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I'm not going to crunch any numbers in this H1N1 post. Nope, all verbal. In fact, I'm not even going to write this post. I'm going to lift it all from recent US government sources.
Here are excerpts from the CDC and from Homeland Security’s Water and Wastewater Annex to the Guide for Critical Infrastructure and Key Resources. (“Annex”) You can download the whole W/W/ Annex here:
http://wwn-online.com/Whitepapers/2009/08/Flu-Pandemix-Annex/Asset.aspx
Bold added. [My comments in brackets.]
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CDC – http://pandemicflu.gov/plan/pandplan.html
Not dated.
[Note: these are CDC planning assumptions, not predictions. I'm not sure what the difference is. Why would one assume something that is not predicted? I do not assume it's gonna' rain when the forecast says "sunny."]
1.1. Planning Assumptions
1.1.1. Susceptibility to the pandemic influenza virus will be universal.
1.1.2. Efficient and sustained person-to-person transmission signals an imminent pandemic. [Thanks. I think we’re already past that point.]
1.1.3. The clinical disease attack rate will likely be 30% or higher in the overall population during the pandemic. Illness rates will be highest among school-aged children (about 40%) and decline with age. <strong>Among working adults, an average of 20% will become ill during a community outbreak.</strong>
1.1.3.1. Some persons will become infected but not develop clinically significant symptoms. Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection.
1.1.4. <strong>Of those who become ill with influenza, 50% will seek outpatient medical care.</strong>
1.1.4.1. With the availability of effective antiviral drugs for treatment, this proportion may be higher in the next pandemic.
1.1.5. The number of hospitalizations and deaths will depend on the virulence of the pandemic virus. Estimates differ about 10-fold between more and less severe scenarios. Two scenarios are presented based on extrapolation of past pandemic experience (Table 1). Planning should include the more severe scenario.
1.1.5.1. Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to include infants, the elderly, pregnant women, and persons with chronic medical conditions.
1.1.6. Rates of absenteeism will depend on the severity of the pandemic. [Thanks for that.]
1.1.6.1. In a severe pandemic, absenteeism attributable to illness, the need to care for ill family members, and fear of infection may reach 40% during the peak weeks of a community outbreak, with lower rates of absenteeism during the weeks before and after the peak.
1.1.6.2. Certain public health measures (closing schools, quarantining household contacts of infected individuals, “snow days”) are likely to increase rates of absenteeism.
1.1.7. <strong>The typical incubation period (interval between infection and onset of symptoms) for influenza is approximately 2 days.</strong>
1.1.8. <strong>Persons who become ill may shed virus and can transmit infection for up to one day before the onset of illness.</strong> Viral shedding and the risk of transmission will be greatest during the first 2 days of illness. Children usually shed the greatest amount of virus and therefore are likely to post the greatest risk for transmission.
1.1.9. <strong>On average, infected persons will transmit infection to approximately two other people.</strong>
1.1.10. <strong>In an affected community, a pandemic outbreak will last about 6 to 8 weeks.</strong>
1.1.11. <strong>Multiple waves </strong>(periods during which community outbreaks occur across the country) of illness could occur with each wave lasting 2-3 months. Historically, the largest waves have occurred in the fall and winter, but the seasonality of a pandemic cannot be predicted with certainty.
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CDC – http://pandemicflu.gov/plan/pandplan.html
Not dated.
Table 1. Number of Episodes of Illness, Healthcare Utilization, and Death Associated with Moderate and Severe Pandemic Influenza Scenarios*
Characteristic Moderate (1958/68-like) Severe (1918-like)
Illness 90 million (30%) 90 million (30%)
Outpatient medical care 45 million (50%) 45 million (50%)
Hospitalization 865,000 9,900,000
ICU care 128,750 1,485,000
Mechanical ventilation 64,875 745,500
Deaths 209,000 1,903,000
*Estimates based on extrapolation from past pandemics in the United States. Note that these estimates do not include the potential impact of interventions not available during the 20th century pandemics.
[Note that CDC is saying moderate and severe models are predicting the same numbers of people infected, with the severe being more lethal. Ironically, unless deaths reach into the tens of millions, the lethality of H1N1 likely has little or no impact on how much social disruption there will be.]
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W/W Annex, page 3
Aug13.2009
<strong>Industries in every sector of the American economy will experience influenza pandemic impacts.</strong> The Water and Wastewater sector will play a key role in keeping one of America’s most crucial and life-saving services operational. Shortages and disruptions to basic services, functions, and national infrastructure may cause localized challenges for communities. Effective coordination with public safety officials and community leaders will facilitate the integration of water and wastewater utilities into community emergency operations planning.
Unlike other disasters, an influenza pandemic will not directly physically damage infrastructure. However, planners need to assess the indirect impact that worker absenteeism due to the influenza pandemic will have on reduced or delayed normal maintenance on essential equipment and may have on emergency repair or equipment replacement. In addition, an influenza pandemic’s impact on the supply chain (i.e. “just-in-time” delivery, warehousing, and logistics) could have a significant impact on the ability to get replacement equipment as well as essential parts and supplies such as valves, pipes, motor starter centers and hydrants to repair and maintain equipment. <strong>Contingency plans should address the potential lack of equipment replacements and parts and supplies for an extended period for all primary and supporting essential equipment.</strong>
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W/W Annex, page 5
Aug13.2009
<strong>A pandemic influenza “wave” may linger in a community for six to eight weeks, and nationally for approximately 12 weeks.</strong> The negative impacts on individuals, businesses, and the nation from the illness and disease mitigation strategies will have an effect over a much greater duration than other typical disaster scenarios. A severe influenza pandemic may disrupt access to your essential materials and supplies necessary to function for up to 12 weeks. Utilities should explore their supply chains, beginning with internal storage capacity and tracking along the network to the source of the materials. Given an increased reliance on “just- in-time” delivery and the potential impacts that could affect your supply chain, you may need to stockpile chemicals (e.g., coagulants, pH adjustors, and disinfectants), fuels, lubricants, filters, repair parts, and Personal Protective Equipment (PPE) (e.g., masks, gloves, hand sanitizer) on site or locally or ensure availability by making other contingency plans.
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W/W Annex, page 6
Aug13.2009
A severe influenza pandemic may generate extended absences for essential workers that might affect you and your supply chain. <strong>During an influenza pandemic the actual level of workforce absenteeism could approach 40 percent.</strong> To complicate matters, the disease will strike randomly among employees from operation managers to front-line workers as well as employee families
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W/W Annex, page 8
Aug13.2009
<strong>When a pandemic influenza strikes, it will affect nearly every sector of our society, not just health care, but energy, transportation systems, workplaces, schools, public safety, and more. </strong>Successful preparedness and response will require a coordinated nation-wide effort, including Federal, State, local governments and most importantly the private sector. To facilitate a swift response and recovery to a pandemic influenza outbreak, the Water and Wastewater Sector must identify and be able to sustain its essential interdependencies within and across sectors. Interdependencies requiring advanced coordination include support from other utilities, businesses, government agencies, as well as essential goods and services, including, but not limited to, electricity, fuel, telecommunications and transportation.
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W/W Annex, page 9
Aug13.2009
To reduce impacts from a pandemic influenza outbreak, Federal, State, tribal, and local government authorities, in addition to private entities, may implement a variety of strategies, including: voluntary isolation; voluntary home quarantine; school closures; and social distancing of adults in the community and workplace. <strong>The public health and social distancing strategies may ultimately contain the disease and may reduce the risk of infection and loss of life, but they also will have significant consequences for utilities and private sector businesses that must be managed carefully. </strong>
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