandemic stage Everyone will be staying home, how will you handle it? Do you have enough laptops? Can your VPN concentrators handle the load Who will stay in the data center Can you operate server systems from home Link to SANS reading room paper on pandemic and network systems

H1N1/A Business Opportunities amazon_twit: New product: N95 Particulate Respirators Surgical, Dust & Avian Flu Mask, 10/ pack (

Bird Flu H5N1 Worldwide, 608 cases ( 359 fatalities) most recent action is in Egypt. Most cases are in Egypt, Viet Nam and Indonesia. Four cases in Egypt in December 2010/January 2011.

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