CIO Council Pandemic Workgroup February 9, 2007 Morris Hall, House Office Building Tallahassee, FL
Women sell geese at an open air market in Luxor February 6, 2007. An Egyptian girl has died of bird flu, bringing the number of confirmed deaths from the disease in Egypt to 12, a World Health Organisation official said on Monday.
A/H5N1 acquires polymorphisms E627K, (A/H9N2) S227R, M230I, N294S The NAMRU-3 detection of Tamiflu resistance polymorphism, N294S, in the NA sequences from the Gharbiya cluster, has caused concern. An E627K substitution in the viral polymerase basic protein 2 (PB2), which is associated with adaptation and virulence of H5N1 viruses in mammals, is universally found in H1, H2, and H3 isolates from humans. A search of the Los Alamos flu database identified 42 exact matches representing the S227N polymorphism. All were in H9N2 HA and were in the Middle East in chickens, turkeys, geese, and an ostrich.H9N2 has become endemic in Israel and millions of migratory birds pass through the area annually. Thus, the potential for dual infections by H9N2 and H5N1 is high. The nucleotides offer an opportunity for homologous recombination that would create the S227N polymorphism and increase the efficiency of H5N1 human transmission. The sequence also has an alteration, M230I, near the receptor binding domain.
The “Fog of Pandemic Preparedness” • How our global just-in-time economy will affect access to goods and services • How effective and plentiful antiviral drugs and vaccines will be—and when they'll be ready • How many waves of the pandemic will occur, and how severe they'll be • How high mortality rates will be • How our overloaded healthcare systems will cope • How our communities will mitigate damage
The “Fog of Pandemic Preparedness” • Learn from veterans. We need to look at those in the military who have studied the fog of war to explore what to do when unsure about what steps to take. • Work around "just in time." "Don't try to change the global just-in-time economy," he said. "That's like swimming up Niagara Falls. Forget it. You've got to work around it." • Overcome pandemic fatigue. Recognize that some executives may see pandemic planning as no longer important, Osterholm said, calling the phenomenon "pandemic fatigue" and saying, "Acknowledge, accept, and plan around pandemic fatigue." • Maintain flexibility. Osterholm recognized the uncertainty involved in pandemic planning and stressed that plans need malleability so they can adapt to the elusive realities of a pandemic. "Anyone who develops a concrete plan is making a mistake," he said. "Be capable and be flexible. • "You're not stuck to a plan," Osterholm said. "You're stuck to a process."
Highlights • There are now over 1,600 different subtypes of H5N1. • N95 masks and respirators are becoming constrained as demand outpaces supply. • Risk communications must remain constant and must stay “on message”. England is failing in this regard. • Legal issues regarding employee family leave, HIPAA and the like are emerging as serious impediments to corporate and government preparedness • Growing concern the Internet may fail • Experts all agree that Tamiflu must be stockpiled and is the only reliable weapon against the virus. It is proven to be effective at keeping healthy people from catching the virus.
Quote of the Month • "I wouldn't bet my family’s life on H5N1 not becoming the next pandemic.“ – Dr. Michael Osterholm. Key Deliverables • Deloitte cross-training matrix • San Francisco business preparedness guide
Methodology • Categorize all operating tasks within one of four operating quadrants • Supporting: Break and fix oriented tasks; user issues; application outage, etc • Operating: Task needed to keep the wheels turning -- backups, routine jobs, admin work • Changing: Application updates, small code drops; hardware renewal • Optimizing: Large projects, version upgrade, performance management • Determine in which quadrant the critical tasks are located • What type of work will we focus on in the event of a crisis • What type of work can we stop doing without affecting our services • Determine amount of time spent on activities from within each quadrant • Calculate how many FTEs are assigned to each quadrant • Determine how many FTEs can be reassigned to other functions.
Individual Skill Matrix Overview Blank = No experience 1 = limited experience 2 = some experience - basic knowledge 3 = good experience - can do configuration setup, some basic troubleshooting 4 = strong experience - strong troubleshooting, configuration, setup skills 5 = very strong experience - configure, troubleshoot - go to person
Next Steps • Distribution of agency cross-training matrix • Adoption of agency pandemic checklists • Identification of IT needs that require budgetary approval • Symposium on cross-training, work-at-home plans • Focus on specific topics, speakers for future meetings • Ordering of masks, gloves, eye protection, antimicrobial hand sanitizer