On June 11, 2009, the U.N.’s World Health Organization (WHO) declared an H1N1 pandemic, moving the alert level to phase 6 and marking the first global pandemic since the 1968 Hong Kong flu. A November 8, 2009, worldwide update from WHO stated, “206 countries and overseas territories/communities have officially reported over 503,536 laboratory-confirmed cases of H1N1 infection, including 6,250 deaths.”

Although many health surveillance organizations believe the peak for H1N1 cases has passed, most research indicates that the virus will be around for a while with surges and declines in the number of cases. In fact, at this particular time, 32 states in the U.S. are still reporting widespread infections.

Actual numbers in the millions
National Centers for Disease Control and Prevention (CDC) statisticians estimate that between 14 and 34 million cases of H1N1 occurred between April and October 17, 2009, with a mid-level range of about 22 million people infected in 2009. Between 63,000 and 153,000 H1N1-related hospitalizations occurred in the same period, with a mid-level range of 98,000. CDC estimates that there have been between 2,500 and 6,000 deaths from H1N1, with a mid-level range of about 3,900.

Because there is no absolute requirement for reporting cases to the CDC or WHO, no one knows the exact number of cases, and statisticians have been forced to estimate the incidences of infection. Many people with flu do not seek medical care, and since the testing for H1N1 is relatively expensive, only a small number of people with flu-like symptoms have been tested.

Hand contact is a culprit
Seasonal flu typically affects older populations — 60 percent of hospitalizations and 90 percent of deaths occur in patients 65 and older. With H1N1, however, the most affected groups are younger than 65, perhaps because previous flu epidemics may have imparted a degree of immunity to the older population. Schools, in particular, are breeding grounds for the virus, and parents have been urged to keep sick children home until they have been free of fever for 24 hours.

Although H1N1 is a respiratory disease, evidence shows that it is transmitted more from surfaces and hands than directly via the air. In the event of a cough or a sneeze, the heavier virus particles released orally are deposited on hands and inanimate surfaces, and the virus is then transferred via an unsuspecting touch.

For this reason, the Society of Healthcare Epidemiologists, the Infectious Disease Society and WHO recommend precautions based on transmission by droplet infection rather than airborne infection. In certain circumstances, disposable gloves have become the hero in protecting workers. In all cases, frequent hand washing, even sanitizing, is becoming standard practice.

Possibility of mutation
Thus far the H1N1 infections have not caused as many deaths as regular seasonal flu, but there is fear that the virus will change or mutate during subsequent waves as it spreads across the globe. A changed version of the H1N1 virus could produce a much deadlier, treatment-resistant strain that could render previous immunizations useless.

An example of such change in a global pandemic occurred in 1918 when the Spanish flu killed 50 to 100 million people worldwide. Spanish flu was an avian influenza with a first wave that was not all that deadly. Later, when the virus mutated, the deadliest wave of pandemic occurred.

Be prepared
Thus far, H1N1 is not as deadly as seasonal flu and seems milder in severity. Nonetheless, massive preparation for widespread illness and expected absenteeism in schools and the workplace is ongoing, and disaster teams continue to prepare for mass illness and mass fatalities should the virus change in virulence.

Much of the preparation involves personal hygiene and common sense avoidance of germs including:

• Respiratory etiquette (coughing into your sleeve)
• Personal protective equipment
• Social distancing
• Staying home from social events
• Washing hands frequently
• Using hand sanitizer

An effective defense against H1N1 starts with an assessment of your facility and the people who use it. Certain critical service providers such as police, fire departments and emergency medical service providers must plan for absenteeism of 30 to 40 percent of their staff due to illness while still being able to provide the needed services.

Emergency medical services such as the New York City Emergency Medical Services Fire Department experienced one of the first massive outbreaks of H1N1 in the spring of 2009. In response, the New York City Fire Department EMS adopted protocols for answering calls that might involve H1N1 cases. If a call came in from someone with a fever and cough, EMS personnel were required to wear complete NFPA 1999 compliant personal protective equipment ensembles on every call, including NFPA 1999 compliant gloves, gowns, N95 masks and eye protection.

This NFPA 1999 PPE requirement worked — very few of the EMS workers answering the H1N1 related calls contracted H1N1. Those who did contract the virus may have contracted it from their own sick children.

NFPA 1999 compliant PPE works
The H1N1 experience in New York City proved that NFPA 1999 compliant personal protective equipment works. The NFPA 1999 Standard on Protective Clothing for Emergency Medical Operations sets the minimum requirements for protective clothing that provides protection from bodily fluids and bloodborne pathogens.

In order to pass the testing for compliance with NFPA 1999 Standard on Protective Clothing for Emergency Medical Operations, gloves have to pass the ASTM F 1671, Standard Test Method for Resistance of Materials Used in Protective Clothing to Penetration by Blood- Borne Pathogens Using Phi-X174 Bacteriophage Penetration as a test system. The model viral particle utilized for testing is 27 nanometers in size and is smaller than the 100-nanometer H1N1 swine flu virus. The test data show that NFPA 1999 compliant PPE does not allow the virus to penetrate. By requiring the use of these NFPA 1999 certified products, New York City protected its EMS providers, enabling them to sustain their continued efforts to deliver critical services to those in need.

At workplaces across the country, companies and government agencies are making similar decisions as to the best way to prevent the spread of H1N1. In many cases, the decision is being made to have workers wear disposable gloves that can protect them from contact with this global virus.