BarnesCare H1N1 Update Number 7 -- Wednesday, October 28, 2009
H1N1 Business Summit Set for November 9
The St. Louis Business Journal has an expert panel including BarnesCare medical director, Scott C. Jones, DO, MPH, FAOCOPM, to discuss what business leaders can do to prepare employees and keep business functioning at full speed during the H1N1 flu pandemic. The free summit is 7:30 a.m.-9 a.m. Thursday, November 19 at the Missouri History Museum. Register online or call 314.421.6200 .

General Information on Antiviral Drugs
Influenza antiviral drugs are prescription drugs (pills, liquid, or inhaler) that decrease the ability of flu viruses to reproduce. While getting a flu vaccine each year is the first and most important step in protecting against flu, antiviral drugs are a second line of defense in the prevention and treatment of flu.

At this time, treatment with oseltamivir (trade name Tamiflu®) or zanamivir (trade name Relenza®) is recommended for all people with suspected or confirmed influenza who require hospitalization. When used to prevent the flu, these drugs are about 70 percent to 90 percent effective against susceptible viruses (viruses that are not resistant to the antiviral medication).

For treatment, antiviral drugs should be started within 2 days after becoming sick. When used this way, these drugs can reduce the severity of flu symptoms and shorten the time you are sick by 1 or 2 days. They may also prevent serious flu complications. Some studies of oseltamivir treatment of hospitalized patients with seasonal influenza have indicated benefit, including reductions in mortality or duration of hospitalization even for patients whose treatment was started more than 48 hours after illness onset.

Antiviral drugs may be especially important for people who are very sick (hospitalized) or people who are sick with the flu and who are at increased risk of serious flu complications, such as pregnant women, young children and those with chronic health conditions.

President Obama Signs Emergency Declaration for H1N1 Flu
In an effort to proactively address the ongoing pandemic, the President signed a National Emergency Declaration on H1N1 that allows health care systems to quickly implement disaster plans should they become overwhelmed.
 
As experts expected, H1N1 flu is moving rapidly throughout the country and the majority of states now have widespread influenza activity. This declaration gives authority for the Department of Health and Human Services (HHS) to waive certain regulatory requirements for healthcare facilities in response the ongoing pandemic. Specifically, health care facilities will be able to submit waivers to establish alternate care sites, and modified patient triage protocols, patient transfer procedures and other actions that occur when they fully implement disaster operations plans.
 
 Past instances where authority to grant Section 1135 waivers was enabled include:

• Hurricane Katrina (2005)
• 56th Presidential Inauguration (2009)
• Hurricanes Ike and Gustav (2008)
• North Dakota flooding (2009)

Learn more about this National Emergency Declaration and get information on H1N1 and seasonal flu.

BarnesCare H1N1 Update Number 6 -- Monday, October 19, 2009 
Missouri Sets Up H1N1 Flu Hotline
The Missouri Department of Health and Senior Services has set up a 24/7 toll-free number for state residents to call and get information about the H1N1 flu -- toll-free 877.FLU.4141 (877.358.4141). Callers can get information on topics ranging from symptoms and basic medical advice to availability of the new H1N1 vaccine. 
 
Pandemic Planning Made Easy
The U.S. Department of Health & Human Services' (HHS) flu web site is an excellent resource for pandemic planning information. The HHS and the Centers for Disease Control and Prevention (CDC) have developed guidelines, including checklists, to assist businesses, industries, and other employers in planning for a pandemic outbreak as well as for other comparable catastrophes. 
 
Checklist One: Plan for the impact of a pandemic on your business

• Identify a pandemic coordinator with defined roles/responsibilities for preparedness/ response planning
• Include input from labor representatives and all business/work units
• Identify essential employees and other critical inputs
• Train and prepare ancillary workforce
• Develop and plan for scenarios likely to result in an increase or decrease in demand for your products and/or services during a pandemic
• Determine potential impact of a pandemic on company business financials using multiple possible scenarios that affect different product lines or production sites
• Determine potential impact of a pandemic on domestic and international travel
• Find up-to-date, reliable pandemic information from community public health, emergency management, and other sources and make sustainable links
• Establish an emergency communications plan and revise periodically
• Implement an exercise/drill to test your plan, and revise periodically 

Checklist Two: Plan for an impact of a pandemic on your employees and customers

• Forecast and allow for employee absencespersonal and family illness
  
  
  • Community containment measures and quarantines
  • School or business closures
  • Public transportation closures
• Implement guidelines to modify the frequency and type of face-to-face contact
  
  
  • Hand-shaking, seating in meetings, office layout, shared workstations
• Encourage and track annual influenza vaccination for employees
• Evaluate employee access/availability of health care services during a pandemic
• Evaluate employee access to and availability of mental health and social services during a pandemic
• Identify employees and key customers with special needs, and incorporate the requirements of such persons into your preparedness plan

Checklist Three: Establish policies to be implemented during a pandemic

• Employee compensation and sick-leave absences unique to a pandemic
  
  
  • Non-punitive, including policies when a no longer infectious and can return to work after illness
• Flexible worksite and flexible work hours
  
  
  • Telecommuting
  • Staggered shifts
• Preventing influenza spread at the worksite
  
  
  • Promote respiratory hygiene/ cough etiquette
  • Prompt exclusion of people with influenza symptoms
• For employees who have been exposed to pandemic influenza, are suspected to be ill, or become ill at the worksite
  
  
  • Infection control response
  • immediate mandatory sick leave
• For restricting travel to affected geographic areas
  
  
  • Evacuating employees working in an affected area when an outbreak begins
  • Guidance for employees returning from affected area
• Set up authorities, triggers, and procedures for activating and terminating the company’s response plan, altering business operations
  
  
  • Shutting down operations in affected areas
  • Transferring business knowledge to key employees

BarnesCare H1N1 Update Number 5 -- Thursday, October 8, 2009
Cold vs. Flu: Signs and Symptoms
The novel H1N1 (swine)  flu is spreading quickly in many area communities. Learning to recognize the symptoms of flu is important to help stop the spread of the virus. However, adults may be able to infect others up to one day before experiencing symptoms and up to seven days while sick and up to 24 hours after being fever-free with out use of anti-fever medications. Here is a quick review of signs and symptoms associated with the common cold and influenza:

Distribution of the H1N1 Vaccine
The first shipment of H1N1 vaccine has arrived in the area and is being distributed to vaccination clinics this week. BarnesCare will receive a limited supply of the initial shipment for use solely on the Centers for Disease Control and Prevention (CDC) target groups. These target groups include pregnant women, people who live with or care for children younger than 6 months, health care and emergency medical services personnel, persons between 6 months and 24 years, and people 25-64 who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems.

We do not expect that there will be a shortage of 2009 H1N1 vaccine, but availability and demand can be unpredictable. It is estimated that it will take approximately 18 weeks (end of February) to have on hand enough vaccine for every person.

Seasonal Flu Vaccine
Don't forget to  protect yourself from the seasonal flu. This year, because of  H1N1, there are two separate influenza vaccines -- one for seasonal and one for H1N1.  Getting just one flu shot this year is not enough. BarnesCare has seasonal flu vaccine available at each clinic and can provide shots on-site. 

Each BarnesCare location is prepared to provide the seasonal flu vaccine. No appointment is necessary. A BarnesCare nurse is also available to come directly to your company to administer seasonal flu vaccines to your employees.

The BarnesCare seasonal flu shot program is for adults 18 and older. All scheduled on-site dates are subject to change or cancellation based on vaccine availability and the Centers for Disease Control distribution guidelines.

For more information or to schedule on-site seasonal flu shots call 314.727.0078.

BarnesCare H1N1 Update Number 4 -- Thursday, October 1, 2009
Who should receive the 2009 H1N1 vaccine?
The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) has recommended that certain groups receive the 2009 H1N1 vaccine when it becomes available. These target groups include pregnant women, people who live with or care for children younger than 6 months, health care and emergency medical services personnel, persons between 6 months and 24 years, and people 25 through 64 who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems.

We do not expect that there will be a shortage of 2009 H1N1 vaccine, but availability and demand can be unpredictable. There is some possibility that initially the vaccine will be available in limited quantities. Based on the CDC's estimated vaccine production and shipment capabilities, the initial shipment to the city and county health departments will cover approximately 10 percent of our population and then weekly shipments of approximately 5 percent of our population. At this rate, it will take approximately 18 weeks (end of February) to have on hand enough vaccine for every person.

The Committee recognized the need to assess supply and demand issues at the local level. The Committee further recommended that once the demand for vaccine for these target groups has been met at the local level, programs and providers should begin vaccinating everyone 25 through 64. Current studies indicate that the risk for infection among persons 65 or older is less than the risk for younger age groups. Therefore, as vaccine supply and demand for vaccine among younger age groups is being met, programs and providers should offer vaccination to people over 65.

Pandemic Flu Planning:  Actions to Maintain Business Continuity
Business continuity means ensuring that essential business functions can survive natural or man-made disruptions. Many existing business continuity plans anticipate disruptions such as fires, earthquakes and floods. These events are restricted to certain geographic areas, and the time frames are fairly well defined. Pandemic flu, however, demands a different set of continuity assumptions since it will be widely dispersed geographically and will potentially arrive in waves that could last several months at a time.

Here are actions your business can take to decrease the spread of flu and to maintain business continuity. Keep in mind that many strategies take time to implement.

1. Update sick leave and family and medical leave policies and communicate with employees about staying away from the workplace if they are ill; for example, employers may want to temporarily forgo requiring sick notes from employees' doctors to relieve some of the strain on the nation's health care system
2. Maintain a healthy work environment; ensure adequate air circulation; post tips on how to stop the spread of germs at work; promote hand and respiratory hygiene; ensure widespread and easy availability of alcohol-based hand sanitizer products, including wipes and gels
3. Establish an emergency communications plan and revise periodically; the plan should include key contacts (with backups) as well as the processes for communicating pandemic status and actions to employees, vendors, suppliers, and customers inside and outside the work site in a consistent and timely way; during the outbreak this past spring, internal web sites proved effective for communicating to employees and providing links to trusted Internet sources
4. Identify your company's essential functions, including accounting, payroll, and information technology and the individuals who perform them; the absence of these individuals could seriously impair business continuity; cross-train employees to perform essential functions
5. Plan for interruptions of essential government services like sanitation, water, power, and transportation or disruptions to the food supply; for example, your employees may need backup plans for car pools in case mass transit is interrupted
6. Determine which outside activities are critical to maintaining operations and develop alternatives; for example, what transportation systems are needed to provide essential materials? Does the business operate on just-in-time inventory or is there typically some reserve?
7. Establish or expand policies and tools to promote "social distancing" such as reducing the number of face-to-face meetings and allowing employees to work from home (telecommuting) with appropriate security and network access to applications
8. Check that existing business continuity contingency plans address long-term absenteeism rates; In particular, check to see if core business activities can be sustained over several weeks with only a minimal workforce available
9. Collaborate with insurers, health plans, and major health care facilities to share your pandemic contingency plans and learn about their capabilities and plans
10. Educate employees now and over the course of a pandemic to limit the negative effects of H1N1 among your workforce; tell your employees about the threat of a more severe wave of the H1N1 flu virus and about the steps the company is taking to prepare for it, and how basic policies they rely on would, or would not, be impacted

BarnesCare H1N1 Update Number 3 -- Thursday, September 24, 2009
Prevention Is the Big Deal
While the initial wave of the H1N1 flu in the United States this spring briefly dominated the headlines, its impact was relatively moderate. But the nation -- the business community, in particular -- cannot let down its guard. Federal officials warn that a second wave may come during this next flu season and could be much more widespread and severe.

What if 10 percent of your employees are too sick to come to work on any given day? Imagine that over the course of several months to a year 15 percent of your workforce is absent for weeks. Imagine that the other businesses you rely on are also facing the same massive absentee rates. Absentees will include sick employees, those who must care for others who are sick, and the "worried well," who may want to avoid the workplace for fear of being exposed to the virus.

Preventing the spread of flu is key to keeping your business in business. Flu is caused by viruses that infect the nose, throat and lungs and is generally spread from person to person when an infected person coughs or sneezes. A vaccination against the seasonal flu and H1N1 flu -- when it is available -- will be the best way to prevent the disease.

The following common-sense precautions recommended by the Centers for Disease Control and Prevention (CDC) should be communicated to your employees to help prevent the spread of flu this season:

• Avoid close contact with people who are sick; if you are sick, keep your distance from others to prevent them from getting sick
• Stay home when you're sick or have flu symptoms; get plenty of rest and check with a health care provider as needed
• Cover your mouth and nose with a tissue when coughing or sneezing; if you don't have a tissue, cough or sneeze into your sleeve or elbow, not your hands; it may prevent those around you from getting sick
• Clean your hands after coughing or sneezing; washing your hands often will help protect you against germs; when soap and water are not available, use alcohol-based hand rubs or wipes
• Avoid touching your eyes, nose, or mouth; germs are often spread when a person touches something that is contaminated and then touches his or her eyes, nose, or mouth

Practice other good health habits. Get plenty of sleep, be physically active, manage stress, drink plenty of fluids, eat nutritious foods and avoid smoking, which may increase the risk of serious consequences if you do contract the flu.

Next H1N1 Webinar Topic:  Pandemic Flu Planning
Join us as the H1N1 webinar series continues on Wednesday, September 30 with a discussion on Pandemic Flu Planning hosted by BarnesCare's medical director, Scott C. Jones, DO, MPH, FAOCOPM. Dr. Jones will review specific actions your business can take to decrease the spread of the flu and to maintain business operations.

This is one topic in a series of webinars designed to help organizational leaders prepare and react to the threat of a flu pandemic. Attendees who will benefit from this webinar series include:

• Employee health professionals
• Risk and safety managers
• Human resource managers
• Business owners

Each presentation will include up-to-date novel H1N1 flu (swine flu) information and the latest on vaccine availability.

Attendees will have the opportunity to ask real-time questions of Dr. Jones.

• September 30 -- PANDEMIC FLU PLANNING -- Home and workplace tactics
• October 7 -- SIGNS AND SYMPTOMS -- Colds, seasonal and H1N1 flu
• October 14  -- WORKPLACE ISSUES -- Educating employees
• October 21  -- VACCINE AND MEDICATIONS UPDATE -- Guidelines and recommendations; Antiviral medications
• October 28  -- TRAVELING DURING A PANDEMIC -- How to protect yourself
• November 4  -- BEST PRACTICES AND REVIEW

Topics are subject to change to provide timely updates on new information pertinent to the workplace. Enrollment is limited to 20 per session. Each one-hour session will be 10 a.m.-11 a.m. Central Standard Time, Wednesdays, begining September 16, 2009. Cost is $99 per session or $299 for the remaining sessions. Subscribe now to receive the H1N1 webinar series or contact a BJC corporate health consultant for more information at 314.727.0078.

BarnesCare H1N1 Update Number 2 -- Thursday, September 17, 2009
H1N1 Vaccine Update
The U.S. Food and Drug Administration announced on September 15, 2009, that it has approved four vaccines against the 2009 H1N1 influenza virus. The vaccines will be distributed nationally after the initial lots become available, which is expected within the next four weeks.

The vaccines are made by CSL Limited, MedImmune LLC, Novartis Vaccines and Diagnostics Limited, and Sanofi Pasteur Inc. All four firms manufacture the H1N1 vaccines using the same processes, which have a long record of producing safe seasonal influenza vaccines.

Based on preliminary data from adults participating in multiple clinical studies, the 2009 H1N1 vaccines induce a robust immune response in most healthy adults eight to 10 days after a single dose, as occurs with the seasonal influenza vaccine.

In the ongoing clinical studies, the vaccines have been well tolerated. Potential side effects of the H1N1 vaccines are expected to be similar to those of seasonal flu vaccines.

For the injected vaccine, the most common side effect is soreness at the injection site. Other side effects may include mild fever, body aches, and fatigue for a few days after the inoculation. For the nasal spray vaccine, the most common side effects include runny nose or nasal congestion for all ages, sore throats in adults, and -- in children 2 to 6 -- fever.

H1N1 vs. Seasonal Flu
The St. Louis metropolitan area is beyond the early stages of the 2009 novel H1N1 influenza (swine flu) pandemic and is currently experiencing sporadic outbreaks in settings such as schools and daycares.  Since H1N1 has been established as present in our community, laboratory confirmation of H1N1 vs. seasonal influenza will be limited.  However, it is not critical to know if an influenza like illness is H1N1 vs. seasonal flu because the avoidance, recognition, and treatment for both are similar.

How Seasonal and H1N1 Influenza Can Spread Between People
Influenza is thought to be primarily spread through large droplets (droplet transmission) that directly contact the nose, mouth or eyes. These droplets are produced when infected people cough, sneeze or talk, sending the relatively large infectious droplets into the nearby air and into contact with other people. Large droplets can only travel a limited range; therefore, people should limit close contact (within 6 feet) with others when possible. To a lesser degree, human influenza is spread by touching objects contaminated with influenza viruses and then transferring the infected material from the hands to the nose, mouth or eyes. Influenza may also be spread by very small infectious particles (aerosols) traveling in the air. The contribution of each route of exposure to influenza transmission is uncertain at this time and may vary based upon the characteristics of the influenza strain.

Four Workplace Practice Tips to Implement Today

• Provide resources and a work environment that promotes personal hygiene; for example, provide tissues, no-touch trash cans, hand soap, hand sanitizer, disinfectants and disposable towels for employees to clean their work surfaces
• Encourage employees to obtain a seasonal influenza vaccine (this helps to prevent illness from seasonal influenza strains that may continue to circulate)
• Provide employees with up-to-date education and training on influenza risk factors, protective behaviors, and instruction on proper behaviors (for example, cough and sneezing etiquette and proper hand washing technique)
• Develop policies to minimize contacts between employees and between employees and clients or customers

BarnesCare's H1N1 Webinar Series Continues
BarnesCare's H1N1 webinar series, facilitated by medical director, Scott C. Jones, DO, MPH, FAOCOPM, focuses on flu prevention strategies Wednesday, September 23, 2009.
Attendees who will benefit from this webinar series include:

• Employee health professionals
• Risk and safety managers
• Human resource managers
• Business owners

Presentations include up-to-date novel H1N1 flu (swine flu) information and preventive measures for the workplace.

A new topic for discussion will be presented each week. Scheduled topics include:

• September 30 -- PANDEMIC FLU PLANNING -- Home and workplace tactics
• October 7  -- SIGNS AND SYMPTOMS -- Colds, seasonal and H1N1 flu
• October 14  -- WORKPLACE ISSUES -- Educating employees
• October 21  -- VACCINE AND MEDICATIONS UPDATE -- Guidelines and recommendations, Antiviral medications
• October 28  -- TRAVELING DURING A PANDEMIC -- How to protect yourself
• November 4  -- BEST PRACTICES AND REVIEW

Topics are subject to change to provide timely updates on new information pertinent to the workplace. Enrollment is limited to 20 per session. Each one-hour session will be 10 a.m.-11 a.m. Central Standard Time, Wednesdays, begining September 16, 2009. Cost is $99 per session or $299 for the remaining seven sessions. Subscribe now to receive the H1N1 webinar series or contact a BJC corporate health consultant for more information at 314.727.0078.

BarnesCare H1N1 Update Number 1 -- Thursday, September 10, 2009
H1N1 Webinar Series: Protecting Your Employees and Business During an Influenza Pandemic

Organizational leaders will be better prepared to understand and react to the novel H1N1 flu pandemic with relevant, timely information. Based on requests from local employers, BarnesCare is presenting eight weekly topics facilitated by medical director, Scott C. Jones, DO, MPH, FAOCOPM.

Attendees who will benefit from this webinar series include:

• Employee health professionals
• Risk and safety managers
• Human resource managers
• Business owners

Presentations include up-to-date novel H1N1 flu (swine flu) information and preventive measures for the workplace.

A new topic for discussion will be presented each week. Scheduled topics include:

• September 16 -- SEASONAL AND H1N1 FLU -- What is H1N1 and how it is different from the seasonal flu
• September 23 -- FLU PREVENTION -- Personal hygiene, social distancing
• September 30 -- PANDEMIC FLU PLANNING -- Home and workplace tactics
• October 7  -- SIGNS AND SYMPTOMS -- Colds, seasonal and H1N1 flu
• October 14  -- WORKPLACE ISSUES -- Educating employees
• October 21  -- VACCINE AND MEDICATIONS UPDATE -- Guidelines and recommendations, Antiviral medications
• October 28  -- TRAVELING DURING A PANDEMIC -- How to protect yourself
• November 4  -- BEST PRACTICES AND REVIEW

Topics are subject to change to provide timely updates on new information pertinent to the workplace. Enrollment is limited to 20 per session. Each one-hour session will be 10 a.m.-11 a.m. Central Standard Time, Wednesdays, begining September 16, 2009. Cost is $99 per session or $299 for the remaining seven sessions. Subscribe now to receive the H1N1 webinar series or contact a BJC corporate health consultant for more information at 314.727.0078.

Spread the Word Not the Flu
Many employers are contacting BarnesCare asking what information they should be sharing now with their employees.
Below is a sample email you can edit and send out to your employees.

To our knowledge there have been no confirmed cases of Novel H1N1 Flu (swine flu) involving ____ (insert your company's name here) employees. We do, however, want you to be aware of the signs and symptoms and to encourage you to stay home if you feel ill.

We will continue to update you on changing conditions in our community, about vaccine availability and on how to best protect yourself from Novel H1N1 Flu (swine flu). Here are the basics:

Signs and Symptoms of Novel H1N1 Flu (Swine Flu)
Most people with H1N1 flu report similar symptoms of seasonal flu such as a sudden onset of fever, cough, sore throat, body aches, headache, fatigue, or chills. Not everyone experiences every symptom. Some people have reported diarrhea and vomiting.

Steps for Treating Flu Symptoms

• Stay home
• Notify your doctor
• Rest
• Drink plenty of liquids
• Take fever reducing medicines such as acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®)

Do not return to work until your fever is gone for 24 hours without fever reducing medicine

Steps to Avoid Getting the Flu

• Clean your hands often with soap and water or alcohol based hand cleaner, especially after coughing or sneezing
• Avoid touching your eyes, nose or mouth -- germs enter your body this way
• Cover your mouth and nose with a tissue when you cough or sneeze and throw the tissue in the trash
• Avoid close contact with people who are sick
• Stay home if you get sick to prevent others from catching your illness
• Get plenty of sleep, exercising regularly, drink plenty of water and eat healthy foods for overall health