The show brings together an eclectic group of “colonists” and puts them down in a post-pandemic world (actually 10 acres of abandoned neighborhood on the Gulf Coast of Louisiana left decimated by Hurricane Katrina, a naturally occurring disaster zone that was slated to be bulldozed and turned into a public park.)

It is in that stark environment of empty buildings, weedy streets and the backwoods that the colonists will be working over the 10 episodes to scavenge essentials for survival from their surroundings while fending off threats such as wild animals and malicious outsiders without electricity, running water, government or outside communication.

The show also includes features on-going play-by-play commentary experts in homeland security, engineering, psychology and the medical community. Unlike the “Survivor” show, the colonists aren’t eliminated in a tribal council every week; instead, the emphasis on how they will work together as a team to survive.

I found the first episode pretty engaging. Of course, I will admit that I like — much to my wife’s consternation — a lot of reality shows. But at least this one (unlike “The Bachelorette” or “Top Chef”) I could tell her I was watching  for my work.

In fact, while it is heavy on the drama — about half the first show involved fistfights between the “colonists” and some interlopers — the show makes you consider how you would react in the event of a major catastrophe and think about your own self sufficiency. It will be intriguing to people interested in the topic of disaster response and survival skills. I probably will be checking in and out of the show of the next 10 weeks.

For more more information on “The Colony” including schedule information, click here.

The report, “The Public’s Response to the 2009 H1N1 Influenza Pandemic,” reviewed 20 national opinion polls, including eight by Harvard School of Public Health (HSPH) researchers, taken during the 2009 H1N1 pandemic. It was authored by HSPH’s Gillian K. SteelFisher, and Robert J. Blendon, Professor of Health Policy and Political Analysis. The analysis appears as an Online First Perspective in this week’s New England Journal of Medicine:

Throughout the H1N1 pandemic, more than half the U.S. population appeared to have a positive impression of the government’s response, although a sizable minority did not. For example, in the early days of the pandemic, 54% believed the response of the federal government was appropriate, whereas 39% believed the government had overreacted (CNN, May 2009). Nine months later, in January 2010, 59% believed that public health officials did an excellent or good job in their overall response to the pandemic, whereas 39% believed they did a fair or poor job (HSPH, January 2010)…

Our review of these data suggests that in the event of a future influenza pandemic, a substantial proportion of the public may not take a newly developed vaccine because they may believe that the illness does not pose a serious health threat, because they (especially parents) may be concerned about the safety of the available vaccine, or both. More work may need to be done to understand the basis of these beliefs and to address them in the case of a serious influenza outbreak.

Parental concern must be better addressed in any future pandemic vaccine rollout, according to the HSPH press release:

First, many people who did not get the vaccine were not convinced that the illness was a serious threat to them personally. In one January poll, 30% of people who would not or might not get the vaccine said a “major reason” was their belief that they were not at risk of serious illness and 37% said the H1N1 outbreak was not as serious as public health officials once thought. A second reason for not taking the vaccine was concerns about the safety of the vaccine. This was especially a concern for parents. In one poll, 56% of parents who were not going to or might not get the vaccine said a “major reason” for their decision was their concern about “safety risks from the vaccine,” compared to 35% of adults making the same decision for themselves about the H1N1 vaccine.

“These findings suggest that in the event of a future influenza pandemic, a substantial proportion of the public may not take a newly developed vaccine,” said SteelFisher. “Public health officials who want to encourage vaccination must better understand and address the beliefs and concerns of those who chose not to get the H1N1 vaccine.”

Polls during the 2009 H1N1 pandemic also suggest that public health communication efforts related to other personal influenza prevention behaviors, like hand-washing and staying clear of people with flu-like illness, were effective in reaching a large swath of the public. Even early in the outbreak, a large majority of people (59%-67%) said they had washed their hands more frequently due to H1N1, according to polls in April, May and June 2009.

“Building on these self-protection measures, as well as a vaccine strategy, may be useful for future response planning and throughout an outbreak,” said Blendon.

Michael Coston at Avian Flu Diary says that the survey results indicate a potential public complacency issue:

The concern here is that the impressions left by the experience of 2009 may mean that a lot of people may not be quick to accept a pandemic vaccine in the future. It is the same sort of reaction we see in Florida, and along the Gulf and Atlantic Coastline, after every hurricane season.

People who emerged unscathed, or who may have ridden out a weaker storm, come away believing that they’ve seen a hurricane . . . and they weren’t particularly impressed. People who evacuated upon the order (or advice) of local officials, only to return and find their house intact, are less likely to evacuate in the future. But of course, all hurricanes aren’t created equal. And basing your future expectations on the last storm can be a fatal error.

The same holds true for pandemics. As epidemiologists like to say, “If you’ve seen one pandemic . . . you’ve seen one pandemic.”

Although there were some missteps along the way (particularly in the overpromising of vaccine supplies in October and November) the HHS and the vaccine manufacturers pulled off a considerable coup by delivering a safe and effective vaccine a month sooner than originally anticipated. Despite the ominous warnings of the anti-vaccine contingent, we have not seen any spike in Guillain-Barre syndrome, or any other serious vaccine related side effects.

The pandemic shot has proven to have roughly the same safety profile as the seasonal flu shot, which is excellent. Unfortunately, the message that the `vaccine is deadlier than the virus’ continues to persist – particularly online – and that raises doubts in many people’s minds.

While everyone is happy that the pandemic of 2009 proved less deadly than first feared, the public complacency that this has engendered may prove to be a substantial obstacle the next time we face an emerging public health threat.

According to campaign press release:

 “The holidays are one of the busiest travel times of the year,” said Dr. Anne Schuchat, director of CDC’s National Center for Immunization and Respiratory Diseases. “People are in close contact – whether they’re on a plane, train, ship or just visiting with loved ones. This campaign provides practical advice to help travelers prepare for their trips and stay healthy during their holiday travel.”

 CDC is urging people to take the following steps when planning their travel and to stay informed about what to do if they get sick while they’re gone, including:

• Traveling only when they are feeling well

• Getting vaccinated for flu (both seasonal flu and 2009 H1N1 if they are in a priority group)

• Washing hands often

• Covering coughs and sneezes with a tissue or sleeve

 “We know that flu – and specifically H1N1 this year – is a big concern for people, but flu shouldn’t ruin the holidays,” Dr. Schuchat said. “By practicing a little prevention, people can enjoy their holidays and stay well at the same time.”

Around the nation, authorities are now distributing the limited supplies to priority groups. Here in New York, the low turnout last weekend at clinics set up specifically for young people prompted officials to open access to other ’special’ populations. The City Department of Health’s new vaccine distribution widget is below:

Health officials concern about the workplace and H1N1 is the subject of an article by Stephen Greenhouse in today’s New York Times, “Lack Of Sick Days May Worsen Flu Pandemic”:

Public health experts worried about the spread of the H1N1 flu are raising concerns that workers who deal with the public, like waiters and child care employees, are jeopardizing others by reporting to work sick because they do not get paid for days they miss for illness.

Tens of millions of people, or about 40 percent of all private-sector workers, do not receive paid sick days, and as a result many of them cannot afford to stay home when they are ill. Even some companies that provide paid sick days have policies that make it difficult to call in sick, like giving demerits each time someone misses a day.

Public health experts say policies like these encourage many people with H1N1, commonly called swine flu, to report to work despite official warnings from the government and most companies that they should stay home.

“For people who are really caught on a weekly income, if they can’t make a go of it, they might say, ‘I’m desperate. I’m going to do what I have to do, and I’m going into work even though I’m sick,’” said Robert Blendon, a professor of health policy at Harvard.

He warned that this might spread disease, and that these financially squeezed workers might send their flu-stricken children to school, infecting others.

Well before President Obama declared H1N1 a national emergency, the federal Centers for Disease Control and Prevention was emphasizing that businesses should adopt “flexible leave policies” to allow workers with the flu to stay home. In one advisory, the C.D.C. encouraged employers “to develop non-punitive leave policies.” Despite such recommendations, some employees say they have no choice but to go to work sick.

As has been suggested previously on the blog, one way officials at local, state and federal levels — including President Obama — could be helpful is by highlighting businesses of all sizes who are already making plans for their workforce. This attention would provide guidance, encouragement (and, in some cases, pressure) for other organizations.

Using the bully pulpit in that way would underscore how seriously the government takes this and make special planning/policies for H1N1 seem like the norm not the exception. The media can also play a constructive role here by examining what is and is not being planned by organizations in their areas.

Media reports have continued to highlight the skepticism of many Americans about the H1N1 vaccine. More than half of Utah residents surveyed in a KSL-TV/Deseret News poll said they were planning to skip the vaccination. And the New York Times reported that as of last week, “…fewer than half of New York City parents with children in elementary school have given permission for their children to receive the vaccine at school, reflecting some ambivalence about the need for the vaccine or concern about its effects.”

FOURTH-GRADER LESLIE CRUZ GETS HER H1N1 FLU VACCINE WITH NYC DEPUTY MAYOR LINDA GIBBS, HEALTH COMMISSIONER THOMAS FARLEY, AND SCHOOL CHANCELLOR JOEL KLEIN AT BROOKLYN’S P.S. 157.

Every citizen/parent will have to make their own choice on the vaccine. However, as Shenk argues, we all have a stake in each other’s decisions, because the numbers vaccinated will likely have an impact on the flu’s spread. The Times article, written by Jennifer Medina, explains the role of “herd immunity” in dealing with H1N1:

Experts debate exactly what level of flu vaccination is ideal, but a computer model developed several years ago by epidemiologists at Emory University, based on experiences with mandatory flu shots for Japanese schoolchildren, suggested that when 50 percent of children are vaccinated, a community’s risk of a seasonal flu epidemic falls by two thirds, and when 70 percent are vaccinated, the risk drops to 4 percent.

U.S. Homeland Secretary Janet Napolitano has spoken often about the “shared responsibility” of each stakeholder, including the public, when it comes to emergency preparedness and response. However, to date officials have not emphasized that messaging approach yet on the H1N1 vaccinations. Of course, as there is not enough available vaccine it may be premature to make that communications push right now. And, ultimately you want people to get the vaccine, because they believe it is in their own interest. Nevertheless, to help move some Americans off the vaccine fence, I think using the shared or civic responsibility approach might be helpful.

In a post titled, ” Flu Prevention Tips on the Fields,” Katie Stanton, “Director of Citizen Participation and a Soccer Mom,” writes:

“If your kids are playing on sports teams this fall, here are a few more tips to help them stay healthy:

* Have coaches remind children to cover sneezes and coughs with their sleeve or a tissue. Dispose of any tissues in a separate bag.

* Coaches (and parents) should make sure players stay home if they have a cough, cold, or flu for 24 hours after their symptoms have cleared.

* Have players wash their hands or use hand sanitizers before starting the game.

* Make sure players bring in their own water bottles and do not share them.

* Instead of post-game handshakes or high-fives, cheer or clap for the opposing team.”

My kids have soccer games scheduled for this Sunday (I’ll be refereeing), and I have passed this information on to our coaches and the league administrators.

PRESIDENT OBAMA WATCHING HIS DAUGHTER, SASHA, PLAY SOCCER  (ABOVE)

That’s exactly how students at P.S. 157 in Brooklyn got their H1N1 vaccinations delivered yesterday. They were among the first New York school children to be given the new vaccine as the City kicked off its campaign. The kids got their shots or nasal spray (the former for those with asthma or other respiratory issues) with Commissioner Thomas Farley and Chancellor Joel Klein and a passel of local media looking on.

NINE-YEAR-OLD FRANCISCO GOMEZ (ABOVE) GETS HIS H1N1 VACCINE AS NYC SCHOOL CHANCELLOR JOEL KLEIN AND HEALTH COMMISSIONER THOMAS FARLEY LOOK ON.

Though the vaccinations and media event seemed to go well, it did highlight one of the challenges for the program: getting parental permission slips in. At P.S. 157 as of yesterday morning, according to officials, 115 kids were cleared out of the student body of 369 (or 31%). Officials said that they expect that percentage to go up soon. And, Chancellor Klein said that many children in the school system will be going to their own doctors for the vaccination.

The City’s program, which aims to cover 300,00 children, will expand its rollout to middle and high schools early next month. Another issue for the New York school system is the diversity of the student body, and the Health Department’s web site offers information and consent forms in 10 languages

LESLIE CRUZ BEING INTERVIEWED BY THE MEDIA (ABOVE) AFTER GETTING HER H1N1 FLU SHOT.

At P.S. 157, the students seemed a bit overwhelmed by all the press (though it may have distracted them from any vaccine discomfort). But I think the coverage will have a positive impact on the H1N1 rollout here: most of the news stories included interviews with kids who said the vaccination wasn’t a big deal and parents who felt the risk of H1N1 outweighed any concerns about the vaccine. Typical was this article (accompanied by a video) on the website of the New York Times (which, continues. despite my blog post on Monday, to use the term Swine Flu interchangeably with H1N1):

Despite an extensive outreach campaign — including the distribution of screening and consent forms to all parents and guardians — doubts have lingered. The parents who streamed in and out of the rain at P.S. 157 expressed mixed views, but in most cases, they said their concerns about the safety and efficacy of the vaccine were outweighed by worry that that their children might contract the H1N1 virus.

“I have a lot of questions, but I think it’s a good thing,” said Reina Mendez, who was dropping off her 9-year-old grandson.

Jimmy Rivera, who has two sons, 7 and 5, at the school, said: “I wasn’t really convinced about it, but after I did a little research on the computer, I decided it was a good idea. Actually, I had a debate with my wife — my wife wanted it.”

The two-minute video (below) and resources are available at www.FasterVaccines.org. It is part of the Commission’s effort to engage citizens on issues of bioterrorism and weapons of mass destruction.

“WHY WEREN’T H1N1 VACCINES AVAILABLE FOR CHILDREN BEFORE SCHOOL STARTED?” VIDEO (ABOVE)

“Whether the threat is from naturally occurring disease or bioterrorism, the United States needs to be able to produce vaccines and other medicines faster and less expensively. We had six months of advance warning for the H1N1 pandemic. A bioterrorism attack will have no advance warning,” said former senator Graham, chairman of the Commission. “Creating the infrastructure for rapid development of large quantities of safe vaccines and medicine is a win-win for public health and national security.”

According to Graham, the United States—unlike the European Union and China—continues to use a 60-year old production method, using chicken eggs, to make H1N1 and other important vaccines. Modern methods will shave months off the typical six-to-nine months that current processes require. These newer methods can produce more vaccine and be quickly scaled-up, on demand.

“We want the public to know there are better options,” said Commission vice chairman Talent, “and encourage policymakers to have the foresight to invest in them.”

However, I continue to see that many in the major media are still using “Swine Flu” interchangeably with “H1N1″: an editorial in today’s New York Times is titled, “Swine Flu and You,” there’s a video feature on CNN.com called “Swine Flu Latest,” and NPR has dubbed its recent special series, “Swine Flu: The Second Wave.”

As someone who writes about the topic a lot, I understand why: first, it’s easier to have another way of writing or headlining the same term, second “Swine Flu” is not only more colorful than H1N1 but it’s also more familiar to viewers and readers, and third the media doesn’t always follow government guidance. (And, in fairness, even the U.S. Health of Human Services’ @Flu.Gov Twitter tweets are still being tagged #swineflu, because it helps reach more people.)

Yet, last month, U.S. Secretary of Agriculture Tom Vilsack reiterated his plea to the media that “Swine Flu” be dropped from use, saying in a statement:

“Each time the term is used it unfairly hurts America’s farmers who are suffering severe economic losses during these challenging economic times. And each time the media uses the phrase “swine flu” a hog farmer, their workers and their families suffer. It is simply not fair or correct to associate the 2009 pandemic H1N1 influenza with hogs, an animal that does not play a role in the ongoing transmission of the pandemic strain.”

In a post on CNN.com’s own “Paging Dr. Gupta” blog, Medical News Editor Miriam Falco explains that using the term is not only a matter of the economic fortunes of the pork industry, but also of factual accuracy:

“Back in the spring, when we first heard about ’swine’ flu, it was given that name because initial tests showed it resembled some known viruses that have circulated in pigs. However, the CDC explains on its Web site, ‘…further study has shown that this new virus is very different from what normally circulates in North American pigs.’ The agency explains that this new H1N1 virus has genetic material from viruses found in European and Asian pigs, as well as genes from birds and humans.

Plus, USDA officials point out that this is a human virus because it was first detected in humans. They say there are no reports of H1N1 circulating in any swine herds here in the United States. They acknowledge that Canada, Australia and Argentina have found H1N1 in a few pigs. And Deputy Agriculture Secretary Dr. Kathleen Merrigan says she wouldn’t be surprised if the H1N1 virus does eventually surface in U.S. pig herds. But she stresses that pigs infected with the virus would not be sent to market.

Of course, unless you are a hog farmer, naming the pandemic is obviously much less important than dealing with it (or in the media’s case, covering it). But as someone who has been dutifully following the terminology ‘rules’, I’d like to see other media do the same or else just let this obedient older child go back to using both terms.

[UPDATE: Jim Garrow helpfully points out in a comment (below) that some of the confusion may result from the Associated Press stylebook which instructs using "swine flu on first reference, then specifies H1N1 virus on follow-up reference.” David Stephenson in a follow-up comment says he's "astonished" by the AP policy "formally mandating inaccurate reporting."]

“With flu season in the northern hemisphere upon us, and cooler weather bringing the likelihood of new H5N1 bird flu reports as well, the newshounds that work the flu forums are looking at six very busy months ahead.

Newshounds are volunteers who spend hours each day searching in the hundreds of online English and Foreign language news sources for information pertaining to pandemic influenza, avian flu, and other emerging infectious diseases…Their work thankfully is archived on the flu forums, where it is discussed, analyzed, and becomes part of the historical record. The flu forums have essentially become repositories of flu and infectious disease information, that function like real-time libraries.”

Coston notes that the newshounds’ good work appears on flu forums like Flu Wiki and FluTrackers as well as on blogs like his (and mine) — and is ultimately used by public health practioners, policymakers and average citizens:

Flu Wiki

“Much of what I do in this blog is dependent upon their labors. While I still do a fair amount of news hounding myself, at least half of the stories I blog about come by way of these hardworking news analysts…

Both FluTrackers and the Flu Wiki produce a daily summary of news items, which helps make it easier to pluck out individual news stories from the onslaught of posts.

The Flu Wiki summary is updated in real time, during the day, at the top of each day’s news thread. Each item has a corresponding link to take you to the original source material (news article, journal article, etc.)…FluTrackers takes a slightly different approach, posting a summary at slightly irregular intervals, but generally every 24 to 36 hours.”

“All of this, as you might imagine, takes an incredible amount of work and dedication. Scores of these folks work on the forums without pay, and far too often without recognition. Their work, by the way, is freely shared between forums and with the world.

The expertise of many of these newshounds is remarkable, with some becoming quite adept at translating articles, and knowledgeable about local customs and idioms in places like Indonesia and China.”

If you have not already, I recommend you checking out these forums both for the flu information available on them as well as a model of what can be done by knowledgeable, committed and public spirited citizens in the area of emergency preparedness and response.

The proclamation, which Obama signed Friday night, will make it easier for U.S. medical facilities to handle a surge in flu patients by allowing the waiver of some requirements of Medicare, Medicaid and other federal health insurance programs as needed, the White House said in a statement.

The U.S. Centers for Disease Control and Prevention said on Friday that H1N1 swine flu has become widespread in 46 of the 50 U.S. states, a level comparable to the peak of ordinary flu seasons but far earlier and with more waves of infection expected.

The White House statement said the declaration was intended to prepare the country in case of “a rapid increase in illness that may overburden health care resources” and was similar to disaster declarations issued before hurricanes hit coastal areas.

According to the survey, 83% of women surveyed responded that they made an extra effort to cover coughs and sneezes with a tissue, compared to 67% of men; 35% of women surveyed have gotten their seasonal flu shots this year, compared to 26% of men.

Though overall the poll found that roughly 7 in 10 Americans are confident they could take time off from work, have the right supplies at home and know what flu symptoms signal a need to go to the hospital.

The poll also indicated that in the past two months, one in five households has someone who has gone to work or school when they were sick. The latter statistic would seem to be troublesome in part because it appears to underscore the fact that some people fear they need to go to work or risk losing pay or their jobs.

More information on the survey can be found on the Red Cross’ blog here.

“My biggest concerns as of the moment:

1) Concerned that a substantial portion of country may be infected before vaccine arrives — will depend on speed with which epidemic moves in next month, as well as speed with which vaccine can be delivered to states, as well as how fast states are able to get vaccine into people.

2) Concerned that large numbers of persons who could get vaccine will choose not to vaccine because of concerns that it is experimental or untested — great deal of misinformation out there on the streets. The Paul Offit editorial in [Monday's] New York Times describes many of the widely circulating beliefs about the vaccine and the actual facts. Poll about 2 weeks ago showed that while 60% of American parents willing to get their kids vaccinated for seasonal flu, only 40% were planning on their kids vaccinated for H1N1 – even though almost all of the flu circulating now is H1N1.

3) Concerned that antiviral resistance could develop –so far there is no sustained neurominidase inhibitor resistant strain circulating, just single cases popping up and very rarely. If sustained resistance occurred, we would lose key tool for treating the sickest patients. It is good sign that no sustained resistance has developed so far, but it would be a non-linear event if it happened. No accepted view from the hard core flu virology community on the likelihood of this happening or not.”

She suggests that when it comes to the flu every American should make this commitment: “If you get sick, pledge to yourself: ‘This germ stops with me.’ Don’t pass it forward.” In his post, Coston writes:

“Yesterday, on Twitter, this `tweet’ came across my desktop from @Caroldn. It was so good, I immediately re-tweeted it.

“A simple enough message. Yet – if we all followed this advice – we could substantially reduce the impact of this pandemic virus practically overnight. You see, this novel H1N1 virus needs fresh, susceptible hosts in order to survive. Each person who gets infected, on average, ends up passing on the virus to between 1.5 to 2.0 other people. If we can reduce that number, we slow the pandemic. We break the chain of infection. Which means, if you are sick. Please stay home.”

Of course, for some workers — who may fear losing their jobs or being docked pay — staying home may not seem like a viable option, particularly if they can physically make it into the workplace. However, hopefully, employers increasingly will be making special allowances including sick leave in the event of a major outbreak. Because as Coston points out, “the marginal gain you might get out of having that person working isn’t worth the risk of their infecting other employees or your customers.”

“Just how concerned should the average (insert your nationality here, AFD gets visitors from more than 100 countries) be about this novel H1N1 pandemic virus? It isn’t an easy question to answer. Particularly since many people have a bad tendency to either ignore a threat completely, or go overboard in an extreme over-reaction to it. In view of what we’ve seen over the summer months, I still believe that what is needed is more of a measured `middle-ground’ approach…”

And, he outlines what that “measured ‘middle ground’ approach” means for members of the public:

“So . . . what is the appropriate level of concern you should have about a possible pandemic? Well . . . if you’ve followed the advice that has been offered by this blog and numerous agencies for the past several years and . . .have a good family and business emergency plan, have acquired at least a 2-week supply of emergency supplies, routinely practice good flu hygiene, get the appropriate vaccines when they are available, have and are a flu buddy, are looking out for your neighbors and greater community. . . . then I think (for now, at least) you can simply keep a wary eye on developments and go about your life.

I see no need to hunker down at home, or to live in fear over this virus. This is a serious situation, of course. And tragically, this virus will claim thousands of lives over the next few months. It certainly deserves your attention, vigilance, and respect. But not your fear. Stay informed, of course. Check back here, with Flu.gov, and with my fellow bloggers often. It is, after all, an evolving and fascinating story.

We are likely to remain at pandemic level 6 for a year, perhaps two. Maybe longer. This is the `flu normal’, and we all need to get used to living life in a pandemic. If you’ve done all of these things, and this pandemic hits your community hard (or a hurricane, or a flood, or a forest fire), you will be about as well prepared to deal with it as you can reasonably expect to be. The point, you see, isn’t to be afraid.”

* “Swine Flu Reaches An Anxious Nation” – (New York Times)

“The fear of swine flu is being compounded by new worries, this time among primary care doctors who say that they are swamped by calls from patients seeking the new vaccine, and that they are ill-prepared to cope with the nationwide drive to immunize everyone, particularly children and chronically ill adults.”

* “America Takes On Swine Flu” — Opinion (NYTimes.com)

“The roll-out of the swine flu vaccination program, one of the largest such drives in U.S. history, started Monday. The federal government has ordered 250 million doses of vaccine, which will be distributed by state health officials this fall.

Yet surveys have found that a large portion of the public is uncertain about getting the vaccine, either because of concerns about potential side effects or because they sense the health warnings about the H1N1 virus are overblown. At the same time, many doctors worry that they are ill-prepared to handle the nationwide drive to immunize everyone. We asked some doctors and public health experts, will such an ambitious immunization program work? What worries you most?”

David Ozonoff, epidemiologist, Boston University

Gregory Dworkin, pediatric pulmonologist

Robert Blendon, Harvard School of Public Health

Kevin Pho, primary care doctor

* “The 0.5 Pandemic. Relax. H1N1 is not going to be nearly as bad as you may have been led to believe…Unless …” — Cover story (New York)

“Despite the widespread outbreaks, the virus seems to have evolved—not genetically, but in the minds of public-health officials. What looked like a lethal miscreant in the spring looks a little different now—still capable of causing serious disease and rare deaths in vulnerable groups, like pregnant women and young children—but not the second coming of 1918’s global pandemic. Officials just hope it stays that way.”

* “The ‘Great Flu’ vs. Today’s” – Interview with author John Barry (Boston Globe) – [Thanks to Michael Coston for flagging this article and for all his work in this area.]

“Q. What’s similar and what’s different about the two pandemics?

A. The pattern in terms of spread seems to be like not only 1918 but pandemics in 1889, 1957, where there were sputters of intermittent outbreaks, sort of like you turn an engine over and it coughs, coughs, coughs before it catches fire. In 1918, there were hints all through the spring it could be something really nasty. But so far this year, we’ve not seen clusters where a lot of people in the same area have suffered severe illness or death.”

* And finally, the video of a recent webinar, “Social Media and Technology Breakthroughs: H1N1 and Seasonal Flu Communication,” is now available. The webinar was sponsored by the Center of Excellence for Risk and Crisis Communications at Booz Allen Hamilton Inc., American Public Health Association, International Association of Emergency Managers, and the National Association of Government Communicators.

Clarke said his win was a “pleasant surprise” since he wasn’t exactly sure what HHS was looking for when he submitted the video and “rap music is not usually used by government.” However, he knew that his entry would appeal to a younger demographic which is a key target of public health outreach for H1N1. He told me he is planning to donate the $2500 prize to the Shriners Hospital.

Clarke has previously written health awareness raps including this one on diabetes. When not rapping, he is the Medical Director for the Long Island Railroad in New York. In addition having his PSA aired nationally, the doctor hopes to do some public appearances, including at schools, during the Fall as part of the H1N1 education effort.

“H1N1 RAP BY DR. CLARKE” (ABOVE)

Dr. Clarke’s video was ‘endorsed’ by this blog in the contest and was the top pick of experts I contacted. Since competition began, Clarke has done a number of television interviews ranging from the Fox News Channel to the “Wendy Williams Show.” But he felt that the “viral” nature of social media was key to his win, particularly since the voting took place on the web. Clarke asked me to thank the readers of this blog which he said was the first blog to support his PSA in the contest.

By the way, Clarke’s favorite PSA among the other 10 finalists was “Chainsaw”(below).

“CHAINSAW” PSA FINALIST (ABOVE)

I think that one way officials at local, state and federal levels can be helpful is by highlighting businesses of all sizes who are already making plans for their workforce. This attention would provide guidance, encouragement (and, in some cases, pressure) for other organizations. Using the bully pulpit in that way would underscore how seriously the government takes this and make special planning/policies for H1N1 seem like the norm not the exception. The media can also play a constructive role here by examining what is and is not being planned by organizations in their areas. The Minneapolis/St. Paul Star-Tribune recently had a couple of helpful articles along those lines which I wanted to post. According to “Next Test: Flu 101″:

…With the number of flu cases expected to peak within the next five to seven weeks and send absenteeism rates soaring, experts at a national conference in Minneapolis on Tuesday recommended that companies do what they can to make sure sick workers stay home. Suggestions include loosening sick-leave policies or allowing workers to use time off that they haven’t yet accrued.

Some companies already have taken that a step further. Medtronic Inc. is giving all its U.S. employees, including hourly workers, three extra paid sick days because of H1N1. The Fridley-based medical-device manufacturer said its decision was based on concern that workers would still come in despite being sick. “We were getting concerns from particularly the hourly side that if they’d already used up their sick time, well then what?” said Tanya Raso, Medtronic’s director of corporate risk and business continuity. “And managers were feeling some of the pressure of: ‘I’m going to send this person home and potentially they’re going to miss their car payment as a result.’ This will help alleviate concerns on both ends.” Raso said she realizes that some abuse might take place but that the company is relying on the honor code.

Best Buy is telling its managers to make sure employees know it’s OK to take sick time. It’s also telling managers to tell workers to go home if they appear to be sick. If a worker who doesn’t have sick time is sent home during a shift, managers are encouraged to pay the remainder of that day’s shift.

Target and other businesses are waiting to see just how serious the pandemic is before they solidify personnel plans. ”We’re prepared to react and be compassionate depending on the extent of the epidemic,” said Darrell Amberson, president and part-owner of Lehman’s Garage Inc., which employs just under 100 people in Minneapolis and area suburbs.

For now, he plans to shift people among Lehman’s six locations as needed if the flu hits. If it gets worse, he’s considering changing the company’s sick-leave policy. Technicians and other hourly workers earn vacation time but not sick time, but Amberson said it’s unlikely a sick employee would drag himself in if he had the flu just to save a vacation day. “I’d like to think that most of our people are pretty conscientious, and we’re small enough that we have a relatively close-knit group,” he said. “Someone would say, ‘Stay home, take it easy and we’ll cover for you. It will be OK. It’s not worth making other people sick or yourself worse to tough it out.’”

New Horizon Academy, which has 7,000 kids and 1,400 workers in 60 child-care centers in Minnesota, is taking precautions in all of its centers, even telling parents to wash their hands before they go into a classroom. Most of the workers in the centers are paid hourly and accrue paid time off (PTO) but not sick time. The Plymouth-based company is considering allowing workers to use PTO hours they haven’t yet accrued if they need to stay home because of H1N1, said Chad Dunkley, chief operating officer. It also has beefed up its list of substitutes by about two dozen in case the flu takes a toll on workers, he said.

At the conference, called “Keeping the World Working During the H1N1 Pandemic,” experts advised businesses to come up with a plan now, if they haven’t already. And the first priority should be keeping people home without fear of losing their jobs.

Another Star-Tribune article, “What employers are doing”, offers this list of corporate plans:

MEDTRONIC

•Providing three extra paid sick days for all U.S. employees, including hourly.

TARGET

•Evaluating more flexible sick-time policies if H1N1 escalates.

•Might reduce staff needed at stores if necessary to remain open.

•Offering seasonal flu and H1N1 vaccinations, as available, to employees and customers at some pharmacies.

•Securing hand sanitizers and masks for employees, as well as customers.

BEST BUY

•Managers encouraged to pay the remainder of a shift if employee goes home sick.

NEW HORIZON CHILD CARE

•Considering allowing employees to use more personal paid time off than they have accrued.

•Bulking up its list of substitute workers.

DELTA AIR LINES

•Following CDC recommendations; has not made operational changes related to H1N1.

The scope of the challenge for the nation when it comes to businesses and employees during a serious H1N1 pandemic was underscored this week at the conference: fewer than half of the organizations in attendance said they plan to pay employees for time off when they need to stay home to care for their children while schools are closed or to care for sick family members.

“H1N1 RAP BY DR. CLARKE” (ABOVE), THE WINNING VIDEO IN THE HHS FLU PREVENTION PSA VIDEO CONTEST

The “H1N1 Rap” was chosen from more than 200 entries. Out of these initial entries, a panel determined the top 10 entries which were posted on the HHS YouTube Channel and put to a public vote. Dr. Clarke will receive $2500 in cash and his PSA will be featured on national television.

The announcement was made at a flu prevention ‘town hall’ for college students at George Mason University (a video of the event, including Dr.Clarke’s ‘acceptance speech’ can be found here). In his remarks, Clarke, who is the medical director of the Long Island Railroad, thanked “the voters, blogs and Twitter” as well as his wife who suggested he do the video. I believe Clarke — who Sebelius called the “hip-hop doctor” — could be the breakout star of the Fall.

I think it was a terrific idea for HHS to solicit, unleash and highlight the creativity from Americans of a variety of ages, backgrounds, and points of view for this contest. It was fun, citizen-driven/focused, and most importantly I believe will be effective in raising flu preparedness among the public.

Among those I surveyed, the most popular entry was “H1N1 Rap By Dr. Clarke” (which was also my favorite) with “Hazmat” second and several other finalists also receiving support (their PSAs are below). You can watch all the nominees and vote here through tonight.

PICKS

Sharon Sanders, FluTrackers.com – “They are all great! ‘H1N1 Rap by Dr. Clarke’ is my favorite. Apparently he wrote and performed the lyrics himself! If that Doctor gig does not work out, he has a real career in the music industry waiting for him!”

David Stephenson, Stephenson Strategies — “‘Dr. Clarke’s’ got my vote!”

Wendy Harman, American Red Cross, Social Media — “‘Dr. Clarke and the H1N1 rap’. They’re all great efforts, but that’s my pick.”

Greg Dworkin, FluWiki – “‘Dr. Clarke’”

Andre Blackman, Pulse + Signal Blog — “Dr. Clarke. It’s pretty awesome.”

Robin Parker, Red Cross/Oregon Trail Chapter – “I think ‘Hazmat’ is both clever and conveys a strong, clear message. That’s my pick!”

Amanda Ripley, The Unthinkable — “Hazmat all the way!”

Jolie Kaye Breeden, University of Colorado’s Natural Hazards Observer — “I love the ‘Hazmat’ guy the best, although ‘Toothbrush Prank’ is also good at driving the message home-and might serve the dual purpose of getting my daughter to stop leaving her toothbrush on the bathroom counter.”

Nedra Kline Weidrich, Weidrich Communications — “‘Toothbrush Prank’. I thought it made the point really powerfully.”

Rich Cooper, SecurityDebrief — “It’s a coin toss between the ‘Chainsaw’ and the ‘Flu Droplets’. I actually think the ‘Flu Droplets’ is better given it shows what happens when you don’t cover your mouth and that’s the message that needs to get out there….”

Michael Coston, Avian Flu Diary — “‘Chainsaw’. Very droll.”

David Konig, EMS Blog Rounds – “My favorite is ‘Bagman’, but I’m also a fan of ‘Hazmat’. Similar themes that I think convey the point clearly.”

You can watch all 10 of the finalists and vote here through 11:59 p.m. EDT tonight. The winner will receive a $2500 prize and have their PSA featured on national television.

The finalists are all good and their entries are better produced than I would have thought. Each makes useful H1N1 points in creative ways. And, the idea of asking the public to create PSA’s allows for more pushing of boundaries than if a government agency produced them. It is unlikely that the government would be able to show a man wielding a chainsaw through the streets to illustrate a version of  ’social distancing’ as one of the finalists does.

According to the rules set out in HHS Secretary Kathleen Sebelius’ own video on YouTube, contestants were asked to: “Create a 15, 30, or 60 second video Public Service Announcement (PSA) that will inform and motivate people to take steps that will help prevent the spread of the flu. Make your video fun, smart, and entertaining.”

Though I thought all the finalists were effective, only one video can win. So, in consultation with my two young daughters (my YouTube consultants), this blog picks “H1N1 Rap By Dr. Clarke” (see his entry below). In his video, Dr. Jon Clarke, in shades, raps about H1N1 prevention before concluding a little more soberly and without the sunglasses. We thought the combination was effective. If he is chosen, Clarke could be the breakout video star of the Fall.

“H1N1 RAP BY DR. CLARKE” (ABOVE). A FINALIST IN THE FLU.GOV H1N1 PSA CONTEST

It turns out that Clarke is a family physician in New York City with a music degree — and puts both credentials to good use in his entry. His YouTube page shows that he’s also rapped on behalf of diabetes awareness.

To watch all the finalists and vote go to the entry site here.

You can also view the entire group of 242 judged entries here. Most of these provide a more homemade video feel and are filled with kids, superheroes, and pigs. Some are also pretty effective. This one (below) called “Barnyard Conference” was a favorite among my kids, and it’s pretty funny (though it may not help efforts to replace the term “swine flu” with H1N1!).

ONE OF THE FLU CONTEST ENTRIES, “BARNYARD CONFERENCE” (ABOVE)

In all, I think that soliciting, unleashing and highlighting creativity from Americans with a desire to help on flu prevention — and from of a variety of ages, backgrounds, and points of view — was a terrific idea. It is fun, citizen-driven/focused, and most importantly should be effective in raising flu preparedness among the public. By the way, if you disagree with my selection please tell me why you picked one of the other finalists (or preferred one of the other 232 entries) instead.

“Even though most Americans aren’t extremely worried about the virus, they seem interested in taking steps to protect themselves and their families,” said Scott Conner, Red Cross senior vice president of preparedness and health and safety services. “Taking those basic steps-such as washing your hands more frequently and remaining at home if you are sick become even more important as the new flu season approaches.”

According to the results, women are more likely to take protective actions, with 84 percent making an extra effort to cover coughs and sneezes (versus 71 percent for men), and 81 percent washing their hands more carefully and more often (compared to 71 percent for men).

The survey also found that 62 percent plan on being vaccinated against this new flu virus if one is offered. Nearly half of those surveyed (46%) plan on assembling a two-week supply of food, water and medicine that they might need in the event they or someone in their family becomes sick and need to stay home for extended periods of time.

The survey results seem to indicate that Americans are in a relatively good mental posture for the Fall — not getting too scared but taking some actions and beginning to think about contingencies in the event of a widespread health emergency. (Of course one would want both personal and societal preparedness to be a higher for such a potential pandemic but the best should not be the enemy of the better here.)

As far as the gender findings, come on men get with it!

*Allow sick workers to stay home without fear of losing their jobs;
*Develop other flexible leave policies to allow workers to stay home to care for sick family members or for children if schools dismiss students or child care programs close;
*Share your influenza pandemic plan with employees and explain what human resources policies, workplace and leave flexibilities, and pay and benefits will be available to them;

There are no laws or mandates to back this up except in some limited areas (the New York City Council may act to mandate paid sick days in time for the Fall along the lines of laws in San Francisco and Washington D.C.) and getting widespread voluntary private sector compliance is a challenge (ie. unlike schools there is no local managerial authority; it has to be done firm by firm).

Further, while many large corporations have contingency plans already, it will be more difficult for smaller companies and their employees to comply. In the joint interdepartmental press release, Secretary of Commerce Gary Locke emphasized the need for  leadership for business and government:

Secretary Locke suggested businesses set the right tone in the workplace. That means implementing common sense measures to reduce the risk of spreading the flu and encouraging workers who are sick to stay home.

“The President has mobilized the federal government to get America prepared,” DOC Secretary Locke said. “But government can’t do it alone. For this effort to be successful, we need the business community to do its part.” Making the right decisions will not only improve public health, it also has the potential to protect economic productivity: Employees who are sick and stay home will not spread the flu in the workplace.

At the news conference, DHS’ Secretary Janet Napolitano added: ”Be responsible and understanding for the absenteeism that needs to occur with this strain of the flu.”

In order to help set that “tone” in businesses around the U.S., I would suggest that national leaders (including President Obama) as well as those in states and localities should begin to do high profile media events highlighting businesses of all sizes that are taking the actions being recommended by the government. That use of the bully pulpit would show how seriously the government views this, help other businesses figure out how to do it and make it seem like the norm not the exception.

I still am unclear whether there will be some need for stronger government action and/or assistance regarding business, employees and H1N1. But in the meantime, showing how some companies are already planning to handle it would seem to be helpful. (n.b. There will be a webcast on Flu.Gov Thursday at 1:00pm (ET) focusing the new federal business and employer guidance.)

Most Americans are either “not too” or “not at all” worried about the swine flu hitting home and broad majorities have confidence the government and local health providers will be able to effectively deal with an outbreak, according to a new Washington Post-ABC News poll…

A key component in the federal response is the swine flu vaccine currently in production, and in the poll, 55 percent of Americans say they are apt to get the vaccine for themselves or someone in their household. Stipulating a doctor’s recommendation, that percentage jumps to 65 percent. But the government has to battle some complacency: Only about one in eight Americans is very worried that swine flu will affect his or her family, with more than twice as many “not at all” concerned. Overall, more than six in 10 are not worried.

If “not too” worried means that most Americans are not overly concerned or hysterical but are still beginning to look into contingency planning at home, school and work then that would seem to be a good state of mind going into the Fall. If, however, “not too” worried is a synonym for complacency then that could be a problem. I don’t know how to evaluate the 55/65% who say they will take a vaccination. It seems relatively high considering that H1N1 is currently not really in the news and not viewed as a major threat. That would undoubtedly go higher when/if the flu begins spreading in the Fall.

“Everyone recognizes that H1N1 is going to be a challenge for all of us, and there are people who are going to be getting sick in the fall and die,” said John O. Brennan, the U.S. deputy national security adviser for counterterrorism and homeland security. “The strategy and the effort on the part of the governments is to make sure we . . . collaborate to minimize the impact.”

Concern about a second wave has prompted a flurry of activity by federal, state and local officials, including intensifying flu virus monitoring and making plans to distribute vaccine and antiviral drugs and other treatments if necessary. ”There’s a lot of moving parts to this,” said Joseph S. Bresee, who heads the CDC’s influenza epidemiology and prevention branch. “Hopefully we won’t have a panic, but instead we’ll have the appropriate level of concern and response.”

On Friday, the federal government issued revised guidelines for local schools in dealing with H1N1. Many officials felt that widespread school closures during the Spring were not effective in stopping the flu and had a negative collateral impact. As a result, officials are now recommending that schools only close when there is a major outbreak and reduce the amount of time sick students should stay home when their fever breaks. The article notes the challenging balance officials are trying to find when it comes to communicating with the public on these issues:

The Obama administration has been updating recommendations for when to close schools, what parents should do if their children get sick, how doctors should care for patients and how businesses should respond to large-scale absences. Officials are hoping to navigate a fine line, urging precautions to minimize spread, serious illness and deaths while avoiding undue alarm and misinformation.

“The last time we had anything similar to this was prior to the Internet,” said one senior official who spoke on the condition of anonymity last week during one of a series of background briefings for reporters.

First of all, I’m not sure it makes sense for “senior officials” to get themselves quoted only as “senior officials” during briefings for reporters on this topic. I think it lends a secretive tone that isn’t really called for here. Why couldn’t that statement be attached to a name? Further, though its possible the quotation is not in full context, the official probably should have noted that the Internet also can and would also play a positive role in a pandemic helping distribute information between all stakeholders, including the public.

But apart from the attribution language, I wanted to make a couple of brief points from the weekend:

* On Schools — I think it is good that officials have publicly issued the new guidelines. At the H1N1 Summit, I heard many experts dispute the widely-held view (among the public and the press) that the school closings had been effective in stopping the flu during the Spring. Correcting that history and publicly explaining the reasons for a ‘less agressive’ policy is smart.

However, in the Fall, if individual local school systems are ‘more aggressive’ in closing their buildings, it will be difficult — in this media age — for other places to resist pressure that will undoubtedly come from parents asking why they are not being similarly aggressive. It’s tough to resist that pressure as the situation in the Spring indicated no matter what the experts say. Here I think the media — particularly the cable news channels — are very important. Obviously, they need to report the truth. However they would best serve their viewers if they explain the pro’s and con’s of school closings and the specific situations in each place rather than just transmitting and exacerbating panic. The CDC and other agencies can help by doing more briefings (anonymous or not) and also discussing some of these scenarios with the public so they understand if their school districts do stay open.

On Businesses – While there is a governance structure that can implement policy on H1N1 in schools around the U.S., the challenge is more difficult when it comes to business, particularly small and medium sized firms. A big challenge in dealing with a major outbreak is how the private sector will deal with significant absentee rates due to illness to employees and their children.

For the government, the bully pulpit is the tool they have to rely on most over the next few weeks. Officials have been repeatedly asking employers to start planning for H1N1 in the Fall. In many businesses, particularly large corporations, that type of preparation builds upon existing plans and is definitely happening. The real challenge is smaller companies. No matter what they do in the event of a virulent outbreak business will be disrupted. However, I would suggest that officials — including President Obama — begin highlighting businesses and other institutions who are models of H1N1 prep as a way to guide others who aren’t sure how or even if they can do it.

On Communities — One final thing from the weekend. I read on the very helpful Avian Flu Diary blog about another H1N1 preparedness idea — that Canada was urging their citizens to find a ‘flu buddy’. This type of one-to-one preparation and planning is something that we all should be doing with our neighbors whether it has to do with H1N1 or another emergency like a power failure or fire. If H1N1 is the catalyst for more of this then something will definitely have been gained. public.