Digi-cam justification

 

A FEMA announcement fell into my in-box the other day. The blurb was titled "Being Ready For When The Inspector Calls Can Speed Assistance" (Release Number: 1842-006 if anyone wants to track it down.)

The Montgomery, Ala.-datelined piece focuses on flood recovery efforts and ways that applicants can speed up the process - and put in damage mitigation measures while waiting for the FEMA-assigned inspector to arrive.

Two paragraphs in particular caught my eye.

"FEMA officials said registrants do not have to wait for the inspector to arrive before beginning repairs. Photos, contractor estimates, and receipts can be provided to FEMA inspectors to document the extent of the damage."

"The inspectors all have proper identification and will be able to verify the number assigned to each registrant. Be aware of the potential for fraud. Only a FEMA inspector will have the number that was provided during registration."

Insurance companies - at least mine - tell customers to do whatever it takes to mitigate post-event damage. In other words, if a window is blown or knocked out, get it covered with something to keep out the elements until the glass can be replaced. Save the receipts .

But while some evidence of recent damage is obvious, other damage might be thought "pre-existing." Insurance companies will balk at paying for something that was damaged before the event.

Digital cameras to the rescue.

Business owners and homeowners alike are well advised to take camera/camcorder in hand and to document photographically the pristine condition of their property; Aunt Ann's antique writing desk, the over-priced office furniture bought when the economy was better and we KNEW things were going to get even better.

Camera memory is relatively inexpensive. Shoot everything. Copy the images to a disk - CD, DVD, whatever. Then, take the memory and store it "off site." If the graphics are from company, save the memory at the house and vice versa. Take the disc and mail it to your cousin across the state. The idea is to make certain (a) the images are safe and (b) that the media - memory and disc - can be retrieved in relative short order. Do not depend on the Post Office to deliver the media - it may have its own problems and you may not be where you think you'll be when the mail arrives.

One of the joys of living in southeast Florida is the financial benefit of risk mitigation. On one hand, there are local laws requiring (newer) structures to have wind mitigation and wired-in smoke detectors. On the other hand, insurance companies offer - perhaps by State mandate - discounts for buildings with these features.

Naturally, as a risk management practitioner, I'm delighted. My financial manager also is less aggrieved when the insurance bill arrives - it's still painful.

When we moved into the new abode, I took pictures inside and out. I didn't save the memory, but I did copy the photos to disc and I did put the same photos on the WWW - that equates to putting the memory media in the "other" location. I do practice what I preach.

If ever there was an excuse to buy a digital camera/camcorder, this is as good as it gets. If shooting the business, the camera might be written off as a business expense.

Being able to prove property damage was caused by an event will help assure that the insurance will pay.

 

John Glenn, MBCI, SRP
Enterprise Risk Management/Business Continuity practitioner
Ft. Lauderdale FL
http://johnglennmbci.com/
Planner at JohnGlennMBCI dot com

Influenza A (H1n1) - Worldwide : Other Viral Infections

 

A ProMED-mail post http://www.promedmail.org
ProMED-mail is a program of the International Society for Infectious Diseases http://www.isid.org

Date: Thu 18 Jun 2009
Source: Eurosurveillance, Volume 14, Issue 24, 18 Jun 2009 [edited] http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19242

A variety of respiratory viruses found in symptomatic travellers returning from countries with ongoing spread of the new influenza A(H1N1)v virus strain

By: P Follin[1], A Lindqvist1, K Nystrom1, M Lindh [2]

At:
    1. Department of Communicable Disease Prevention and Control, Region Vastra Gotaland, Sweden,
    2. Department of Virology, Sahlgrenska University Hospital, Gothenburg, Sweden

Clinical specimens from 79 symptomatic individuals with a recent history of travel to countries with verified transmission of influenza A(H1N1) virus (North America) were tested with a multiple real-time PCR targeting a broad range of agents that may cause acute respiratory infection. This analysis revealed that besides 4 cases of influenza A(H1N1) virus, other respiratory viruses were diagnosed in almost 60 percent of the samples. These observations are a reminder that many different viral transmissions occur simultaneously in countries with ongoing spread of influenza A(H1N1) virus. The findings demonstrate that the definition of suspected cases by clinical and epidemiological criteria has only a poor capacity for discriminating influenza A(H1N1)v from other viral infections.

Background

A new influenza A(H1N1) virus variant has spread globally since its 1st appearance in April 2009 [1,2] and as of 17 Jun 2009, there were 39 620 cases reported by the World Health Organization (WHO) [3]. On 30 Apr 2009, the European Commission suggested a case definition [4], which has been adopted and modified by most authorities in the European Union Member States. In agreement with this recommendation, testing for influenza A was recommended in Sweden for cases with a clinical presentation including respiratory symptoms and fever above 38 C and epidemiological circumstances such as recent travel (within 7 days) to areas where the new influenza has been observed [5] or close contact with confirmed cases.

The regular sentinel surveillance for seasonal influenza has been extended and now focuses on identification of imported cases with influenza A(H1N1) virus, and on preventing secondary transmission by contact tracing and antiviral medication in an attempt to delay sustained community transmission. In order to provide a better basis for the decision whether or not to initiate preventive measures, expanded testing, targeting a broad range of respiratory agents has been applied to specimens from all suspected cases in the region Vastra Gotaland (1.5 million inhabitants). We report here the results of this expanded testing.

Material and methods

This report includes samples of patients who, during the period from 24 Apr to 10 Jun 2009 presented with influenza-like symptoms and a history of recent travel to the United States or Mexico, and therefore were recommended for examination and sampling. This clinical examination was performed by infectious disease clinicians on call at Sahlgrenska University Hostpital/Östra in Gothenburg, and our report is based on their evaluation and laboratory results. In summary, of all 79 patients included with a travel history, 90 percent presented with respiratory symptoms, 5 percent without respiratory symptoms, and for the remaining 5 percent this information is not documented. 66 percent had fever above 38 C, 29 percent had no fever; information on fever was missing for 5 percent. Nasopharyngeal swabs were sent to the molecular diagnostic unit at the virological laboratory at Sahlgrenska University Hospital for testing by a multiple real-time PCR targeting 13 viruses and 2 bacteria, ! run in 6 parallel multiplex PCRs on an ABI 7500 instrument [6]. Samples that were reactive for the influenza A component (matrix protein target, [7]) of this PCR were subtyped by an additional real-time PCR targeting the haemagglutinin gene, run in 3 parallel reactions specific for the H3N2 and H1N1 subtypes that have been circulating for a long time, as well as for the new H1N1v strain. [Readers requiring information on the primers and probes used in the real-time PCR are referred to a Table in the original text].

Results and discussion

In total, samples from 79 patients were tested (42 males, 37 females; median age 30 years, range 1-75 years), with between 10 and 16 samples on average each week and most of them taken from patients with respiratory symptoms and a history of recent travel to North America. Four cases with the new influenza A (H1N1)v variant were diagnosed. Interestingly, in 56 percent of the cases, other aetiologies were identified (Table).

Table. Viral aetiologies for the patients fulfilling definition of suspected cases of influenza A(H1N1)v, Region Vastra Gotaland, Sweden, Apr-Jun 2009 (n=79)

Viral aetiology / Number / Percentage

Rhinovirus / 28 / 34
Coronavirus / 8 / 10
Influenza B virus / 3 / 4
Human parainfluenza virus types 1-3 / 3 / 3 / 4
Adenovirus / 2 / 2
Influenza A (H1N1) virus / 4 / 5
Metapneumovirus / 1 / 1
Enterovirus / 1 / 1
Respiratory syncytial virus / 0 / 0
Mycoplasma pneumoniae, Chlamydia pneumoniae / 0 / 0
Negative / 32 / 39

Total number / 82 / 100

(Note: 3 patients had double infections with rhinovirus, together with enterovirus, metapneumovirus or adenovirus.)

The most common finding was rhinovirus, observed in 28 of 82 cases (34 percent), and 3 of these patients also had a 2nd viral infection (enterovirus, metapneumovirus and adenovirus). The frequent identification of rhinovirus and other viruses demonstrates that the criteria for suspected cases of influenza A(H1N1)v are relevant as indicators of a viral infection, but not specific for influenza A. On the other hand, applying more restrictive criteria would probably have excluded most infections with the new A(H1N1) virus strain, considering that their clinical presentation has been reported to be relatively mild. This illustrates a dilemma with surveillance actions aiming at revealing the spread of new respiratory infections. If the applied criteria are too strict (for example fever above 39 C, cough and muscle pain), the epidemic is likely to be underestimated, because only the severe cases are identified. If on the other hand the criteria are liberal, as illustrated by the cur! rent epidemic, most of the cases will probably have other aetiologies. The positive predictive value of clinical criteria for identification of influenza A is particularly low in the early phase of an epidemic, when the incidence of influenza A is low, but will become relatively high during the peak when a large proportion of respiratory infections will be due to influenza A virus. The value of broad virology testing decreases in the course of an influenza epidemic, when the detection rate of other aetiologies may decrease from above 50 percent as observed in this report to below 10 percent during the influenza peak (unpublished observations from our laboratory).

The cases with influenza A were analysed further by a typing PCR that within 4-5 hours could identify whether the strain was a traditional H1N1 or H3N2 virus, or the new H1N1 variant. This typing system targets specific regions of the haemagglutinin gene and has been developed in our laboratory (unpublished). It has proved to have a good sensitivity, as illustrated by cycle threshold (Ct) values that are typically lower than those obtained in the general PCR for influenza A, which targets a conserved region of the matrix protein gene.

The results of the multiple PCR used in our setting were available within 24 hours after sampling and served at the same time as confirmation for the result of the 1st, general influenza A PCR. In cases that presented with typical influenza-like symptoms but were negative for influenza A in the 1st PCR, the finding of an alternative aetiology was helpful for the decision to refrain from preventive measures. Such measures include oseltamivir treatment of patients and influenza testing and prophylactic treatment of their close contacts. The clinical practice was not always different, but in some cases, the identification of an alternative aetiology such as rhinovirus was helpful for the decision not to treat the patient of contacts, even when the patient had symptoms clearly indicative of possible influenza. From this experience, we therefore conclude that a broad diagnostic test is a valuable tool in the early investigation of a new emerging respiratory virus like the new influ! enza A(H1N1)v.

[Note added in proof: On 17 Jun 2009, Sweden changed to a stricter case definition for suspected cases. It now requires more than 2 symptoms besides epidemiology and fever.]

References

1. Centers for Disease Control and Prevention (CDC). Swine influenza A (H1N1) infection in 2 children--Southern California, Mar-Apr 2009. MMWR Morb Mortal Wkly Rep. 2009;58(15):400-2.

2. Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team. Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans. N Engl J Med. 2009 Jun 3. [Epub ahead of print].

3. World Health Organization (WHO). Influenza A(H1N1) - update 50. Jun 17, 2009. Available from: <http://www.who.int/csr/don/2009_06_17/en/index.html>.

4. Commission Decision of 30 Apr 2009 amending Decision 2002/253/ EC laying down case definitions for reporting communicable diseases to the Community network under Decision n 21/19/98/EC. 2009/363/EC. Official Journal L 110/58. 01.05.2009. Available from: <http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2009:110:0058:0059:EN:PDF>.

5. World Health Organization (WHO). Influenza A(H1N1) - update 2. Apr 26, 2009. Available from: <http://www.who.int/csr/don/2009_06_17/en/index.html>

6. Brittain-Long R, Nord S, Olofsson S, Westin J, Anderson LM, Lindh M. Multiplex real-time PCR for detection of respiratory tract infections. J Clin Virol. 2008;41(1):53-.

7. Ward CL, Dempsey MH, Ring CJ, Kempson RE, Zhang L, Gor D, et al. Design and performance testing of quantitative real time PCR assays for influenza A and B viral load measurement. J Clin Virol. 2004;29(3): 179-88.

Communicated by:ProMED-mail promed@promedmail.org

[These data among other things reveal that the positive predictive value of clinical criteria for identification of influenza A is low in the early phase of an epidemic, when the incidence of influenza A is low, but will become relatively higher during the peak, when a large proportion of respiratory infections will be due to influenza A virus. Among the viruses detected, rhinoviruses and coronaviruses predominated in this survey. - Mod.CP]

 

John Glenn, MBCI
Enterprise Risk Management
John.GlennMBCI at gmail dot com
Fort Lauderdale FL

Economy, H1N1 provide lessons for risk management practitioners

A Donne deal

The worldwide economic woes and the World Health Organization's (WHO) escalation of H1N1 influenza to "pandemic" level teach risk management practitioners that they must look beyond their organizations and beyond their national borders if they intend to truly manage risks.

The days when InfoTech staff could hunker down behind the data center doors and feel safe are long gone. History.

Ditto the days when an organization's business continuity planner could tick off a set of standard risks such as power failure, fire, flood, and perhaps vendor failure.

In the "old days," a ripple effect was like tossing a pebble into a still pond; something to be considered, but limited in impact. Today, it is more like a huge earthquake in the bowels of the ocean; the ripples are now a tsunami waves that impact distant shores.

Narrow view vs. broad view

Risk management practitioners have a choice of views as they consider global risks.

The narrow view, a view taken by too many, is to focus on the risk du jour: e.g., the financial troubles and the current pandemic.

The broad view is to understand that threats can come from all points of the compass and as fast as a jet plane flies.

The broad view also is to understand that a threat that happens to someone else can impact your organization.

An organization need not be international in scope to suffer when another organization continents away hiccups. A Mom-n-Pop business in rural anyplace can find itself between the same anvil and hammer as a multi-national conglomerate in a metropolis. The Mom-n-Pop and the multi-national conglomerate may respond differently to the threat: the Mom-n-Pop may be able to react faster and more efficiently but the multi-national may be able, as an "800 pound gorilla," to marshal resources that would not consider dealing with the Mom-n-Pop operation.

For all that, both the Mom-n-Pop and the multi-national are linked by the same spider web of interdependency.

Lenders as vendors

Consider a simple money issue.

A builder near Washington DC - this is a true story, by the way - had a contract with the federal government to build an office building. There is a deadline in the contract that the builder must meet. Failure to meet the deadline and the feds will implement the contract's penalty clause and the builder will be paying the government for each day the building remains unfinished.

The builder started the project with a promise from a lender - a/k/a money vendor - that the contractor had a sufficient line of credit to buy the materials and pay for the labor to build the building.

Such arrangements are pretty much Standard Operating Procedure (SOP) in the building - and many other - industry.

At the beginning of the builder's project the nation's economy seemed in good shape.

We, along with the builder and the lender, discovered that rather than a healthy economy, we had one wheezing and staggering from a long-hidden illness: valueless paper created by greed.

The lender suddenly discovered its backer lacked funds to lend. Since the builder's lender was suddenly unable to meet its commitment to the builder, the builder was unable to buy materials and services and to pay the trades people.

Tsunami effect

Mom-n-Pop expected to sell a substantial quantity of materials to the builder. Since the contractor was well known and had multiple multi-million dollar projects, Mom-n-Pop already lined up its suppliers, including a few outside the country.

Locally, the builder is forced to lay off personnel; if building materials are absent, why have people stand around being paid for doing nothing?

The laid off personnel go on unemployment compensation which normally is a pittance of what they bring home in their regular pay check.

The hard hat's spouse goes into Squeeze-the-Nickel-'til-the-Buffalo-Bellows mode and all luxuries are put on hold and "economies" are made. The planned remodeling of the bedroom into a den is shelved (probably just as well since Junior, who used to sleep in that room, just announced he lost his job and he's coming home "just 'til he finds a new job")

The local contractor, who hired his nephew in anticipation of the hard hat's remodeling job, has to furlough the nephew (and face his sister's wrath).

Meanwhile, over at Mom-n-Pop, the folks are busy cancelling orders for both domestic and foreign materials the builder cancelled.

Which means, Mr. Kim cancels his contract with his raw materials supplier and the dominos in the layoff chain continue to fall.

That seems a long way from the hard hat's mortgage which, it turns out, caused the worldwide financial collapse. (It was sold and resold and packaged with other mortgages that may be less trustworthy than the hard hat's, and probably resold again, each time at a discount.)

When pigs fly

A couple of years ago risk management practitioners were dealing with Bird Flu, H5N1, then the headline threat.

We hurried and scurried to "get ready" for a threat that, while still a threat at some level, never developed into the pandemic everyone feared. (It still could develop in to the feared pandemic, and smart risk management folks will hang on to, and maintain, all the work that went into The Pandemic Push.)

We were told "the flu will come in several waves." No one predicted where the waves would originate. China was, and remains, the most frequently cited starting point, but even if it is, which way will the birds fly? East? West?

With the advent of H1N1, Mexico's contribution to the world of maladies, we now know that (a) the influenza will come not as waves but as individual incidents. H1N1, misnamed "Swine Flu," travelled at the speed of flight to diverse points in the US and the world, stopping some places and skipping others.

No waves.

H1N1's tsunami impact, like the money vendors, takes its toll worldwide.

The very name, albeit a misnomer, caused a drop in some countries' hog markets.

There was a time not so long ago that a drop in the market price of milk led to the wholesale slaughter of dairy cows which in turn left feed-and-seed stores with unsold good, veterinarians with unused vaccines, and dairies without milk.

Today's risk management practitioner must anticipate both the threat and the impact, both direct and indirect, the threat will have on the organizations - all organizations from the business to the family (or perhaps the family to the business).

It no longer is sufficient to "think local."

Interdependencies abound and are not bound by business or locality or even national borders.

John Donne was right back in the early 17th century when he wrote his Meditation XVII.

Several centuries later, some of us still fail to understand we all are part of a worldwide web - not the Internet variety, but the relationship variety.

    Successful enterprise risk management practitioners take Mr. Donne's words to heart.

Good advice is everywhere

The followng is from MDERN - Maryland Emergency Radio Network via the Florida Emergency Radio Network's Yahoo presence (ergo the email format). It is worth all practitioners' attention. NACO is the National Association of COunties.

---

From: Rocky Lopes <rlopes@naco.org>
Subject: [MDERN- Maryland Emergency Radio Network] Those who fail to learn...
To: MarylandEmergencyRa dioNetwork@ yahoogroups. com
Date: Friday, June 5, 2009, 7:50 AM

There is an old adage, “those who fail to learn from history are doomed to repeat it”

We learned from Hurricane Andrew (1992) that telling people to have supplies for “72 hours” was wrong. Why? When interviewed, many people thought that the cavalry would rise over the hill at hour 73, and therefore, had far fewer supplies to last during prolonged periods when stuck in their homes because they couldn’t get out of their neighborhoods. A subsequent study showed that people who were asked to acquire “72 hours-worth” of supplies gathered far fewer supplies than a statistically significant parallel group which was asked to acquire “3 days-worth” of supplies. People just can’t do mental math. “Three days” sounds far longer than 72 hours. Go figure.

We must get over this “72-hour” thing, which dates back to the nuclear attack preparedness days of the Cold War. Preparing for prolonged periods of being confined to home due to a disaster is different. People think differently. We must get the old language out of our system.

Further, having co-created those long lists of supplies in cooperation with FEMA when I was Manager of Disaster Education at the Red Cross – I learned very clearly that promoting having a “grab-and-go” kit of some sort is a good thing, but implying that one has to go out and BUY all that stuff doesn’t work. Especially when the economy sucks and people are fighting day-to-day to put food on the table. It has to be easy, quick, and simple, as was written in the headline of the message on this list to which I am responding.

Studies have shown that most people already have what they need to eat and drink during a prolonged period of confinement OR to take with them if they have to leave home. The problem is, most people don’t have these items all in one place. So the focus should be on gathering and organizing, rather than buying. (Thus the current statement that “putting together a kit isn’t a costly enterprise… most items… are likely scattered throughout your home”) … this is good.

While on a history lesson, other things we learned include:

• Do not say "rotate" supplies – a lot of people thought you meant to turn them around. We began saying “change and replace” with much more effectiveness. After all, it’s what we meant. (The word “rotate” dates back to the Cold War, too).
• The word "evacuate*" can be misunderstood by people whose primary language is not English. To some, it means to take a dump (evacuar in Spanish). That’s why for public education, we try to say “leave” instead of “evacuate.” I recall the gales of laughter when in Puerto Rico, I said, “in caso de hurican, evacuar immediamente”. Well… they might have had to do that, but that’s not quite what I meant.
• The word "citizens" is often mistakenly used by local, state, and federal officials when intending to mean the *public*. In these days with heightened concern and political wrangling over “citizens” and those who are in the United States who are not citizens – what’s best is to avoid a political hot potato and if you mean “the public” then say it. (“Residents” works well, too.)

---

John Glenn's comment: "Resident" is ill-advised; as a tourist/visitor do I need to leave? After all, I'm not a "resident." (The answer, of course, is "Yes, you DO have to leave.")

---

I commend “unopsec” (whoever s/he is) in sending out this series of messages to this list, to remind us of important preparedness actions to take ourselves and to recommend to others. He or she is using public domain information which, for the most part, is well-established information based on research and content in the standard messages guide “Talking About Disaster: Guide for Standard Messages.” It’s good to see the work that went into building that Guide from some 21 agencies continue to live through the various pubdom docs and content being sent out.

If you want more information as to the basis of research to which I refer, see “The 12Cs of Disaster Preparedness Education” which is available free from my website, here: http://www.rockylopes.com/publications.html. The Guide for Standard Messages is also linked from that page.

Be safe, be prepared, and lead by example!

Best,
Rocky Lopes

When distant news is local

Barely noted in the Gillette WY News-Record is a mention that June 1 is opening day for the hurricane season.

Hurricanes in Gillette are not an obvious threat for this northeast Wyoming oil/coal town.

But a wise Enterprise Risk Management practitioner in Gillette might do well to consider hurricane season opening day, even though the likelihood of a hurricane blowing through town is more than remote.

Why?

Glad you asked.

Vendors.

Vendors of all types.

Let's start with importing raw materials - including fuel for the trucks, shovels, and drilling rigs. Don't forget the personal vehicles workers use to get to the job; or the company vehicles used to carry people to remote sites or to search for more product.

Most of the fuel comes to town via rail or truck.

Gillette has a daily newspaper, the Gillette News-Record.

In order to publish the newspaper, it needs newsprint - paper.

It needs chemicals, special plates, ink, glue, and other production equipment.

All of the above are imported into Gillette.

Some of the materials may come into the US via a ship offloading cargo at an Atlantic or Gulf port.

The staff needs to get to work. And reporters need to cover their beats. Vehicles that need fuel, oil, parts.

If a 'cane hits, it could - directly or, more likely indirectly - impact operations at the News-Record or the mining and drilling operations that keep the town's economy going. The ripple effect.

Granted, Gillette in northeast Wyoming is an extreme example of a place at risk from a hurricane, but hurricanes and other distant events (fires in California, strikes in Canada, avalanche in Colorado - any number of possibilities) can easily impact life in Gillette.

We live in a world of inter-dependencies.

If the News-Record can't print its newspaper, the Wyndham hotel and nine other lodges can't advertise locally. That might mean a drop in room occupancy that leads to layoff of housekeeping staff that causes them to cut back on expenses that could impact Albertsons and other markets.

Domino effect.

Any organization management that thinks protecting IT is all it needs to survive an "event" is on the brink of its own disaster.

Any organization with management that thinks what happens "somewhere else" can't impact its organization is something beyond foolish.

There recently was a little matter of the US economy.

A few mortgage lenders suffered, but the Man in the Street?

Yes, and how! Some of those "Men in the Street" now LIVE on the street. These people were neither mortgage lenders nor did they have a financial interest in the mortgage lenders.

What about the guy in England or China? Haruhiko Kuroda, president of the Asian Development Bank, sais the current global economic crisis "has erased $50 trillion in wealth around the world." (See http://www.voanews.com/english/archive/2009-03/2009-03-08-voa23.cfm?CFID=221972241&CFTOKEN=35830828&jsessionid=6630bda66f4b6713f6d0505a6277a4480353)

Did the US financial crisis, caused at least in part by financial shenanigans, also drive Chrysler and GM into bankruptcy ?

Is the Federal government's attempted bailout of Big Banks and Big Business going to force the US taxpayer into bankruptcy?

For want of a nail ...

What happens when a hurricane strikes very likely will impact distant communities, even if only indirectly.

John Glenn, MBCI, SRP
Enterprise Risk Management/Business Continuity practitioner
Ft. Lauderdale FL
http://johnglennmbci.com/
Planner @ JohnGlennMBCI.com